CHAPTER 12 Head and Neck Surgical Fires
Mark E. Brule
The risk of a fire on or within a surgical patient continues
to be present in modern surgery. It is especially acute
during surgery of the head, neck, and upper chest if
open oxygen sources are used. Unfortunately, the sen-
sitivity of surgical, anesthesia, and operating room (OR)
nursing staff members to this hazard waned after the
cessation of the use of flammable anesthetic agents
during the 1970s. During the last several years, the sur-
gical community has experienced the beginnings of a
resurgence in the awareness of this continuing risk as
well as an understanding of the need for a surgical team
approach to the prevention of surgical fires. Preventive
measures have existed for decades, but they have be-
gun to diffuse across professional boundaries and to be
put into wider practice only in recent years. Aiding in this
diffusion have been initiatives by a variety of health care
organizations and medical professional societies.
This chapter draws together pertinent information and
recommendations regarding surgical fires with respect to
the head and neck surgeon. It discusses the relevant
literature that addresses surgical fires, their incidence,
the various responsibilities of surgical team members for
surgical fire prevention in the perioperative setting, and
the procedures for surgical fire extinguishment. It signifi-
cantly updates the information and recommendations
presented in the first edition of Complications in Head
and Neck Surgery.1 It is based on an updated review of
the medical literature and relevant databases, on partici-
pation in the standards activities of professional societ-
ies, and on decades of experience from field investiga-
tions and collaborations with surgeons, anesthesiologists,
and OR nurses.
EFFECTS OF SURGICAL FIRE ON PATIENTS
AND FAMILY
It is appropriate for this chapter to succinctly address
up front the adverse effects of a surgical fire on the
patient. Surgical fires of the head, neck, upper chest,
and airway are frequently disfiguring or disabling and
can seriously affect the quality of life of a patient.2 Every
year in the United States, there are typically two or
three publicized incidents on the television news or in
the newspapers. Whether the patients survive or not,
their families are also adversely affected.
The horror of a surgical fire can be particularly unique in
that many patients having head and neck surgery are
under monitored anesthesia care with local anesthesia
and therefore somewhat conscious when the fire erupts.
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Their recall of the surgery, the fear and smell of the fire
and the resulting pain would obviously have a movin
effect on their lives. One tragic fire incident led th
daughter of the burned patient to initiate a websit
dedicated to surgical fire prevention and educatio
(www.surgicalfire.org).
Virtually all surgical fires are preventable. In this new er
of patient safety, surgical fires are an error worthy of n
less attention by our medical profession than other low
incidence yet highly notorious surgical misadventure
(e.g., retained instruments, wrong site/side/patient su
gery). Surgeons owe it to their patients to become mor
proactive with regard to the prevention of this acute
horrific complication.
LITERATURE, NEW INITIATIVES,
AND INCIDENCE OF SURGICAL FIRE
There are numerous articles of recent vintage in th
medical literature that present overviews of surgical fir
risks along with safety considerations, precautions, an
recommendations for prevention.1,3–25 Complementin
these are a number of articles and formally promu
gated recommended practices and guidelines for surg
cal fire prevention.12,23,26–46 Educational initiatives an
the proliferation of fire drills specific to a surgical patien
fire have also recently emerged.2,14,22,48–55
In addition, there are references that specifically de
with surgical laser safety issues and suggested prac
tices.28,39,42,56–64 The even more acute risks of lase
ignited fires in the airway have stimulated significan
research into laser-safe airway devices, materials, an
techniques during the last 15 years.57–61,63,65–78 At th
technical level, only a few articles have discussed
detail the subtleties of accidental ignition and flam
propagation as they relate to head, neck, and airwa
surgery.16,17,58–60,79,80
Of special interest are the surgical fire hazards from
oxygen and flammable skin preparation agents. Th
concerns regarding the buildup of oxygen under surg
cal drapes during the use of open oxygen sources o
the face and those regarding the oxygen-enriched ign
tion and flame spread of fires in the airway have grow
considerably since the early 1990s; they have stimu
lated research and preventive recommendations spe
cific to these oxygen-enriched fire hazards.8,66,67,78,79,82,
Surgical fires from the use of alcohol and alcohol-base
skin preparation agents have also been addressed
8/1