Archive December 2014 XV, No. 12

Surgical Fire Q&A

"Even though most surgical fires last only about 4 or 5 seconds," says fire safety expert Mark Bruley, CCE, "they change lives."

Jim Burger

Jim Burger, Senior Editor

BIO

— MORE PROGRESS NEEDED Surgical fires are becoming less common, says Mark E. Bruley, CCE, but misunderstandings still pervade.

Mark E. Bruley, CCE, investigates medical mishaps of all kinds for the ECRI Institute in suburban Philadelphia, but he's known the world over as an expert in surgical fires — both what causes them and how to prevent them. We caught up with Mr. Bruley for an update.

Q Are there common misconceptions about surgical fires?
Mark Bruley: What's largely unappreciated is how much of a hazard the buildup of oxygen presents when it's coming from an open source, like a nasal cannula or mask — how easy it is to ignite cotton surgical towels, drapes and patient hair. At least 70% of surgical fires involve oxygen-rich concentrations that are under the drapes, and in and around the head and neck area.

Another big misconception is the notion that there are fire-retardant surgical drapes. The technology simply doesn't exist. The reason? It's all about the oxygen. The world of oxygen-enriched ignition and flame spread is unlike anything people experience with candles, campfires or gas stoves. It's a totally different world and a frightening world. In fact, the chemicals used to make fabrics fire-retardant in room air literally add fuel to the fire in an OR, because in an oxygen-enriched environment, they burn.

Q Is time pressure a factor that might lead to inadequate drying time being allotted to alcohol-based preps?
MB: Only about 5% of surgical fires involve alcohol-based skin preps that were still wet when the patient was draped. Alcohol gets much more attention because everyone knows it's flammable. It's easy to understand. But the more important issue is oxygen and how easily it allows things to catch fire and burn faster and hotter. Alcohol's role is overrated. Oxygen's is underrated.

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