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OR Fire — Recognition + Response

Equipment & Safety · 6 min read

OR fires happen ~600x/year in the US. Mostly preventable. When one starts: the response sequence has to be muscle memory — there's no time to think.

The fire triangle in the OR

Three things must coexist: oxidizer (O₂, N₂O), fuel (drapes, ETT, alcohol prep, surgical sponges), ignition source (electrocautery, laser, defibrillator pads, light source). Remove any one → no fire. The classic high-risk case: head/neck/chest surgery + supplemental O₂ via nasal cannula + electrocautery near the surgical field. Fix: drape carefully, use FiO₂ ≤ 0.30, allow alcohol prep to dry fully, communicate with surgeon before cautery activation in airway proximity.

Recognition

Smoke or odor, flash, audible 'pop,' visible flame. In airway fires: pop, smoke from circuit, ETCO₂ change. Don't wait for full flame to act — early signs trigger response.

Response: airway fire

1. STOP: ventilation, oxygen flow, anesthetic gas. 2. REMOVE: ETT immediately. 3. EXTINGUISH: saline-soaked sponge to airway. 4. RE-ESTABLISH: bag-mask room air, then 100% O₂ once fire fully out. Re-intubate with bronchoscopy to assess thermal injury. Steroids, lavage, ICU admission. Document, file fire safety report.

OR fire algorithm →

Response: drape / surgical-field fire

1. STOP electrocautery + supplemental O₂. 2. Smother flames with saline-soaked towel or wet smother. 3. Remove burning material from patient. 4. Saline irrigation to affected skin. Activate fire alarm if uncontrolled — RACE protocol. Most OR fires extinguish in seconds with prompt action. Don't escalate — calm, methodical sequence.

Prevention is the real lesson

Pre-induction time-out should include fire risk discussion for any high-risk case. Open communication with surgeon about cautery timing in airway proximity. Avoid open-system O₂ delivery (nasal cannula) when alternative exists. Allow prep solution to dry fully — wet alcohol is a fuel reservoir.

References

  • · ASA Practice Advisory: Operating Room Fire Prevention
  • · ECRI Institute OR Fire Prevention Guidelines