Fire in ot
- 1. Explosion & Fire Safety in Operation theatre Moderator: Dr Jesni Joseph Speaker: Dr Gagan Brar
- 2. Contents Fire triad Products of combustion Prevention Management Type of fire Fire safety education
- 3. FIRE TRIAD Fuel Oxidizer Source of heat/ ignition Must be present simultaneously & in correct proportions So, fires can be prevented/ controlled by removing any one of these elements
- 4. Typical coexisting ingredients that could cause an OR fire
- 6. Products of combustion Depend upon: Temperature of fire Nature Proportions of the fuel & oxidizer Complete combustion : water, CO 2 , other oxides Incomplete combustion : variety of by products
- 7. Products of combustion Specific combustion products: PVC, silastic, plastics (produce acids such as HCl & hydrogen sulphide, cyanides, CO & phenols) Potentially hazardous
- 8. Pulmonary toxicity of combustion products Consumption of oxygen by fire Reduced oxygen availability, d/t CO
- 9. PREVENTION
- 10. MOST EFFECTIVE METHOD Keep the elements of FIRE TRIAD separated Follow basic Laser & Electrical safety guidelines Minimize presence of flammable materials
- 11. Sources of Heat & Ignition Electrosurgical units Audible warning tones (shouldn’t be disabled) Foot switches should be assigned; & disconnected when not in use Placing probe in insulated, non flammable Holster
- 12. Sources of Heat & Ignition Cardiac defibrillators Electrodes to make direct contact without intervening wires, linen, clothing Alcohol or alcohol soaked pads, nitroglycerine patches, ointments should never be used as conducting medium
- 13. Sources of Heat & Ignition Laser : Energy source; very high power density Incidentally pressing the laser control trigger, tissue damage outside the surgical site Drape fire Eye (patient or other medical staff) Endotracheal tube fires
- 14. Endotracheal tube fires Direct laser illumination Reflected laser light Incandescent particles of tissue blown from the surgical site
- 15. Prevention Reduce the flammability of the endotracheal tube Use of Laser resistant ET tubes Use Venturi ventilation Use intermittent apnea technique
- 16. Sources of Heat & Ignition Electrical fires in anesthetic monitors have been reported NaCl contamination of the interior of monitors resulted in electrical short circuits which led to over heating & ignition of monitors
- 17. Fuel Flammable anesthetic agents Flammable disinfecting & degreasing solutions : alcohol & acetone, must evaporate & fumes eliminated before surgery begins Surgical drapes & dressings free of disinfectants
- 18. Fuel Tissue contents such as bowel gas Contains: hydrogen + methane Laparoscopy : insufflation with air Colonoscopy Preventive measures Unprepared colon is discouraged Low residue diet Pre op fasting for 12 hrs X
- 19. Fuel Electrosurgery in airway: Dangerous ET tubes, oesophageal steth, nasogastric tubes PVC inflammable with high oxygen conc. Preventive measures: Lowest power for cautery Bipolar cautery Helium- oxygen mixture Jet ventilation without tracheal intubation Laser resistant ET tubes
- 20. Fuel Forced air patient warming blankets: Once ignited rapid combustion (fuel source: drape material, oxidizer: forced air)
- 21. Oxidizer Decrease escape of oxygen & nitrous oxide Lowest inspired oxygen conc. that ensures adequate oxygenation, to minimize O 2 accumulation Selective use of supplemental oxygen Avoid use of ESU in and around trachea & pharynx Addition of inert gases (He) to O 2
- 22. MANAGEMENT
- 23. TYPES OF FIRE Class A: wood, paper, cloth & most plastic Class B: flammable liquids & grease Class C: fire involving electricity
- 24. Small, light, no residue/ toxicity Leaves residue, damages equipments, ? toxicity Heavy bulky devices Heavy bulky devices, risk of electric shock Inexpensive, non toxic Notes Interrupts oxidation, disperses heat Interrupts oxidation, disperses heat Interrupts oxidation, disperses heat Interrupts oxidation, disperses heat Interrupts oxd Mechanism Class A/B/C Class A/B/C Class B/C small A Class A/ some B Small class A Type of fire Halon Dry chemical CO 2 Water Fire blanket
- 25. Use of Fire Extinguishers PASS: Pull the Pin to activate Aim at the base of the fire Squeeze the trigger Sweep the extinguisher back & forth across the base of fire
- 26. Fire safety education Activation of alarm & communication system Location & use of fire fighting tools Management of small fire, to prevent spread Appropriate responses when fire spread beyond control
- 27. Fire safety education When & how to evacuate a room, even when it is crowded with equipments & people Appropriate routes to take for evacuation, esp when smoke/ flames block normal entry/ exit Location of ‘safety zones’ inside & outside the building where patients/ personnel can be evacuated
- 28. Summary Fire triad Prevention: Keep them separated Management: Depends on type of fire Safety education for all Fuel Oxidizer Source of ignition
- 29. Responding to FIRE RACE : Rescue Alarm Confine Extinguish
- 30. THANK YOU