When it comes to ensuring fire safety in surgical environments, most healthcare professionals think about quarterly fire drills, fire barriers, and proper storage of flammable materials. Yet, hidden within the text of NFPA 99–2012 is a lesser-known but equally critical requirement: the annual fire exit drill for anesthetizing locations. This drill, distinct from general fire drills conducted hospital-wide or within ambulatory surgery centers (ASCs), addresses the unique risks present in surgical suites.
The Code Behind the Drill
Section 15.13.3.10.3 of NFPA 99 (2012 edition) states:
Fire exit drills shall be conducted annually or more frequently as determined by the applicable building code, NFPA 101, Life Safety Code, or fire code.
This simple sentence carries important implications. Unlike the more familiar quarterly fire drill requirements from NFPA 101, which apply broadly to healthcare occupancies, this section focuses specifically on anesthetizing locations such as ORs and procedure rooms.
It is also important to note what this section does not say. There is no requirement for these fire exit drills to be unannounced, nor do they need to incorporate varying conditions. They are not part of the routine fire drill schedule and are best understood as a unique and targeted training opportunity for OR teams.
Why Are Fire Exit Drills in the OR Different?
ORs present fire hazards that are fundamentally different from those in patient rooms or administrative areas. In addition to the presence of ignition sources (e.g., electrosurgical units, lasers, and fiber-optic light cables), these areas often involve:
- Flammable surgical drapes and prepping agents
- High-flow oxygen and nitrous oxide sources
- A team intensely focused on sterile procedures
Because of these factors, a fire in the OR can spread quickly and create a chaotic and life-threatening environment. The annual fire exit drill provides a dedicated opportunity for surgical staff to practice response actions that can save lives and minimize harm.
Key Elements of an Effective Fire Exit Drill
To be meaningful and compliant, fire exit drills should go beyond checking a box.
1. Involve the whole surgical team: Fire emergencies don’t happen in silos. The drill should engage anesthesiologists, surgeons, nurses, scrub techs, and any support staff who might be present during a procedure.
2. Simulate OR-specific fire scenarios: While it may not be necessary to use theatrical smoke or alarms, the drill scenario should reflect real threats such as:
- A surgical drape catches fire.
- Equipment malfunctions and ignites.
- An oxygen-enriched atmosphere accelerates ignition.
3. Define clear roles and communication protocols: During a drill, assign and practice specific responsibilities:
- Who announces the fire?
- Who turns off the oxygen?
- Who retrieves the extinguisher?
- Who coordinates evacuation or continued patient care?
Incorporate the RACE (Rescue, Alarm, Confine, Extinguish) protocol or your facility’s equivalent.
4. Document and Debrief: Post-drill evaluation is essential for improving performance and documentation is required. Your debriefing session should record:
- Date, time, and participants.
- Scenario overview.
- Actions taken and observed.
- Lessons learned and improvement plans.
Documentation also supports compliance with ACHC hospital and ASC standards, particularly those for acute care and critical access hospitals covering fire drill critique, and staff training in fire response.
Fire On or In a Patient
NFPA 99 does not describe fire response protocols for situations where the fire involves the patient, but this risk is very real in surgical settings. Importantly, because this type of event occurs within an anesthetizing location, it reinforces the rationale behind having a dedicated fire exit drill for these settings. A fire on a patient, particularly involving surgical gases or drapes, is not easily addressed through general facility-wide fire response training.
Guidelines from AORN and the ASA offer best practices for these events. Consider integrating these protocols into your fire exit drills or developing parallel training sessions.
Immediate steps
- Verbally announce: “Fire on the patient!”
- Douse flames using sterile saline (not alcohol-based solutions).
- Turn off all flammable gas sources.
- Remove burning materials and drapes.
- If airway fire: disconnect circuit, remove endotracheal tube.
Post-fire management
- Assessing the patient and providing immediate care
- Documenting the event and the staff response
- Reporting to internal safety and quality committees
Some facilities treat this as a separate fire response plan. Others include it in a comprehensive plan that outlines all fire risks, including evacuation and in-place defense strategies.
Clarifying Terminology: Defend-in-Place vs. Evacuation
The phrase “defend in place” often arises in discussions about OR fire safety, but it can be confusing. In Life Safety Code terminology, “defend in place” refers to protecting patients within a smoke compartment rather than evacuating them immediately – a strategy supported by the presence of fire-rated barriers and automatic suppression systems.
In the operating room, additional clinical realities complicate the idea of evacuation. Patients are often anesthetized and supported by complex life-sustaining equipment. More critically, the surgical procedure may have already begun, meaning the patient is open and exposed. For these reasons, staff must be trained to control the fire as quickly as possible and immediately assess and continue care for the patient. Evacuation may still be necessary for larger or uncontained fires, but only after ensuring the patient’s condition allows for safe transport.
Clarifying this distinction is important during drills and documentation. Surveyors may ask about your defend-in-place strategy, and staff should understand that in the OR, defending in place reflects both the physical constraints of the environment and the clinical imperative to prioritize patient safety and continuity of care.
Best Practices and Pitfalls
A well-executed fire exit drill can identify critical safety gaps and reinforce staff confidence. Consider these tips:
- Don’t skip the pre-drill briefing. Let staff know the purpose of the drill. A short huddle can improve engagement.
- Practice turning off medical gases. Staff often know this in theory, but rarely practice it.
- Rotate roles. Let different staff members take the lead in various drills to broaden familiarity.
- Avoid token participation. All members of the OR team should be fully involved – not just observers.
Common mistakes include:
- Treating the drill like a paperwork exercise.
- Only involving environmental services or facilities staff.
- Failing to debrief and capture lessons learned.
Aligning with Survey Expectations
Accreditation surveyors will likely ask about the frequency, documentation, and content of fire exit drills. Be prepared to demonstrate:
- The distinction between quarterly drills and the annual OR-specific drill.
- Evidence of active participation by OR personnel.
- Integration of training into broader emergency preparedness efforts.
Facilities accredited by ACHC should ensure their drills align with fire response and emergency management standards. Having a clear, practiced plan supports compliance and helps build a culture of safety.
Another Form of Excellence in Surgical Care
Fire exit drills for anesthetizing locations are more than a regulatory checkbox. They are a chance to prepare for a high-risk, high-impact event that demands immediate and coordinated action. By tailoring these drills to the unique environment of the OR, and integrating guidance from organizations like AORN and ASA, healthcare facilities can elevate their fire response readiness.
Most importantly, these drills offer a practical way to protect patients and staff – and reinforce the values of safety and teamwork that define high-quality surgical care.
Richard L. Parker is associate director, physical environment and life safety at Accreditation Commission for Health Care Inc. where he provides guidance to customers and surveyors in the ASC and hospital programs.
