“Fires occur when an ignition source, a fuel source, and an oxidizer come together,” the Centers for Medicare and Medicaid Services stated in a January 12, 2007 memo. “Heat-producing devices are potential ignition sources, while alcohol-based skin preparations provide fuel. Procedures involving electro-surgery or the use of cautery or lasers involve heat-producing devices.”
If you were injured or disfigured in a surgical fire, attorney Chris Mellino welcomes you to contact our office for a free consultation. You may also download or request his free, easy-to-read guide to filing a medical malpractice claim in Ohio. Our experienced surgical injury attorneys in Cleveland can help you fully understand your legal options, as well as your right to recovery.
HOW DO SURGICAL FIRES HAPPEN?
Surgical fires can happen in many ways and for a wide variety of reasons. For example, on October 27, 2013, Reuters reported that a 43-year-old woman settled a lawsuit against a hospital after suffering a third-degree burn during her C-section. According to the article, she’d been prepped with an alcohol-based antiseptic and a surgical tool ignited when it came in contact with her stomach. “In pretrial depositions, four nurses and an anesthesiologist said they were never trained in how to prevent surgical fires when using the antiseptic,” Reuters said.
“Most surgical fires occur in oxygen-enriched environments,” the FDA reported on October 13, 2011. “When supplemental oxygen is delivered to the patient, an oxygen-enriched environment can be created. An open oxygen delivery system, such as nasal cannula or mask, presents a greater risk of fire than a closed delivery system, such as a laryngeal mask. In an oxygen-enriched environment, materials that may not normally burn in room air can ignite and burn.”
In February 2012, a 55-year-old woman underwent an operation to have polyps removed from her vocal cords, and “not just one thing, but a number of things went wrong leading up to the laser surgery fire” that left her unable to breathe on her own or speak, the hospital system’s quality medical director told the media. In this instance, the laser acted as the ignition source, and the patient’s breathing tube provided oxygen. The hospital settled a lawsuit for $12 million and a jury awarded another $18 million.
If a fire does break out in the operating room, you would hope that the hospital staff would put it out quickly in order to minimize injury. Unfortunately, “[m]any surgical team members don’t know where fire safety equipment is located, despite having received formal OR fire safety training,” Daniel Cook reported for outpatientsurgery.net in 2012. In a survey of 118 OR staff at one hospital, “only 11 percent could locate the nearest fire alarm pull-station, 30 percent could locate the nearest fire extinguisher and 61 percent could locate the nearest gas cutoff.” Surgical technicians didn’t fare much better.
SURGICAL FIRE PREVENTION & STATISTICS
One hospital has reported that it will no longer use alcohol-based antiseptic in the emergency room since a patient suffered first- and second-degree burns when vapors caught fire. Alcohol-based solutions can take up to three minutes to dry, according to thepilot.com, but ER staff didn’t wait that long as they worked to save the man’s life.
“We’ve learned an awful lot from this, and hopefully it will never happen again,” the hospital’s chief medical officer told the media.
The Cleveland Clinic removed alcohol-based antiseptic from its operating rooms in 2010, per a suggestion from the Centers for Medicare & Medicaid Services (CMS). As the CMS performed a two-week inspection that year, the clinic volunteered that, between April 2009 and March 2010, an electrocautery device had caused six fires. “In two of those… surgical sponges caught fire or were singed. The third was in a body cavity but caused no harm because it was extinguished within seconds,” the clinic’s chief quality officer told the Plain Dealer. Three patients reportedly suffered “superficial burns.”
In 2007, nonprofit organization ECRI Institute (previously “Emergency Care Research Institute”) said that operating rooms across the country battle up to 650 blazes each year. 20 to 30 of those cause disfigurement or a debilitating injury, and one or two cause death, per Mark Bruley, ECRI’s vice president of accident and forensic investigation.
According to outpatientsurgery.net, “Seven of 10 OR fires occur at the head, neck or upper chest during cases involving oxygen delivery under monitored anesthesia care.”
The FDA has recommended that healthcare providers adhere to the following prevention measures:
- Assess the risk of fire before every operation. For instance, since supplemental oxygen increases that risk, determine whether it’s really needed and, if so, provide the minimum amount necessary.
- If possible, deliver oxygen via an endotracheal tube or laryngeal mask, particularly if the patient needs more than 30 percent.
- “Take additional precautions to exclude oxygen from the field if using an open delivery system. These precautions include draping techniques that avoid accumulation of oxygen in the surgical field, the use of incise or fenestrated drapes which may help isolate oxygen from the surgical site, blowing air to wash out excess oxygen, or alternatively, scavenging oxygen from the field.”
- When using an alcohol-based antiseptic, apply only the amount necessary in order to lessen the amount of time it takes to dry and to prevent spillage onto drapes. If alcohol does soak drapes covering the patient, remove them from the surgical site. Make sure the patient’s skin has dried before applying new drapes and operating.
- Since the majority of fires affect the head, neck, and upper chest, consider using a tool than an ignition source, such as an electrocautery device, if delivering oxygen to the patient. “If an ignition source must be used, know that it is safer to do so after allowing time for the oxygen concentration to decrease. It may take several minutes for a reduction of oxygen concentration in the area even after stopping the gas or lowering its concentration.”
- Even if the drapes you’re using are labeled “flame-retardant,” oxygen can make anything flammable. Be sure to holster surgical tools rather than setting them on the patient or drapes while not in use.
- Make sure that everyone involved in the procedure communicates with one another and knows how to extinguish a fire.
WHEN TO CONTACT A SURGICAL FIRE ATTORNEY
Imagine waking from surgery to a nurse screaming, “Oh, my God! He’s on fire!” That’s what happened to a 68-year-old man on March 19, 2008. As his attorney told ABC News, “It is universally acknowledged this does not happen in the absence of negligence.”
Surgical fires are 100 percent preventable. If you suffered severe and debilitating injuries as a result of a mistake or carelessness, please contact our surgical injury attorneys in Cleveland with any questions you may have about filing a claim before Ohio’s statute of limitations expires.