Preventing and Managing Operating Room Fires

The American Society of Anesthesiologists (ASA) issued an advisory to prevent and manage the rare, but devastating, occurrences of operating room fires.

Robert Caplan, M.D., chair of the ASA Task Force on Operating Room Fires, said the lack of a national reporting system for operating room fires makes it difficult to pinpoint exactly how many occur every year. ASA estimates the number to be between 50 and 100.

ASA’s task force, Dr. Caplan said, developed the Practice Advisory for the Prevention and Management of Operating Room Fires “to identify situations conducive to fire, prevent the occurrence of [operating room] fires, reduce adverse outcomes associated with [operating room] fires and identify the elements of an effective fire response.”

For a fire to occur in an operating room, three components, or a “fire triad,” must be present: An oxidizer, such as oxygen or nitrous oxide; an ignition source, such as lasers, drills or electrosurgery units; and a fuel, which can include tracheal tubes, sponges or drapes.

Education, Preparation, Prevention

ASA made several recommendations to prevent and manage operating room fires. First, the advisory stressed the need for anesthesiologists to obtain fire safety education specific to operating room fires. They also should participate in fire drills with the entire operating room team, ASA said.

Prior to each surgical case, the team should determine whether the case is at a high risk for surgical fires. In these high-risk situations, the team must establish a plan and roles for preventing and managing a fire. In addition, the protocol for the prevention and management of fires should be displayed in every operating room where a fire triad can exist.

ASA’s advisory also listed preventative measures for operating room fires, including:

  • Avoid using ignition sources in proximity to an oxidizer-enriched atmosphere. Surgical drapes should be configured to minimize the accumulation of oxidizers.
  • Allow sufficient drying time for flammable skin prepping solutions.
  • Moisten sponges and gauze when used in proximity to ignition sources.
  • The anesthesiologist should collaborate with all surgical team members throughout the procedure to minimize the presence of an oxidizer-enriched atmosphere in proximity to an ignition source.
  • During high-risk procedures in which an ignition source is used in an oxidizer-enriched atmosphere, announce the intent to use the source; reduce the delivered oxygen concentration to the minimum required to avoid hypoxia; and stop the use of nitrous oxide.

Finally, to manage fires, operating room teams should be able to recognize the early signs of fire, halt the procedures and initiate fire management tasks. In airway fires, the team should remove the tracheal tube, stop the flow of all airway gases, remove all other flammable materials from the airway and pour saline into the airway. For non-airway fires, the team must stop the flow of all airway gases, remove burning or flammable materials and extinguish the fire.

Once the fire has been extinguished, the team must reestablish ventilation, assess the patient’s status and devise a plan for ongoing care.

The advisory also details specific recommendations for fire prevention and management in high-risk procedures, laser procedures, surgery inside the airway and for cases involving moderate or deep sedation and surgery around the face.

The ASA practice advisory was developed as part of a collaborative effort involving safety leaders in anesthesiology, nursing, surgery and equipment safety. It is featured in the May issue of ASA’s Anesthesiology journal. For more information, visit and

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