Articles 
Dear Rapid Response:
I am writing to inquire about requirements for fire extinguishers in the operating room. Is it a requirement that each operating room have its own fire extinguisher located in the room? If it is not a regulatory requirement, what is the APSF recommendation?
Thank you
Jefri Williams, DO
The author has no conflicts of interest.
In Response:
Dear Dr. Williams:
Thank you for your inquiry. First and most importantly, the goal is to avoid OR fires entirely. Strict adherence to published protocols and safety guidelines should ensure that a fire in the operating room is a vanishingly rare if not, a never event. Prevention recommendations from APSF, including an educational video, can be found on the APSF website at https://dev2.apsf.org/videos/or-fire-safety-video/.
The relevant organization regulating fire safety in the operating room is the National Fire Protection Association (NFPA). The relevant document from that organization is NFPA – 99: The Healthcare Facilities Code, which requires a fire extinguisher within 75 feet of every working location. (1) The Joint Commission also has influence on requirements by virtue of the accreditation process and follows the NFPA guidelines. (2) NFPA-99 (2021 edition) section 16.10.1.4 states that ” Clean agent-or water mist-type fire extinguishers shall be provided in operating rooms.” Regulatory compliance will be satisfied by having that type of extinguisher within 75 feet of each operating room.
ASA, APSF, and ECRI do not believe the regulatory requirements are sufficient for protecting patients or staff in the event of a fire in the operating room. Specifically, the recommendation is that CO2 extinguishers be available. (3) APSF also agrees with the specific ECRI recommendation that a 5 lb. CO2 extinguisher be mounted just inside the entrance of each operating room. (4) Although the NFPA technical committee managing the NFPA-99 document did not incorporate these recommendations into NFPA-99, they did add a comment in the Annex (A.16.10.1.4) that states that a CO2 extinguisher could be used in lieu of a clean agent extinguisher. This comment can be cited if there is local resistance to supplying CO2 extinguishers in each operating room.
Should a fire occur, the primary goal is to protect the patient and the staff from harm. In the event of a fire on the patient, the extinguisher is not the first method for extinguishing the fire. All surgical procedures that have a high risk of a fire (i.e., combination of surgery above the xiphoid, heat source e.g., ESU, open oxygen source) must have a basin of water or saline readily available on the OR table. That would be the fastest method of dousing a fire. If the drapes are on fire, they should be pulled off the patient onto the floor. A fire extinguisher could then be used on the burning drapes. It would be an unusual occasion to require that a fire extinguisher be used on the patient. Note that most OR drapes are impervious to water, which is why an extinguisher is needed if they are on fire. A fire in the operating room will require all personnel to be focused on the rescue process. It would not be desirable to lose a team member as they exit the operating room to find a suitable extinguisher. A CO2 extinguisher prominently located in the operating room provides the greatest chance of protecting patients and staff.
Thank you again for the inquiry and your interest in patient safety.
Jeffrey M. Feldman, MD, MSE
Chair, APSF Committee on Technology
Professor of Clinical Anesthesiology
Children’s Hospital of Philadelphia
Perelman School of Medicine – University of Pennsylvania
Jan Ehrenwerth, M.D.
Former ASA Liaison to NFPA
Professor Emeritus
Yale University School of Medicine
Dr. Feldman is a consultant for Micropore Inc.
Dr. Ehrenwerth has no conflicts of interest.
References
- NFPA 99 Health Care Facilities Code. https://www.nfpa.org/codes-and-standards/all-codes-and-standards/list-of-codes-and-standards/detail?code=99. Accessed May 25, 2021.
- What is the requirement for determining fire extinguisher types in the operating room? https://www.jointcommission.org/standards/standard-faqs/critical-access-hospital/environment-of-care-ec/000001245/. Accessed May 25, 2021.
- Why Should I Learn About Fire Extinguishers. APSF Newsletter 2011;25:59-60.
- ECRI Institute. New Clinical Guide to Surgical Fire Prevention. Health Devices 2009;38:314-332. (Excerpted at https://d84vr99712pyz.cloudfront.net/p/pdf/solutions/afig/ecri-institute-recommendations-for-operating-room-fire-extinguishers.pdf. Accessed May 25, 2021.)
The information provided is for safety-related educational purposes only, and does not constitute medical or legal advice. Individual or group responses are only commentary, provided for purposes of education or discussion, and are neither statements of advice nor the opinions of APSF. It is not the intention of APSF to provide specific medical or legal advice or to endorse any specific views or recommendations in response to the inquiries posted. In no event shall APSF be responsible or liable, directly or indirectly, for any damage or loss caused or alleged to be caused by or in connection with the reliance on any such information.