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Fires and explosions

Neil Muchatuta, FRCA, BSc, is Specialist Registrar at the Bristol School of Anaesthesia. He graduated in 1998 from the Royal Free Hospital School of Medicine, London. His main interests are obstetric anaesthesia and teaching
Anaesthesia & intensive care medicine 11/2007; 8(11):457-460. DOI: 10.1016/j.mpaic.2007.09.002

ABSTRACT Fire and explosions require three elements in order to occur (the ‘fire triangle’): oxygen, fuel and a heat or ignition source. Fuel reacts with an oxidizing agent to release energy that may sustain the reaction. An explosion is a rapid physical or chemical change accompanied by a large pressure increase. In the operating theatre environment different team members have control over the three limbs of the fire triangle; good teamwork is paramount in the management of fire. It is the anaesthetist’s responsibility to use oxygen and nitrous oxide judiciously to avoid oxygen-enriched environments in proximity to ignition sources. Potential fuels include surgical drapes and PVC tracheal tubes. Heat and ignition sources include surgical diathermy, lasers, defibrillators and static electricity. Small fires can be patted out or extinguished with sterile saline or water. With larger fires, burning material must be removed and extinguished and oxygen must be stopped, after which ventilation should be re-established with air until the fire risk is removed. The acronym RACE is helpful if evacuation becomes necessary: Rescue patient, Alert other theatres, Confine smoke and fire and Evacuate theatre.

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    ABSTRACT: There is an increase in the incidence of intraoperative fire in Indian hospitals. It is hypothesized that oxygen (O2) enrichment of air, is primarily responsible for most of the fires, particularly in intensive care units. As the amount of ignition energy needed to initiate fire reduces in the presence of higher O2 concentration, any heat or spark, may be the source of ignition when the air is O2-rich. The split air conditioner is the source of many such fires in the ICU, neonatal intensive care unit (NICU), and operating room (OR), though several other types of equipment used in hospitals have similar vulnerability. Indian hospitals need to make several changes in the arrangement of equipment and practice of handling O2 gas, as well as create awareness among hospital staff, doctors, and administrators. Recommendations for changes in system practice, which are in conformity with the National Fire Protection Association USA, are likely to be applicable in preventing fires at hospitals in all developing countries of the world with warm climates.
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