Fire and Explosion in the Theatre, A Catastrophy

_{Bottles of chemicals BY Diane A. Reid - CC BY 3.0, link}

2. Fuel:

There is a large number of potential fuel for combustion in the theatre environment. These include: Alcohol based skin preparations, surgical drapes in oxygen – rich environment. PCV tracheal tubes, methane intestinal gas, dry swabs, gauze and aerosol dressing, body hair with hair spray of gel.

Steps that can be taken to reduce the use of fuel ignition include:

●Avoiding the pooling and wicking of flammable skin preparation
●Ensuring skin prep has dried before applying drapes
●Considering aqueous based skin preparation

3. Heat and ignition sources:

Surgical diathermy is the heat source most likely to cause ignition. High temperatures are reached at the probe tip, which can persist for several seconds after the probe has been deactivated. Cutting mode is likely to ignite fuel than the coagulation mode and fires more likely with monopolar diathermy than bipolar.

Risk may be reduced by:

● Activating the diathermy only when the probe is under direct observation
● Placing the probe in a holster when not in use
● Using bipolar diathermy when open oxygen sources are use

Other ignition sources include: Lasers, Defibrillators, Static electricity, Adiabatic change, Electro-cautery, Malfunction electrical Equipment, drills, saws and fiber optic light source

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Management of Surgical Fire

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The ultimate goal is to prevent the occurrence of surgical fire by putting in place definite control measures of the elements involved in the initiation of fire. These will involve the various groups that control the limbs of the fire triangle, as outlined above. The management of a surgical fire includes prevention of small fire becoming out of control and causing damage to the patient, limiting and prompt control of large fire:

1. Small fires:

● Put out the fire with gloved hand or towel
● Fluid the area with sterile water or saline

2. Large Fire:

● Remove burning materials from patients and extinguish the fire
● Stop flow of oxygen to patient, & ventilate with room air
● If evacuation become necessary, use the acronym “RACE” which means Rescue patient, Alert other staff, Confine smoke and fire (close doors, shut gas and vacuum)
● Evacuate to a predetermined area.