Thursday, February 5, 2009

600 Fires During Operations Reported Annually


Surgical fires -- in which patients actually catch fire in the operating room -- are rarely talked about, but they do happen, Baltimore television station WBAL reported.

Cathy Reuter Lake became a crusader to make people aware of surgical fires after her mother, Catherine Darahano Reuter, underwent a tracheotomy on New Year's Eve in 2002.

Lake said her mother signed release forms that explained everything that could go wrong during the procedure -- bleeding, a heart attack, infection and death -- but there was one frightening possibility those papers did not include.

"She went into an operating room, trusting that they would make things better for her, and instead she came out burned," Lake told the station.

Lake said her mother was disfigured by the surgical fire.

"My mom had second- and third-degree burns to the right side of her face. Both of her eyes were burned, inside her nose and her mouth and down her back," Lake said.

Reuter, a diabetic heart patient, declined rapidly, according to her daughter.

"She couldn't walk. She couldn't eat. She couldn't talk. Her vision was impaired further. So, I became literally her voice, eyes and ears to help her," Lake said.

Lake had never heard of surgical fires. Sinai Hospital anesthesiologist Dr. James Pepple told the station that most accidents happen when oxygen is flowing and a surgical tool such as a laser creates a spark that ignites the flammable items surrounding a patient, including alcohol-based antiseptics, paper and surgical drapes.

Even a person's hair can catch fire, Pepple said.

"Once that happens, it can go to the mask or the nasal canal, and then it becomes a blowtorch, because you've got this flammable plastic with oxygen flowing through it," Pepple said.

Pepple said he has never seen a fire in his 30-year career but has testified as an expert in a number of lawsuits.

"People joke about anesthesia being 99 percent boredom and 1 percent stark terror. The reality is that there are those moments where we have those awful things happen, and that's got to be one of the worst," he said.

The Emergency Care Research Institute estimated there are about 600 surgical fires in the U.S. annually -- a tiny percentage of the 50 million operations performed every year. The actual number could be considerably higher because many states don't require hospitals to report fires in the operating room, the station reported.

"I hear this, 'Oh, they're rare, they rarely happen.' Well, you know, that may be true. But I never in my wildest dreams thought it would be my mother that was set on fire. That's how rare they are -- until it's you," Lake said.

Surgical fires are most common in head and neck surgeries because all three fire elements -- air, heat and fuel -- are in close proximity, according to Pepple.

There are simple ways to cut your risk. The Emergency Care Research Institute recommends that you talk with your doctor about fire prevention, which may include using less oxygen or no oxygen during the procedure. You can also request a non-alcohol-based skin prep such as betadyne.

"The more informed you are, the better off you are. If you can raise the awareness of the physicians and the nurses in the room, that's your best prevention," Pepple said.

"I didn't have the knowledge to ask those questions, and had I asked, maybe somebody in the O.R. would have said, 'Oh, wait. Let's make sure and double check this,'" Lake said.

Reuter died two years after her ordeal began. Her daughter reached a legal settlement with the D.C. hospital involved and launched SurgicalFire.org to raise awareness in memory of her mother.

"This is just something that nobody wanted to talk about. And to me, personally, it's a dirty little secret that people don't want to talk about," Lake said.

The station asked more than a dozen hospitals in the Baltimore area if their surgical consent forms alert patients to the possibility of a fire. The only facility that responded did not include that information. Pepple said it would be too time consuming to detail every potential side effect in the pre-operative paperwork.

Maryland requires hospitals to report serious surgical fires; however, Wendy Kronmiller, director of the Maryland Office of Health Care Quality, told the station she believes they are under reported.