McLaren Bay Region Fire Drill Surgery

1. McLaren Bay RegionFire DrillSurgery Lori A. Majeske, RN, CNOR MSN Student Ferris State University November 7, 2012

2. Objectives for presentation Fire Prevention understand techniques to prevent fires identify policies to use as reference Fire Plan educate staff on current plan determine strengths and weaknesses Next steps create ongoing dialogue and team approach to safely care for patients in the perioperative experience with surgeons and anesthesia providers

3. AORN Perioperative Standards and Recommended Practices 2012 Edition ECRI Institute Evidence based practice source for Healthcare Research and Quality FDA ASPF Anesthesia Patient Safety Foundation McLaren Bay Region Policies and Procedures Sources of Information

4. According to 2011 statistics, 550-650 surgical fires occur each year (Bruley, 2012) The best method to fight fires is to prevent them from starting McLaren Bay Region has various fire codes and regulations based on date of construction According to Safety Policy #60 Fire Plan “Each member of the fire response team has specific responsibilities. As a fire can easily reach the flash over point within 2 or 3 minutes, the response time of members of the response team is a critical element in MBR’s ability to defend against fires. All members of the fire response team will be expected to respond to the area of activation as quickly as possible.” (Warszawski, 2012) As stated in Safety Policy #19 Fire and Smoke Barrier Doors “The greatest loss of life in health care facilities results from smoke asphyxiation due to doors failing to close or be closed.” (Warszawski, 2012)

5. AORN Recommended Practices for a Safe Environment of Care Recommendation IXPotential hazards associated with fire safety in the practice setting should be identified, and safe practices should be establishedThere are 12 associated items for this recommended practice(Association of PeriOperative Nurses, 2012)

6. A written fire prevention plan and management should be developed by a multidisciplinary group • Ignition sources should be controlled • The tip of the bovie should be in a holster when not in use • ESU provides an ignition source when not used according to manufacturers recommendations • Use of oxidizers, flammable solutions and volatile or • combustible chemicals or liquids • Lasers, lights cords and light sources • Fuel sources should be controlled • Scrub solutions be allowed to COMPLETELY dry to decrease potential to produce ignition by static electricity or sparks • Allow adequate dry time and any fumes to dissipate before applying drapes using bovie or laser or activating light cord • Prevent prep from pooling or soaking into table linens or patient hair • Gowns and drapes should not be exposed to ignition sources

7. Oxidizers should be controlled • Oxygen and nitrous should be used with caution in the presence of an ignition source • Oxygen enriched environments are created when concentration is greater than 21% -lowers the temperature and energy which fuels will ignite • Anesthesia circuits should be free of leaks • Suction should be used to evacuate anesthesia gas accumulation (WAGD) • Head and neck surgeries should use water soluble substances to cover facial hair • Oxygen concentration under drape should be minimized by • tenting of drapes consider open draping • Using lowest possible concentration for adequate patient oxygen saturation • mixing oxygen with nonflammable gases such as medical air reduces risk • Precautions should be taken when operating in the GI tract • Hydrogen and methane are flammable • Nitrous oxide is also considered an oxidizer

8. Risk of airways fires should be minimized by • Use radio opaque wet sponges in the back of the throat • Inflate ET tube with tinted solutions to improve visibility R/T cuff rupture • Use suction to evacuate oxygen build up • Using pulse oximetry to evaluate patient’s optimal oxygen saturation level • Inspect fire extinguishers • Have evacuation routes

9. (Bruley, 2012)

10. (Bruley, 2012)

11. Fire Extinguishers • For placement in each O.R. and use on patient: CO2 Extinguisher • Has a cooling effect • Does not leave a residue • Not likely to injure patients or personnel Use the acronym PASSP Pull A Aim S Squeeze S Sweep (Bruley, 2012)

12. According to AORN, Fire blankets should not be used in an operating room (2012) • They may trap fire next to or under the patient and cause more harm • They can burn in an oxygen enriched environment • They are less effective in controlling a fire then other methods • Usage can lead to wound contamination or spread fire

13. (Bruley, 2012)

14. True or False •Drapes are fire retardant treated. False There are no fire retardant drapes. The technology does not exist to make a textile that is fire retardant in elevated O2 levels. •Betadine™ skin prep is flammable. False •Get a fire extinguisher first to fight the fire. False •Lanugo hair is highly flammable in air. False (Bruley, 2012)

15. Fires burn hotter and faster in an oxygen enriched environment. The image below shows a nasal cannula set on fire in room air (left) and in an oxygen enriched environment (right). fda.gov (2012)

16. •Burned tracheal tube from fatal fire during tracheostomy. •Tube was not removed immediately when fire started. Extinguishing Tracheal Tube: Pull out! (Bruley, 2012)

17. McLaren Bay Region Fire Plan

18. (Warszawski, 2012)

19. What is our plan? First, attempt to extinguish the fire with saline from back table Remove drapes if on fire Call Code Red over stentophone be sure to give location ie., room 1 or room1 ante room or room 1 equipment room Consider dialing 2-2-2-2-2 give specific location When code is called if you are in a room, stay in your room if you are in lounge, locker room, report to inner core if appropriate Core coordinator will be incident command for department will call rooms to determine case progress and notify of plan stay in place or evacuate, will determine route will determine staff assignments according to needs will send one person to switchboard or south tower desk to meet Security,Environmental Services, Facilities, Fire Department will compile needed paperwork staffing schedule, room assignments, break/lunch form notify PPH and PACU to discuss patient and visitor status

20. What is our plan? Shelter in place is best defense but need to be aware of fire area as it relates to air handler In the event a procedure must be continued in another operating room, we need to consider air handler plans identified on surgery floor plan located in each room Proceed through one set of fire doors each room will have route A and B Designated person will go to Switchboard or South Tower Desk to escort responders to area Fire Department, Security, Environmental Services, Facilities Always use stairwell #4 or #9 When the Fire Department is activated, EMS personnel also respond to help evacuate and to care for Fire Department Elevators cannot be used unless there are 2 barrier door separation and is totally separate can only be determined by Fire Department Smoke doors cannot be propped during evacuation Refer to Surgery policy #9 Emergency Preparedness in the OR

21. What is our plan? Remember We are 100% sprinkled Rooms 9 and 10 has smoke detectors Every incident will need to be considered separately as the department is dynamic. Standard procedures should be followed as necessary to provide safe care to patients. Only Security can call Code Clear

22. Surgery Floor Plan Main Hospital South Tower (McLaren Bay Region, 2012)

23. See Route A and Route B (McLaren Bay Region, 2012)

24. Next steps • Revise policies • Begin fire risk assessment during time out • Continue to discuss near misses and learn from each incident • Be aware of potential hazards in rooms and remove as appropriate • Continue plan to complete fire drill with horizontal and vertical evacuation with Bay City Fire Department • Determine regroup location for department • Keep floor plan readily available • Review Critical Alarm Systems policy to determine Who can set alarm, turn it off and service equipment

25. Questions?

26. References American Society of Anesthesiologists. (2008). Practice advisory for the prevention and management of operating room fires. Anesthesiology 2008, 108, 786-801. Association of PeriOperative Nurses. (2012). Perioperative standards and recommended practices. Denver, CO: AORN. Bruley, M. E. (2012, October 12). New clinical guidance on surgical fire prevention and management, 1-47. Retrieved from http://www.aorn.org/Events/Webinars/Upcoming_Webinars.aspx#SurgicalFirePrevention ECRI Insitiute. (n.d.). https://www.ecri.org/surgical_fires McLaren Bay Region. (2012). McLaren bay region floor plan. . McLaren Bay Region Mechanical Documents, Bay City, MI. Warszawski, K. (2012). Safety policy #19 fire plan. Retrieved from www.mclaren.org/BayRegion/intranet/policyand proc Warszawski, K. (2012). Safety policy #60 fire plan. Retrieved from www.mclaren.org/BayRegion/intranet/policyand proc