Surgical Fires

Surgical fires are fires that occur in, on or around a patient undergoing a medical or surgical procedure.1 Surgical fires are rare but serious events. The ECRI Institute estimates that approximately 550 to 600 surgical fires occur each year.2 The AANA is a collaborating partner of the FDA Preventing Surgical Fires Initiative. This initiative was launched to increase awareness of factors that contribute to surgical fires, disseminate surgical fire prevention tools, and promote the adoption of risk reduction practices throughout the healthcare community.1 This page contains information about causes of surgical fires, recommendations, and links to posters, videos, and resource materials, which can be used to educate all staff on the surgical team on the importance of fire safety.
Fire Triangle
Causes of Surgical Fires

Surgical fires can occur any time all three of the following elements are present:

  • Ignition source (e.g., electrosurgical units, lasers, and fiberoptic light sources)
  • Fuel source (e.g., surgical drapes, alcohol-based skin preparation agents, the patient)
  • Oxidizer (e.g., oxygen, nitrous oxide, room air)1
Recommendations for Preventing Surgical Fires

The FDA Preventing Surgical Fires Initiative has outlined a detailed set of recommendations for surgical fire prevention for healthcare professionals.  Anesthesia professionals control an important component of the surgical fire triangle: the oxidizer (oxygen and nitrous oxide).  FDA recommendations pertinent to the safe delivery of supplemental oxygen are:

  • Evaluate if supplemental oxygen is needed for each patient. Any increase in oxygen concentration in the surgical field increases the chance of fire.
  • If supplemental oxygen is necessary, particularly for surgery in the head, neck, or upper chest area:
    • Deliver the minimum concentration of oxygen needed to maintain adequate oxygen saturation for your patient.
    • Use a closed oxygen delivery system such as an endotracheal tube or laryngeal mask whenever possible, especially if high concentrations of supplemental oxygen (greater than 30 percent) are being delivered.
    • 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.
  • Encourage communication among members of your surgical team.
    • Ensure the anesthesia professional delivering the gases is communicating with the surgeon controlling the ignition source and the clinician applying the skin preparation agent.

The complete set of detailed recommendations for the prevention of surgical fires can be accessed here.   

In most cases, surgical fires are preventable.  As an integral part of the surgical team, it is important for CRNAs to be aware of potential hazards that may cause surgical fires, prevention techniques, and steps to extinguish a surgical fire.  The AANA encourages all CRNAs to be knowledgeable about and take steps to mitigate the risk of surgical fires.  It is important for anesthesia professionals to participate in a fire risk assessment, identifying the presence of the three elements of the fire triangle, at the beginning of each procedure.  Continuous communication among the entire surgical team throughout the procedure is a vital component in the prevention of surgical fires. 

Surgical Fire Resources
The ECRI Institute is a nonprofit, independent, evidence-based research organization which conducts applied scientific research in healthcare. ECRI has developed downloadable posters related to surgical fire safety:
Other Resources
  1. U.S. Food and Drug Administration. Preventing Surgical Fires. Accessed January 20, 2012.
  2. ECRI Institute. Surgical Fire Prevention. Accessed January 20, 2012.

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