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Surgical Fire Patient Dies

Fri, 09/18/2009 - 6:47am

Illinois woman dies after catching fire during surgery

A southern Illinois woman died after suffering severe burns in a flash fire while undergoing surgery, the Associated Press recently reported.

Janice McCall, 65, of Energy, IL, died at Vanderbilt University Medical Center in Nashville, TN, on September 8, six days after being burned while on the operating table at Heartland Regional Medical Center in Marion, IL.

The family’s attorney, Robert Howerton, declined to say why McCall was having surgery. Meanwhile, the Tennessee state medical examiner’s office proclaimed McCall’s death due to complications from thermal burns and classified as accidental.

In a statement, Heartland said that "there was an accidental flash fire in one of the hospital's operating rooms," injuring a patient before being immediately extinguished. The hospital did not disclose how the fire started, but it said, without elaborating, that it was responding with "necessary and appropriate measures."

Surgical fires are a rare but troublesome problem in the operating room and one that has been brought to the forefront of operating room safety in recent years. According to Mark Bruley, vice president for accident and forensic investigation at the ECRI Institute, surgical fires occur an estimated 550 to 600 times a year — a tiny fraction of the millions of surgeries performed in the U.S. annually — and only kill about one or two people each year.

However, concerns over surgical fires have been considered since the 1970s, when highly-flammable agents such as ether gave way to safer anesthetics. Still today, the increased used of electrosurgical devices and the replacement of cloth hospital drapes with those made of more flammable, disposable synthetic fiber, and added cause for concern.

According to the Joint Commission, the three basic elements of surgical fires make up the “fire triangle:”

Ignition sources: electrosurgical equipment, surgical lasers, electrocautery equipment, fiberoptic light sources and defibrillators. 
Oxidizers: oxygen-enriched atmospheres, nitrous oxide, medical air and ambient air. 
Fuels: common OR material such as mattresses, sheets, gowns, towels, drapes, dressings and sponges. Other fuels include volatile organic chemicals, body hair, intestinal gases, tracheal tubes and body tissue.

The ECRI recommends that anesthesiologist stop using 100 percent oxygen in the OR and deliver only what the surgical patient needs, perhaps by diluting the oxygen concentration with room air when surgical tools such as electronic scalpels and cauterizers are in use.

"What we've been advocating for years is that the open delivery of oxygen under the drapes essentially has to stop," Bruley says, with some exceptions such as cardiac pacemaker surgery or operations involving a neck artery.

It’s important for surgical professionals to be aware of the risks and what can be done to prevent fire in the OR because, while it’s rare, a surgical fire can be fatal to a patient.

Sources: The Associated Press; JointCommisson.org

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