Skip banner Home   Sources   How Do I?   Site Map   What's New   Help  
Search Terms: skolnick
Edit Search
Document ListExpanded ListKWICFULL format currently displayed   Previous Document Document 8 of 21. Next Document

Copyright 2000 St. Louis Post-Dispatch, Inc.  
St. Louis Post-Dispatch (Missouri)

May 28, 2000, Sunday, FIVE STAR LIFT EDITION


LENGTH: 1318 words


BYLINE: Andrew A. Skolnick; Special To The Post-Dispatch

The first thing you should know about fires that happen during surgery is that they are rare.

A nonprofit agency that investigates incidents involving medical devices estimates that about 100 of the more than 27 million surgical procedures done in the United States each year involve a fire.

Ten to 20 of those fires cause serious injury, with one or two a year resulting in a patient's death.

The second thing that you -- and more importantly your doctor -- need to know is that virtually all surgical fires are preventable, because nearly all are caused by ignorance, carelessness or both, said Mark E. Bruley, a vice president and investigator for the Emergency Care Research Institute in Plymouth Meeting, Pa. Bruley has been studying and publishing articles on the causes and prevention of surgical fires for 22 years.

There are no laws requiring the reporting of surgical fires, so an exact accounting isn't available. In some cases, hospitals may be reluctant to make reports out of fear of lawsuits or bad publicity.

Fires require three things: something to burn, an ignition source and sufficient oxygen.

When oxygen is given to patients during surgery, high concentrations can build up under surgical drapes, especially around the patient's head and neck. Anyone who has seen a piece of paper or even steel wool burn explosively when dropped in a jar of pure oxygen can understand the danger of using an ignition source near oxygen.

But that's what surgeons often do during surgery. Various surgical instruments -- especially laser knives and electrocautery devices like the one involved in a fire during surgery at SouthPointe Hospital that ended Eleanor Diehn's life -- can set fire to surgical drapes, surgical tubes, the patient's hair or other flammable material.

An electrocautery device also ignited a fire that nearly killed Wallace Beene, 75, a retired University of Arizona journalism professor in Tucson. Two years ago, while undergoing brain surgery to remove a blood clot, Beene's head, neck and shoulders caught fire.

As with many patients undergoing brain, eye or other surgery of the head and neck, Beene had been under local anesthesia and awake at the time. As he struggled to get off the operating table, a quick-thinking nurse dowsed the flames with water.

Beene doesn't remember much of anything from the first two months after the fire. His wife, Geraldine, who is a registered nurse, must recount those events.

Wallace Beene spent nine weeks in the hospital's intensive-care unit and four more weeks in the hospital. After that, he spent 10 days in a rehabilitation facility before he was able to return home to recuperate.

The first- and second-degree burns he suffered led to a series of infections. The powerful antibiotics needed to control those infections caused serious side effects, including damage to his kidneys.

Today, Beene keeps an office at the university. He is still recovering, though there is little scarring left. He also is $ 1 million richer, having received a settlement in a lawsuit against the hospital.

According to Geraldine Beene, the fire started when an electrocautery device ignited the alcohol-based solution that had been used to prep her husband's head for surgery. In an oxygen-enriched atmosphere, the solution burns like rocket fuel, which is why its manufacturer warns against using it for head and neck surgery, she said.

Geraldine Beene blames the accident on a failure to educate doctors and other health care providers about the dangers of surgical fires and how to prevent them.

"I taught nursing students about the need to educate patients who are on oxygen about the serious danger of fire, but never in any nursing textbook have I ever seen information about the danger of setting patients on fire during surgery," she said.

Bruley, of the Emergency Care Research Institute, said the incidence of surgical fires has increased in the United States during the past 15 years or so, despite efforts by the institute to educate physicians.

It makes no difference how experienced the surgeon is, he said. Even a surgeon who operated on a recent president has set a patient on fire, Bruley said. He declined to provide more details.

The increase has been caused in part by the introduction of much better ways to monitor a patient's blood-oxygen level, he said. This has led to the "preventive medicine" practice of keeping the patient's blood-oxygen level at maximum -- which is not always necessary. By increasing the flow of pure oxygen to the patient when an ignition source is being used, you increase the risk of surgical fire.

Dozens of articles have been published in medical journals during the past 20 years that warn of the dangers of surgical fires during head or neck surgery. In 1989, researchers at the Eastern Virginia Medical School in Norfolk published a study in the journal Ophthalmic Surgery recommending the use of compressed air instead of oxygen to reduce the risk of fire during eye surgery.

Bruley said that when oxygen must be used, better communication and coordination between the surgeon and anesthesiologist is needed. The concentration of oxygen should be reduced about a minute before the surgeon uses any possible source of ignition.

Other steps also can reduce fire risk, he said. Flammable preparations should not be used to prepare the skin for surgery. Also, the patient's eyebrows, mustaches and other hair should be coated with K-Y Jelly or similar water-based ointment.

Hair, especially the almost invisible ones that cover our skin, burns in a flash in the presence of concentrated oxygen. A tiny spark landing on these hairs can erupt in a sheet of flame that spreads to surgical drapes. That's exactly what happened to a 2-week-old baby at Cedar-Sinai Medical Center in Los Angeles in 1988. The fire lasted just six seconds. The baby died two hours later.

That fire, like almost every other one Bruley has investigated over the past two decades, could have been avoided if medical personnel had been better educated about surgical fires, he said.

"Every surgeon I've talked to who set their patient on fire never makes the same mistake twice," Bruley said.
Some high-profile fires

Patients catching on fire during surgery happens on average about twice a week in the United States, according to experts. The fires can be devastating, sometimes fatal, but don't often get publicized. Here are some that did:

* July 1998: Journalism professor Wallace Beene enters University Medical Center in Tucson, Ariz., to remove blood clots in his brain. During the operation, an electrocauterizing device sparks a flash fire that burns his face and upper body.

* July 1996: Joyce Levine, a high school teacher, goes into Jewish General Hospital in Quebec to have breast-reduction surgery and some moles reduced from her groin. A spark from the surgeon's cauterizing gun ignites antiseptic solution under her legs. She suffers second- and third-degree burns on her legs.

* November 1993: Douglas Parker, 23, undergoes surgery at Seton Medical Center in Austin, Texas, to remove some benign throat tumors that were making him hoarse. The surgeon's laser ignites a plastic endotracheal tube in his throat, causing an oxygen-induced flash fire in his airways. He dies two months later.

* May 1990: While doctors at UCLA Medical Center in Los Angeles are performing surgery on auto-accident victim Angela Hernandez, 26, sheets covering the patient catch fire. The operating room fills with smoke so thick the medical staff cannot put out the flames and must leave the room. Hernandez dies.

* October 1988: Doctors using an electrocauterizer to seal a blood vessel during surgery on a premature infant at Cedar-Sinai Medical Center in Los Angeles spark a flash fire that kills the baby.

LOAD-DATE: May 29, 2000

Previous Document Document 8 of 21. Next Document
Terms & Conditions   Privacy   Copyright  2005 LexisNexis, a division of Reed Elsevier Inc. All Rights Reserved.