Fires and explosions

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.