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Background and Overview Fire risk is present whenever there is a convergence of fuel, oxidizer, and an ignition source, which is called the fire triangle . A heightened awareness of fire risk is necessary whenever a fire triangle is present. The authors provide a sentinel event case report of fire in a dental office. Case Description A 72-year-old woman received second-degree facial burns from a fire that ignited near the nasal hood supplying a nitrous oxide–oxygen mixture. The presumed ignition source was heat generated during the preparation of a titanium post with a high-speed, irrigated carbide bur. The patient was transferred to the local emergency department and subsequently discharged after possible pulmonary complications were ruled out. The patient was then transferred to a regional burn unit and was discharged home with second-degree burns. Conclusions and Practical Implications When the source of a fuel cannot be removed from the immediate area, soaked with water, or covered with a water-soluble jelly, the dentist should stop the open flow of oxygen or nitrous oxide–oxygen mixtures to the patient for 1 minute before the use of a potential ignition source, and intraoral suction should be used to clear the ambient atmosphere of oxidizer-enriched exhaled gas.

Energy—its use in various forms during surgery has tremendously advanced our practice of surgery since the 1920s with the introduction of the first electrosurgical units by William Bovie, MD. Each type of energy—electricity, heat, and radiation (including intense MRI magnetic fields)—presents variable risks of injury to patients if the risks are not recognized and care not taken to prevent harm. Intraoperative injuries that are suspected of being caused by a medical device/implement and its related energy may not be related to a technology. In many cases, the injury may be an abnormal or idiosyncratic physiologic response to otherwise normal conditions of device use and performance. Alternatively, the injury may be due to pressure necrosis, tissue chemical sensitivity, an adverse drug reaction, or a disease process that happens to develop in the area where a device was applied. Such alternative etiologies, beyond those from energy emitting technologies, are briefly discussed. This chapter addresses the etiology of intraoperative skin and tissue injuries from medical technologies that are the source of electrical, thermal, and radiation energy. A format for investigating such injuries is presented along with guidance on their prevention. The hazards of surgical fire on the patient are also addressed.

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Fire risk is present whenever there is a convergence of fuel, oxidizer, and an ignition source, which is called the fire triangle. A heightened awareness of fire risk is necessary whenever a fire triangle is present. The authors provide a sentinel event case report of fire in a dental office.A 72-year-old woman received second-degree facial burns from a fire that ignited near the nasal hood supplying a nitrous oxide-oxygen mixture. The presumed ignition source was heat generated during the preparation of a titanium post with a high-speed, irrigated carbide bur. The patient was transferred to the local emergency department and subsequently discharged after possible pulmonary complications were ruled out. The patient was then transferred to a regional burn unit and was discharged home with second-degree burns.When the source of a fuel cannot be removed from the immediate area, soaked with water, or covered with a water-soluble jelly, the dentist should stop the open flow of oxygen or nitrous oxide-oxygen mixtures to the patient for 1 minute before the use of a potential ignition source, and intraoral suction should be used to clear the ambient atmosphere of oxidizer-enriched exhaled gas.

Presented is an overview of ECRI's investigations of intraoperative fires concentrating on oxygen- and nitrous oxide-enriched fires, the common medical devices that act as ignition sources, and the combustible substances that are present during surgery. A comparative evaluation of surgical draping materials, specifically including testing for flame spread rates and ignitability in standard atmospheres and ignitability in oxygen-enriched atmospheres, was performed and published by ECRI in 1986. A summary of their flammability findings is presented, along with a discussion of the oxygen-enriched atmosphere phenomenon of surface fiber flame propagation on reusable surgical textiles. Recommendations are made for minimizing the risk of surgical fires, including special precautions for prevention of fires from surgical lasers.