Fire in the operating room, a hot topic? Guideline development for operating room fire incidents by a literature review, semi-structured expert interviews and a qualitative, descriptive, anonymized cross-sectional study

Background: The operating room (OR) is a high-risk environment which necessitates preparedness for potential life-threatening incidents, such as fulminant fires. Existing protocols lack specific guidelines for anesthesiologists regarding emergency evacuation, and steps to be undertaken when leaving patients under anesthesia. Objectives: This research aimed to assess the anesthesiologists' preparedness to respond to fulminant fires in the OR and propose a safe to use guideline to optimize a patients' chance of survival while minimizing the risk of awareness. Design: Methods included a literature study, multi-disciplinary expert interviews (variant Delphi method), and a qualitative, descriptive, anonymized cross-sectional study in a select sample by means of a survey distributed amongst the anesthesiologists and residents working in the Flemish university hospitals. As such, 297 anesthesiologists and residents were addressed of which 64 participated, equal to a response rate of 21,5%. Results: Results indicated inadequate preparedness, with less than half considering crucial measures during emergency evacuation without the patient such as reducing the fraction of inspired oxygen (FiO2) (49.1%), deepening anesthesia (49.1%) or covering patient and ventilator with fire blankets (29,1%). Only 17.2% considered all three critical steps. Despite awareness of risks in the OR, only 36% could identify three specific risk factors. Self-reported confidence and perceived knowledge increased after guideline review by the participants. Conclusions: At this point research amongst Flemish anesthesiologists (and residents) suggests there is insufficient preparation for managing fulminant OR fires. The proposed guideline, addressing gaps in knowledge and actions, enhances readiness. These critical steps, when implemented, can maximize survival chances during an incident. Future efforts should focus on widespread guideline implementation and ongoing training, besides further and more thorough research regarding this topic.