On Fire In the Operating Room

MSNBC brings to our attention the latest under-reported operating room "accident" - surgical fires! I, for one, never thought that I might actually catch on fire while being operated on. It turns out, however, that surgical fires are at least five times as common as once thought, affecting between 550 and 650 patients a year, including 20 to 30 who suffer serious, disfiguring burns. Every year, one or two people die this way. In Pennsylvania, a state in which hospitals are required to report medical errors, fires occur in one in every 87,646 operations, according to the latest 2007 data. That amounts to 28 fires a year in Pennsylvania alone and allows researchers to estimate with greater certainty the incidents in the rest of the country. Surgical fires are still a tiny fraction of the 50 million surgeries performed each year. An excerpt of one patients horrifying tale (emphasis mine):

Rita Talbert's operation was supposed to be a simple thyroid surgery, three hours, in and out, in the spring of 2005. Instead, the Stafford, Va., woman woke up a week later in intensive care, in agonizing pain and horrified at the face she saw in the mirror. “I didn’t know it was me,” said Talbert, now 62. Her chin was gone; her nose was deformed. Her mouth was virtually melted, so damaged that after a dozen reconstructive operations, she still has trouble eating, drinking and breathing. There’d been an accident, the doctors explained. An electrosurgical tool had ignited oxygen inside a mask under surgery drapes during the operation, sparking flames that left second- and third-degree burns from Talbert’s chest to the top of her head. "It just caught fire," she said, still incredulous at the idea. "They didn't even know it had caught on fire."

The root problem seems to be one of communication between the surgeon and the anesthesiologist. In most incidents, the surgeon was not informed that oxygen (O2) was flowing under the surgical drapes. The problem is exacerbated when the surgeon does not inform the anesthesiologist he is going to power on a electrical device in the surgical area. Oxygen concentrations of 50 percent and higher will create a flash fire. About 65 percent of surgical fires occur on the upper body or inside a patient's airway, another quarter occur elsewhere on the body and less than 10 percent actually occur inside the body cavity. Whatever the source, the head and neck region is grimly suited to hosting fires, especially in a high-oxygen atmosphere. There’s the vellus, the peach fuzz on your face and head - each tiny hair burns like a tiny sparkler and propagates a ripple of flame across the face.