One key challenge with fire rescue operation team is the lack of knowledge application of various equipments
By Deepak Agarkhed
A patient had suffered serious burn injury at the buttock during general surgery. The MRI UPS batteries caught fire while it was under installation in equipment room. The faulty power chords resulted into frequent breaking and causing electrical sparks while it is being used.
These examples in hospital are not hypothetical but actual incidents in hospital set-ups. The fire related incidents in Indian hospitals are unfortunately not rare but frequent as lessons from each fire incident are hardly learnt by individual hospital and adopted in their work instructions to their team.
The fire incidents happen due to unsafe environment like garbage storage in highly combustible environment and unsafe practice like people smoking combine. There are many contributing factors for unsafe environment like hazardous material, exposed hot electrical wires, LPG cylinders including medical devices.
The medical devices are spread across hospital right from emergency area to operating theatre. The function of each device varies based its clinical usage. These devices are either fixed in nature (non movable) like Gamma camera or movable like anaesthesia ventilators. The type of equipment like diagnostic or therapeutic form broad based classification of medical device. The fire hazard can occur due to any of these devices mainly connected to electrical power line and present in oxygen enriched environment.
The below mentioned measures right from technology planning to commissioning stage will help to reduce hazardous conditions (i.e. potential source of harm):
Select the technology based on standardisation of equipment through conformity assessment by regulating authorities like the FDA in USA. Unfortunately, the Indian government is yet to strengthen its policy for wide spectrum of medical devices. The hospital authorities may refer to CE or FDA mark as benchmark while shortlisting the technology.
Involve clinical engineer in planning stage to help create good design like separate fire rated wall and door for UPS room for radiology equipment and laying of high tension electrical cables.
Conduct detailed equipment acceptance for clinical usage incorporating safety aspects including electrical safety checks before commissioning new medical devices.
The points cited below are to be regularly tracked during operational stage of medical devices to avoid occurrence of fire related hazard condition on account of medical devices:
User team should be trained on safety aspects of equipment including proper shut down of devices, cable management and following operating manual as guidelines.
The clinical engineer during daily walk through inspection should not limit to operational aspect of medical devices but should extend to proactive risk assessment.
The preventive maintenance of equipment should be extended to equipment and its accessories like UPS.
Proper number of electrical sockets in each clinical area with good grounding protection and proper segregation with medical gas line reduces fire hazards. Fire hazard from equipment may arise under condition of internal short-circuit within equipment or through accessory used along with equipment. Electrical hazards may lead to fire mishap harming patients due to loose electrical wires. The operating room is most venerable to fire hazard as it has all ingredients to catch fire and includes surgeon using ignition source like ESU, defib, fibre optic light source, anesthetist involved with oxidizers like O2,N2O ,compressed air and nurses involved with fuel like surgical drapes, prepping agent. The ERCI recommends the following precautions to ensure that fire hazards are reduced.
Fiber optic light sources can start fires and operating theatre team should complete all cable connections before activating the source and the source to be placed in standby mode while disconnecting cables.
When performing electro surgery, electro cautery, or laser surgery the below mentioned precautions are suggested:
Stop supplemental O2 (if O2 concentration is >30%) at least one minute before and during use of the unit, if possible.
Activate the unit only when the active tip is in view especially if looking through a microscope or endoscope.
Deactivate the unit before the tip leaves the surgical site.
Place electro-surgical electrodes in a holster or another location off the patient when not in active use.
Place lasers in standby mode when not in active use.
Do not place rubber catheter sleeves over electro-surgical electrodes.
One key challenge with fire rescue operation team in hospital is the lack of knowledge application of various medical equipments. The special precaution to be taken in case of fire at MRI gantry room, as no metallic objects including normal fire extinguisher to be taken inside. The emergency stop button of MRI located at console room should be used if and only if any person is struck between magnet and metallic objective .This needs to be done by only skilled radiology staff who is trained in safety aspect of MRI.
The autoclaves used for sterilisation too have emergency stop buttons for usage in case fire mishap happens around the CSSD area. The special precautions to be taken to communicate to people who are within audiometer area during fire mishap as decibel level within the area is kept too low from outside area.
The following precautions are desirable for avoidance of fire mishaps on account of medical devices:
Proper commissioning of equipment with right specification usage of electrical power sockets and medical gases.
Training user and clinical engineer who can identify any unusual hazardous condition that may lead to fire mishaps.
Keeping the area around the medical equipment clean, free from clutter and all cables properly labeled.
Avoid making any modification in electrical circuits including adding additional power sockets.
Avoid substandard accessories or components including modification of equipment without consulting OEM.
Sensitisation of equipment, its application and risk to user, utility engineering, housekeeping and hospital safety.
The fire harm risk components have high severity impact on all factors i.e. human, property and business. As recommended by accreditation bodies, proactive risk assessment on fire can be extended to areas where there are high density of medical equipment like operating room or intensive care area.
It is better to be proactive than reactive for the sake of patients and hospital staff. Indeed spark neglected from medical device may result in burning the hospital down.