When someone mentions a surgical fire, what is the first thing that comes to mind? Perhaps the acronyms RACE (Rescue, Alarm, Contain, Extinguish) and PASS (Pull, Aim, Squeeze, Sweep) come to mind. Or maybe the Fire Triangle is the first thing you think of. You may even think of your facility’s evacuation plan or maybe you remember an actual fire event.
Surgical fires are rare.
In fact, according to the Joint Commission, only about 100 surgical fires occur every year, with about 20 causing serious harm to the patient resulting in 1-2 deaths. (source) Thankfully, these incidents are not common, which is a direct result of the continuous training and vigilance that OR professionals maintain.
As nurse who has been in the operating room for 15 years, my only close call came during an arthroscopy case when the light source was placed on the drapes without anyone paying attention to it. The light only had time to create a small burn hole in the top drape before it was caught by the surgical technician. But, it was one of those moments where the technician and I both realized just how simple and how fast that small hole could have ended up in a complete disaster.
As is the case with most of us, our fire safety training tends to center on the fire taking place in the operating room.
What happens when the fire occurs outside of the OR forcing the evacuation of patients and staff?
This was a surreal concept to me. I have always prepared in case a fire occured in my operating room, and took the necessary precautions to avoid it. But I never thought mother nature would be the actual culprit in causing a mass evacuation of our patients and staff.
December 30, 2021, the historic Marshall Fire tore through Boulder County in Colorado. What started out as a small grass fire rapidly grew into a destructive fire devouring more than 6,000 acres and taking out more than 1,000 structures. Within 4 hours, with the help of massive high winds, the fire was headed straight for the hospital where my surgery center was located. It was my day off when I first got word a grass fire had broken out. During the next hour, the fire grew so fast that all of the news outlets were covering the story. I, along with hundreds of other Coloradans, watched in horror as the strong winds took control of the fire and spread it throughout two large suburbs destroying everything in its path. Home after home was shown ablaze, chaos covered the television as police officers evacuated frantic shoppers at local stores, none of whom had any idea what was happening outside while they were grocery shopping. It was impossible to stop this giant wall of fire - quick evacuation of everything in its way was the only option.
The entire scene was something out of a movie, and the fact that it was happening so close to my home and workplace was even more surreal. Two hours after the fire started it was clear which direction the fire was headed. The helicopters and news vans were covering the fire near the hospital. Live footage of maintenance workers hosing down the grassy areas were flashing across television screens. They had begun the process of evacuating patients to other hospitals and I knew my surgery center would have implemented their evacuation plan as well. The surgery schedule had been light that day and it would prove to be a blessing.
I had not heard from any of my coworkers and had no idea what was going on until the first images appeared on social media. I learned the staff had no idea what was happening outside the facility until it was almost too late. The last of the patients were out within 4 hours of the fire’s ignition and by that time, the parking lot of the surgery center was already on fire. One of the nurses barely escaped the flames as she drove off, while another nurse lost her vehicle to the fire.
Thankfully no patients or staff members were hurt. Surgeries had been completed and the ORs shut down which made the evacuation process a little simpler. Patients who needed to be evacuated had already been recovering in PACU allowing for the staff to quickly get them into their vehicles and driven to safety by their concerned caregivers.
The surgery center is located on the far west side of the hospital. The fire was stopped before it could reach the buildings and before it hit the hospital’s large supply of outdoor oxygen tanks. The neighborhood surrounding the hospital was not so lucky. Almost 10 months later, it is still a hear- wrenching sight to see all the homes that perished in the fire. Everyone who lived through that enormous fire, and those of us who watched it from the safety of our homes, will always be grateful the fire did not claim as many lives as it could have. Sadly, two people lost their lives when they could not evacuate fast enough. Presently, the Marshall Fire goes down in history as Colorado’s most damaging wild fire.
Days later, when it was safe to return to inspect the facility, the smoke damage was immense. The surgery center needed to be professionally cleaned inside and out. The HVAC system was a mess of soot and debris and the sterile supplies were worthless. All of the sterile instruments needed to be resterilized once the water and HVAC system were restored, the equipment needed to be deep cleaned, all linen and uniforms needed to be replaced, and every square inch of the facility needed a thorough wipe down. The facility was closed for weeks afterwards ensuring everything was ready to safely welcome patients and staff back.
Once a year, if not more, we sit down with our coffee and bagels and prepare for our fire safety training. We go over the ignition sources, the evacuation plans, and we may even get to put out a controlled fire while practicing with the fire extinguishers. We imagine what an actual surgical fire might look like and how we would respond. We go through in our heads what we do daily to ensure our patients are kept safe from a fire.
Whether inside or outside the OR, whether the patient is sitting in the lobby, in the OR, or recovering in PACU, a fire is a potential threat to all of us. It is important to remember the next time we are reviewing our facility’s fire prevention protocol to keep in mind that a fire can start anywhere, and can affect not only the patient during surgery, but every person in the building. Whether it’s a small fire in the employee lounge when a bag of microwave popcorn catches fire, or a natural disaster headed straight for your facility, always remember the importance of the evacuation plan and what crucial steps need to be taken to get the patient and yourself to safety as quickly as possible.
Until next time,