醫(yī)療機(jī)構(gòu)火災(zāi)意外課件

1、醫(yī)療機(jī)構(gòu)火災(zāi)意外慈濟(jì)綜合醫(yī)院 品管中心執(zhí)行長李毅醫(yī)師Jersey General Hospital Fire18th July, 1859 2005年12月15日中國遼源市中心醫(yī)院的大火造成39名住院病人死亡，事後當(dāng)局將該院院長、副院長依失職罪起訴。2006年，莫斯科第17醫(yī)院發(fā)生火災(zāi)，造成45名病人死亡近醫(yī)院火災(zāi)94：94.01.25 埔基醫(yī)院空調(diào)機(jī)房：電線走火94.02.08 臺東馬偕醫(yī)院放腫科直線加速器ups散熱(燃物品當(dāng)堆放)94.12.17 高雄長庚醫(yī)院放腫科模型室：燃品當(dāng)堆放95：95.05.23 高雄義大醫(yī)院美食街：電線走火95.06.09 霧峰澄清醫(yī)院管道間：配電盤95.06.

2、29 臺馬偕醫(yī)院地下一：電線機(jī)房95.09.25 署臺東醫(yī)院科病房：電線走火96：96.04.02中國附醫(yī)廚房：火引燃食用油97：97.03.08 中國附醫(yī)停塔：消防檢修作業(yè)失誤97.06.13 口醫(yī)院：管道間縱火97.12.17 臺大醫(yī)院開刀房：電線走火98：98.1.10 馬偕醫(yī)院開刀房：電線走火98.1.11 中山附醫(yī)地下室：照明配電盤冒煙98.3.15 中國附醫(yī)心導(dǎo)管室：配電盤電線短98.5.3 新光吳火獅紀(jì)念醫(yī)院地下2樓資料室起火Fires in the operating roomby Yale D. Podnos, Irvine, CA, and Russell A. Willi

3、ams, MD, FACS, Orange, CA the Bulletin of the American College of SurgeonsVol. 82, Number 8August 1997 In the United States, there are approximately 2,260 reported hospital fires per year, resulting in about one death and 130 injuries. Of these, between 20 and 30 % occur in the operating room. Histo

4、rically these figures were much higher. 臺灣病人安全通報系統(tǒng)(TPR)火災(zāi)事件分析2005年至2009年6月: 已收案之醫(yī)療機(jī)構(gòu)公共意外事件共1,063件，其中火災(zāi)有126件2008年至2009年6月 已收案之火災(zāi)意外則有63件，其中5件對病人造成傷害，中度傷害1件及輕度傷害2件。原因63件火災(zāi)通報事件中，77.8機(jī)構(gòu)內(nèi)有訂定公共意外事件應(yīng)變流程(49件)，發(fā)生可能原因部分，以與器材設(shè)備相關(guān)因素為最多，共45件，又以器材設(shè)備操作不當(dāng)為最多，共18件，其次為器材設(shè)備故障16件，器材設(shè)備未定期保養(yǎng)亦有11件。原因63件火災(zāi)意外中，以電線走火17件為最多，其次

5、為微波爐使用不當(dāng)15件、病人或家屬不當(dāng)行為13件(在病床上抽菸、以酒精膏煮食物、隨意棄置未熄滅菸蒂)，因電器故障起火有7件，醫(yī)療人員使用器材不慎引起之火災(zāi)(如滅菌鍋、熱敷帶乾燒，將加熱器材置於易燃物品上等)有4件。案例一家屬發(fā)現(xiàn)床頭後牆壁插座突冒黑煙並起火燃燒，立即拉鈴?fù)ㄖo(hù)理站，護(hù)理師立即聯(lián)絡(luò)中控室維修人員並關(guān)閉室內(nèi)照明電源，並以滅火器滅火，查看後插座已燒毀，周邊牆壁燻黑，幸無人員受傷。原插座缺乏面版保護(hù)蓋，線路外露，加上線路老舊，可能因而造成走火。已加保護(hù)蓋處理，並檢查其他插座。案例二病友曾因躲在棉被中抽菸點燃床單而引發(fā)火災(zāi)，經(jīng)制止後已加強(qiáng)防範(fàn)。但因菸癮大，於月日破壞消防栓取出電線，將消防

6、栓電線接於病室插孔內(nèi)，進(jìn)行觸電導(dǎo)火，成功後，燃燒紙箱及報紙製造煙霧，然後吸取煙霧來解菸癮，因煙霧漸大產(chǎn)生異味且逐漸蔓延，護(hù)理人員發(fā)現(xiàn)後，立即前往撲滅並通知主治醫(yī)師，前往處理的同仁因吸入煙霧略感不適，且病人於點火過程中亦有輕微灼傷紅腫。經(jīng)主治醫(yī)師評估後，開立戒菸貼片每天使用。案例三執(zhí)行手術(shù)前備妥電燒機(jī)，病人左側(cè)貼上全新電燒導(dǎo)電片（單極迴路版），以75酒精性優(yōu)碘為病人消毒，消毒範(fàn)圍由前頸至前胸乳線，並鋪無菌布單。完成後，固定手術(shù)用物：抽吸管、電燒筆，執(zhí)行電燒筆測試。以75酒精紗布擦拭劃刀部位，並用乾紗布再擦拭一次。劃刀皮膚層約1.5公分，拿取電燒刀進(jìn)行切割止血時，接觸病人第一時間，主刀醫(yī)師及助手驚

7、覺溫度急速升高，立刻放棄手中電燒筆，隨即發(fā)現(xiàn)有煙冒出，病人所戴的不織布手術(shù)帽著火，立即掀起無菌布鋪單散熱及脫下帽子，結(jié)果造成病人後頸部、雙耳廓、肩膀、背部及肩胛骨（約40*20CM）深二度灼燙傷，燙傷面積為13.5。醫(yī)策會2005年迄今收集27件與使用電刀、電燒有關(guān)之病人燒傷、產(chǎn)生火花點燃無菌布、紗布，甚至起火燃燒之事件。美國緊急醫(yī)療照護(hù)研究機(jī)構(gòu)(Formerly the Emergency Care Research Institute；ECRI)調(diào)查發(fā)現(xiàn)，美國每年約有550650件手術(shù)中火災(zāi)事件。Most surgical fires occur in or on the patient.

8、 The most common location of surgical fires are:During the period of April 2003 to February 2005 Tyco Healthcare Valleylab kept statistics on the number of surgical fires reported by health-care facilities. A total of 51 fires were reported:Root Causes of Fires :The Fire Triangle :Ignition Sources :

9、Electrosurgical unitElectrocautery unitLaserSparks tissue embersIgnition Sources :Heat-producing devices High speed drill/burrs/saws Cardiac defibrillators Light sources Fiberoptic light cables Fuel Sources :In or On the PatientHair Gastrointestinal gases Gases in surgical smoke Hydrogen and methane

10、 are extremely flammable gases produced by bacteria in the gastrointestinal tract in quantities of up to 200 ml per day. Forty percent of these gases are contained in the large bowel. Human flatus contains approximately 44 percent hydrogen and 30 percent methane. If in an environment of at least 5 p

11、ercent oxygen, hydrogen can explode at concentrations of between 4 percent and 72 percent, while methane can explode at concentrations of between 5 percent and 15 percent. In the colon the concentration of oxygen is approximately 5 percent, but this level is increased when oxygen or nitrous oxide is

12、 administered during anesthesia.Fuel Sources :Prepping AgentsAlcohol Alcohol solutions- Up to 74% alcohol- Flammability warnings- Must dry 2-3 minutes * In ECRIs surgical fire update published February 2006, alcohol-based surgical preps were reportedly involved in 4 percent of surgical fires.Fuel So

13、urces :Operating Room AttireBarrier Materials should resist combustion Burn or melt when subjected to oxygen accelerant ALL materials burn more vigorously in the presence of oxygen Fuel Sources :SuppliesMattresses, pillows Blankets, sheets, towels Sponges, tape, ace bandages, stockinet, steridrapes

14、Gloves Blood pressure cuffs Tourniquets Stethoscope tubing Fuel Sources :Red rubber cathetersPencil tip protectorsOther material mistakenly used as insulatorFuel Sources :Anesthesia components carry enriched oxidant gases!Breathing circuits Masks and airways Laryngeal Mask Airway Endotracheal tubes

15、Oxidizers :OxygenOxygen-enriched atmosphere = O2 above 21% Nitrous OxideThermal decomposition of N2O can supply oxygen for a fire Preparing for Fires : Locate and test gas shutoff valves and circuit breakers Evaluate traffic patterns Note location and accessibility of fire extinguishers and alarms K

16、eep wet sponge or towel in basin on back field Preparing for Fires :Fire ExtinguishersCO2 best choice for OR Know location and types Allow staff practice Preparing for Fires :Plan scenario Include safety officer Notify administration Designate observers Use drill evaluation form Select staff to part

17、icipate Review policies/procedures Complete fire drill record Evaluate results Preparing for Fires :Develop Team Fire PlanCharge RNNotify Safety Officer Document time Determine people in OR Establish communication Count cases in progress Decide handling of patients Assign personnel Ask visitors to l

18、eave Evacuate if necessary Preparing for Fires :Develop Team Fire PlanCirculating RNCall Code Red Remain with patient Extinguish fire Provide supplies Assist anesthesia Unplug electrical equipment Know escape routes Arrange patient transport Evacuate if necessary Preparing for Fires :Develop Team Fi

19、re PlanSurgeonPut out fire on patient Remove burning material Control bleeding Conclude case if possible Cover site with sterile towels Assist with patient transport Preparing for Fires :Develop Team Fire PlanScrub PersonPut out fire on patient Remove burning material Gather instruments/suture neede

20、d for transport Cover with sterile towels Assist with patient transport Preparing for Fires :Develop Team Fire PlanAnesthesia ProviderTurn off O2 and nitrous oxide Ventilate patient Disconnect electrical equipment Disconnect leads/lines Collect transport meds Maintain anesthetic state Assist with pa

21、tient transport Preparing for Fires :Develop Team Fire PlanAncillary PersonnelClear all passages Obtain transport equipment Assist where directed Preventing Fires :Control Ignition Sources :ElectrosurgeryUse non-conductive safety holster Use caution where GI gases / oxidizers can accumulate Avoid me

22、tal-to-metal arcing Activate only when tip is in view Deactivate before tip leaves the surgical site DO NOT activate close to sponges, surgical drapes, or flammable solutions Control Ignition Sources :Electrosurgery Use lowest possible power setting Avoid long activations of ESU Do not use ESUs to c

23、ut tracheal rings and enter airway Control Ignition Sources :Fiberoptic CablesConnect to scope / headlight before turning on Turn off prior to disconnecting Never lay illuminated or hot light cable on drapes Manage Fuels :Do not activate ignition sources in the presence of flammable agentsAlcohol-ba

24、sed preps are involved in 4% of surgical firesManage Fuels :Flammable AgentsAvoid pooling of prep Drape patient after vapors from flammable agents have dissipated Minimize Oxidizers :Prevent accumulation of O2 and N2O under surgical drapes Verify all breathing circuits are leak-free Use air or 30% O

25、2 Use pulse oximeter to determine O2 saturation and need for supplemental O2 Endotracheal Tubes :Use water-based lubricants Use laser safe tubes for airway procedures Inflate cuff with methylene blue-tinted water or saline during airway procedures In Case of Fire R A C ER rescue the patientA alert t

26、he OR of the fireC confine the smoke and fireE extinguish the fire, evacuate if necessaryA small fire can progress to a life-threatening large fire in about 30 seconds In the event of a small fire on the patient, immediately:Smother fire with a wet sponge or towel Remove burning material from patien

27、t For a large fire on the patient, immediately:Stop the flow of breathing gases Remove burning material Care for the patient If the fire cannot be contained:Toxic smoke will form a hot, dense layer near the ceiling, obliterating overhead lights Smoke can migrate through the ventilation system and fr

28、om room to room Evacuating the patientTransport the patient on OR bed Shut off O2 and N2O valves Turn off electrical equipment, especially if water is used to douse fire If fire progresses past 1 minute, the entire OR suite should be evacuated For endotracheal tube fire, immediately and rapidly:Disconnect breathing circuit from the endotracheal tube