Fires Are a Real and Present Danger in the Operating Room

Fires that occur in the operating room are among the most terrifying and dramatic disasters that can happen during a surgery. Though they are relatively uncommon, there are an average of 650 operating room fires in the U.S. annually, which often cause serious injuries and even death to the helpless patient. Operating fires are preventable – and when they occur it is almost always the result of carelessness on the part of the surgical team.

Operating Room Fires - Medical Negligence

How do operating room fires happen?

In order for any fire to ignite there must be three elements present: fuel, oxygen, and an ignition source. Unfortunately, all three of these components of this “fire triangle” are present in most operating rooms. The fuel includes alcohol wipes used for sterilization, paper or fabric gowns and drapes, and even the patient’s own body and hair. Supplemental oxygen delivered to the patient provides an oxygen rich environment. Ignition can be caused by cautery, surgical lasers, or other operating room tools. When a spark or charge from a surgical tool comes in contact with a patient’s skin that has been rubbed down with alcohol in a room filled with pure oxygen, then a flash fire can occur.

The most common fuels found in operating rooms include the following:

  • Gowns and drapes
  • Alcohol skin prep materials
  • Nasal cannula
  • Sponges and gauze
  • The patient’s skin and hair
  • The patient’s intestinal gasses

Common oxidizers found in operating rooms include nitrous oxide and oxygen.

Common ignition sources in operating rooms include the following:

  • Lasers
  • Electrosurgical units
  • Defibrillators
  • Drills
  • Fiber Optic light sources

Which procedures have the highest risk of a surgical fire?

The greatest risk of an operating room fire is present when a surgical procedure is performed at chest level or above. The highest concentration of oxygen is around the patient’s mouth and nose, so when potential ignition sources are used near the head, the risk can be high.

The procedures that come with the highest risk of surgical fire include the following:

  • Tracheotomies
  • Tonsillectomies
  • Adenotonsillectomy
  • Removal of laryngeal papilloma
  • Skin surgeries of the head and neck
  • Pacemaker implantation
  • Cosmetic surgeries

Why are operating room fires so dangerous?

Operating room fires are inherently dangerous for a number of reasons, including the fact that the patient is often under anesthesia, unconscious, and entirely vulnerable and unable to protect themselves. As noted above, many of these fires ignite in the area of the patient’s airway, which rapidly cause devastating burns to the face and inhalation injuries to the mouth, throat, and lungs.

To make matters worse, oxygen can help accelerate a fire if one breaks out and cause it to burn hotter. If the oxygen is connected to the patient, the patient can literally catch fire in the operating room. Plastic medical devices (like catheters or tubing) can melt, causing additional injury to a patient. If the fire burns hot enough, it can shatter glass or other materials, or even cause an explosion.

Another reason why OR fires are so dangerous is how quickly they can spread. A fire can spread in 30 seconds, as long as the oxygen, fuel, and heat levels are maintained.

Even if the fire remains contained within the room, it can still cause devastating injuries in a very short time. In one case from 2019, a fire broke out in an OR during a procured to remove a tumor from a woman’s jaw. The entire event, from the moment the fire started until it was put out, lasted 10-15 seconds – long enough to cause second-degree burns to the patient’s face.

If smoke and ash can escape through the HVAC system (or the doors), it can put other patients at risk of respiratory infections and injuries.

Consequences of an operating room fire

Victims of an operating room fire can be left with life changing injuries that require constant care and lengthy rehabilitation. Surgical fire victims most commonly suffer from burns and respiratory injuries, though other injuries may be sustained.

What can Virginia medical facilities do to reduce the risk of OR fires?

The Food & Drug Administration (FDA) recommends the following steps to reduce the risk of fires in the operating room:

  • Perform a fire risk assessment at the beginning of each surgical procedure. Surgeons must be aware of potential oxidizers (per the FSA, oxygen “at concentrations of approximately 30 percent, a spark or heat can ignore a fuel source”), ignition courses, and fuels, and follow protocols established to reduce the risk of fire. Medical personnel should be trained to recognize which devices could potentially be ignition sources, too.
  • Encourage communication among surgical team members. This communication is especially important between surgeons, anesthesiologists, and any OR staff “applying skin preparation agents and drapes.”
  • Engage in safe use and administration of:
    • Per the FDA, medical professionals should determine whether any supplemental oxygen is actually needed, as it can increase fire risk. The agency recommends using a closed oxygen delivery system whenever possible to reduce this risk.
    • Any devices that may serve as an ignition source, including lasers and electrocautery devices. Medical staff should ensure there are no defects in the devices, and that they are clean and “free of char and tissue.” Devices should be kept as far away from patients as possible when they are not in sure during the procedure.
    • Surgical suite items that may serve as a fuel source. This includes allowing alcohol-based product to dry, and using caution with plastic products (like suction catheters). Medical personnel should not rely on “flame-resistant” labels to eliminate all risk of fire. Per the FDA,
  • Plan and practice how to manage a surgical fire. Per the FDA, there are six steps all medical personnel should follow in the event of an OR fire:
    1. Stop the main source of ignition. Turn off the flow of flammable gas; unplug electrical devices that may be involved.
    2. Extinguish the fire – Use a safe method to smother the fire such as, water or saline, and a CO2 or other extinguisher if the fire persists.
    3. Remove all drapes and burning materials and assess for evidence of smoldering materials.
    4. For airway fires, disconnect the patient from the breathing circuit, and remove the tracheal tube.
    5. Move the patient to a safe environment. Reestablish the airway to resume respiratory care.
    6. Review the fire scene and remove all possible sources of flammable materials.

You can find a full list of steps and suggestions here.

Surgical fires are almost always preventable, which means they are usually caused by a failure on the part of the operating room team to comply with necessary safety precautions. Patients who are harmed by operating room fires have a right to hold the team accountable for their injuries. The attorneys at Phelan Petty have experience representing medical malpractice victims who have been burned by operating room fires.

If you are a loved one have been hurt in an operating room fire caused by medical malpractice, you deserve to be compensated for your loss. The experienced medical malpractice attorneys at Phelan Petty are available to help. Call our office at 804-980-7100 or submit our contact form to schedule a free initial consultation at our Richmond office today. We proudly serve clients throughout Virginia.