Sim Corner

Fire in the OR

Case summary:

Length 10-15 minutes

Cesarean delivery

Target group: Obstetricians, Anesthesia, Nurses

Team members for the Scenario:

Obstetrician

Anesthesia

Scrub RN

Circulating RN

Patient

Family Member

General Learning Objectives

• Communicate effectively with team using crisis resource management skills
• Communicate an adverse event with a patient and her family

Scenario specific Goals:

1. Complete appropriate documentation of fire risk assessment
2. Recognize and activate the emergency response system to fire in the OR suite
3. Locate the OR suite fire alarms and fire extinguishers
4. Demonstrate how to safely extinguish a fire in proximity to a surgical site
5. Demonstrate appropriate technique in evacuating an intraoperative patient from the affected surgical suite
6. Implement infant security plan
7. Employ the SBARR technique to inform and prepare incoming team members for action

Debriefing overview:

• Review sequence of events
• Review learning objectives
• Review communication and team work skills
• What went well?
• What would you do differently next time?
• Share key assessments and learning points with those present and not present.

Additional Information:

• Allergies: NKDA
• Medications: PNV
• Ht 5’6
• Weight 170lbs
• EFW 3000g
• PSH Neg
• OB History:   Previous C-section x1
• VS HR 85; RR 20; BP 118/70; Temp 37.4
• FHT’s category 2      
• GBS unknown
• 1 hour Glucola:110
• Social history negative

Set up: Patient (staff or mannequin) in OR bed with Cesarean delivery drapes placed.   Large bright orange flames made out of orange/red felt or construction paper with adhesive tape applied.  This is attached to area where flames erupt (Above waist vs below waist)

Equipment:

• OR table
• Cesarean section drapes
• Flames (Bright orange felt or construction paper in shape of flames with adhesive tape)
• Cesarean instruments
• Baby
• Warmer
• Fire Extinguisher

Sequence of Events: 

  Sequence of Events:

1. Responder #1 (Scrub RN)—Identifies emergency and reports fire
2. Responder #1/ 2— Calls for removal of drapes
3. Responder #2 (OB) Asks for extinguisher to extinguish fire
4. Responder #3 (Circulation RN)— retrieval of  extinguisher and activation of emergency system
5. Responder #4 (Anesthesia) Preparation of patient for removal from OR
6. Responder #4 (Charge)—  Removal of baby and all other personnel.

1) Drapes to be removed right away if possible

2) Discuss the RACE mnemonic ( Rescue –Alarm- Contain-Extinguish)

4) Discuss the PASS mnemonic ( Pull-Aim-Squeeze-Sweep)

5) Knowledge of activation of fire emergency

6) Knowledge of local fire alarms and extinguishers

7) Examine patient for burns

8) Maintain communication with patient and family

Debrief: 

• Implement infant security back up plan (stationing staff at unlocked exit doors)
• What can be used to decrease Fire safety risk
• When does Fire safety risk end
• (Establish psychological safety during introduction to scenario and revisit here)
• Emotions --> Ask “How did that feel?”
• Focus on the performance, not the performer
• Ask “What went well?” and “What would you do differently?”
• Move to practice --> “How could this happen to you?”

Calibrate --> Identify and correct misconceptions

Reference:  "Resources and Tools for Preventing Surgical Fires, US, FDA"