Affiliation:
1. Resident
2. Associate Professor
3. Research Professor, Department of Anesthesiology and Pain Medicine
4. Professor, Departments of Anesthesiology and Pain Medicine and Neurological Surgery (Adjunct), University of Washington, Seattle, Washington.
Abstract
Abstract
Background:
To assess patterns of injury and liability associated with operating room (OR) fires, closed malpractice claims in the American Society of Anesthesiologists Closed Claims Database since 1985 were reviewed.
Methods:
All claims related to fires in the OR were compared with nonfire-related surgical anesthesia claims. An analysis of fire-related claims was performed to identify causative factors.
Results:
There were 103 OR fire claims (1.9% of 5,297 surgical claims). Electrocautery was the ignition source in 90% of fire claims. OR fire claims more frequently involved older outpatients compared with other surgical anesthesia claims (P < 0.01). Payments to patients were more often made in fire claims (P < 0.01), but payment amounts were lower (median $120,166) compared to nonfire surgical claims (median $250,000, P < 0.01). Electrocautery-induced fires (n = 93) increased over time (P < 0.01) to 4.4% claims between 2000 and 2009. Most (85%) electrocautery fires occurred during head, neck, or upper chest procedures (high-fire-risk procedures). Oxygen served as the oxidizer in 95% of electrocautery-induced OR fires (84% with open delivery system). Most electrocautery-induced fires (n = 75, 81%) occurred during monitored anesthesia care. Oxygen was administered via an open delivery system in all high-risk procedures during monitored anesthesia care. In contrast, alcohol-containing prep solutions and volatile compounds were present in only 15% of OR fires during monitored anesthesia care.
Conclusions:
Electrocautery-induced fires during monitored anesthesia care were the most common cause of OR fires claims. Recognition of the fire triad (oxidizer, fuel, and ignition source), particularly the critical role of supplemental oxygen by an open delivery system during use of the electrocautery, is crucial to prevent OR fires. Continuing education and communication among OR personnel along with fire prevention protocols in high-fire-risk procedures may reduce the occurrence of OR fires.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Anesthesiology and Pain Medicine
Reference29 articles.
1. The hazard of fire and explosion in anesthesia: Report of clinical investigation of 230 cases.;Anesthesiology,1941
2. Hazards of fire and explosion of anesthetic agents. III. In presence of diathermy.;Surg Gynecol Obstet,1942
3. Practice advisory for the prevention and management of operating room fires.;American Society of Anesthesiologists Task Force on Operating Room Fires;Anesthesiology,2008
4. Surgical fire injuries continue to occur—prevention may require more cautious use of oxygen.;APSF Newsletter,2012
5. New clinical guide to surgical fire prevention. Patients can catch fire—here’s how to keep them safer.;ECRI Institute;Health Devices,2009
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