Operating Room Fires Research Articles

Fire in the Operating Room: Use of Mixed Reality Simulation with Nurse Anesthesia Students

Background: The occurrence of a fire when implementing anesthesia is a high-risk, low-frequency event. The operating room is a high-stakes environment that has no room for error. Mixed reality simulation may be a solution to better prepare healthcare professionals. The purpose of this quantitative, descriptive study was to evaluate the technical and non-technical skills of student registered nurse anesthetists (SRNAs) who participated in a mixed reality simulation of an operating room fire. Methods: Magic Leap OneTM augmented reality headsets were used by 32 student registered nurse anesthetists to simulate an emergent fire during a simulated tracheostomy procedure. Both technical and non-technical skills were evaluated by faculty members utilizing a checklist. Results: The SRNAs’ overall mean technical skill performance was 18.16 ± 1.44 out of a maximum score of 20, and the mean non-technical skill performance was 91.25% out of 100%. Conclusions: This study demonstrated the utility and limitations in applying novel technology in simulation. Participants demonstrated a strong performance of technical and non-technical skills in the management of a simulated operating room fire. Recommendations for future applications include the use of multiple sensory inputs into the scenario design and including all core team members in the immersive mixed reality environment.

The Case of the Inadvertently Triggered Laser: An Historical Example of Simulation-Enhanced Adverse Event Investigation.

This report describes an historical case example that illustrates how simulation used in investigating adverse events can identify underlying, remediable causes that otherwise may not be discovered. The event involved an operating room fire caused by inadvertent triggering of a laser. Guidelines for action after an adverse event were used to guide the postevent actions. An expert in operating room fires was engaged to conduct the investigation. Recommendations and considerations for conducting such investigations with simulation are offered. Simulation is likely underused for healthcare adverse event investigations; this case example may encourage more widespread application.

MP83-20 DOES FOOT PEDAL ILLUMINATION IMPROVE SPEED, EFFICIENCY AND ACCURACY DURING UROLOGIC SURGERY?

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Quality Improvement & Patient Safety IV (MP83)1 Apr 2020MP83-20 DOES FOOT PEDAL ILLUMINATION IMPROVE SPEED, EFFICIENCY AND ACCURACY DURING UROLOGIC SURGERY? Hyelin You, Jon Maldonado*, Andrew Krause, Ashley Li, Jeremy Brown, Akin S. Amasyali, Mohammad Hajiha, Phillip Stokes, Muhannad Alsyouf, John Smith, Jason Groegler, Daniel Baldwin, and D. Duane Baldwin Hyelin YouHyelin You More articles by this author , Jon Maldonado*Jon Maldonado* More articles by this author , Andrew KrauseAndrew Krause More articles by this author , Ashley LiAshley Li More articles by this author , Jeremy BrownJeremy Brown More articles by this author , Akin S. AmasyaliAkin S. Amasyali More articles by this author , Mohammad HajihaMohammad Hajiha More articles by this author , Phillip StokesPhillip Stokes More articles by this author , Muhannad AlsyoufMuhannad Alsyouf More articles by this author , John SmithJohn Smith More articles by this author , Jason GroeglerJason Groegler More articles by this author , Daniel BaldwinDaniel Baldwin More articles by this author , and D. Duane BaldwinD. Duane Baldwin More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000975.019AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Endourologic procedures frequently use pedal activation in a low-light operating room (OR). Foot pedal activation in low-light conditions risks incorrect pedal activation, which may increase radiation exposure, cause patient burns, or start OR fires. This study compares speed, accuracy, dark adaptation, and surgeon preference for pedal activation in 4 different lighting conditions. METHODS: During a simulated percutaneous nephrolithotomy (PCNL), pedals for fluoroscopy (c-arm), holmium laser, and ultrasonic lithotripter (USL) were randomized to 3 different positions. Twenty participants activated pedals in a randomized order in 4 settings: a dark OR with black light illumination, a dark OR with glow stick illumination, a dark OR with no foot pedal lighting, and a bright OR with overhead lights on (Fig 1). Endpoints included time to pedal activation, number of attempted, incomplete, and incorrect presses, dark adaptation, and surgeon preference. Mann-Whitney U Test was used with p<0.05 considered significant. RESULTS: Compared to no illumination (8.47 s), the glow stick (6.77s; p < 0.001) and black light fluorescent illumination (5.34s; p < 0.001) were both associated with decreased combined and individual pedal activation times (p<0.05 for c-arm, laser, and USL). The black light resulted in a significant decrease in attempted (0.30 vs 3.45, p<0.001), incomplete (1.25 vs 7.75, p<0.001), and incorrect presses (0.35 vs 1.25, p=0.035) compared to the dark setting, while demonstrating no difference compared to having room lights on. Dark adaptation was significantly improved with black light illumination compared to having the room lights on (134.5 vs 140.5 luminance units, p<0.001). Subjectively, 100% of participants preferred illuminated pedals compared to the dark OR, with 90% preferring the black light. CONCLUSIONS: During a simulated PCNL, black light foot pedal illumination significantly improved accuracy and efficiency of instrument activation compared to the conventional dark OR, while also maintaining the surgeon’s dark adaptation compared to having the overhead lights on. This study demonstrates that the use of black light foot pedal illumination may reduce errors in the operating room due to inadvertent foot pedal activation while preserving the ability to operate in a low light environment. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1263-e1263 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hyelin You More articles by this author Jon Maldonado* More articles by this author Andrew Krause More articles by this author Ashley Li More articles by this author Jeremy Brown More articles by this author Akin S. Amasyali More articles by this author Mohammad Hajiha More articles by this author Phillip Stokes More articles by this author Muhannad Alsyouf More articles by this author John Smith More articles by this author Jason Groegler More articles by this author Daniel Baldwin More articles by this author D. Duane Baldwin More articles by this author Expand All Advertisement PDF downloadLoading ...

Preventing Operating Room Fires: Impact of Surgical Drapes on Oxygen Contamination of the Operative Field.

The aim of the study was to measure underdrape oxygen pooling, surgical site oxygen contamination, and time to restoration of 21% oxygen concentration after cessation of oxygen delivery by measuring oxygen concentration under simulated clinical conditions with various drapes. In a 2-part study, oxygen permeability of four differing surgical drapes was measured (Part A) and a mannequin was used to measure underdrape oxygen pooling and surgical site oxygen contamination (Part B). In Part A, a container of high concentration oxygen was sealed with a surgical drape. Oxygen concentrations on both sides of the drape were then measured over time to quantify drape oxygen permeability. Part B included a mannequin model draped for a hypothetical surgical site with oxygen administered by face mask. Oxygen concentration was measured at both the surgical site and under the drape nearest the surgical site. Oxygen permeability varied significantly between drapes tested. The surgical site oxygen concentration ranged from 20% to 58% (P = 0.0001). The commonly used woven 100% cotton operating room (OR) towel was highly permeable. The plastic occlusive drape created an impermeable barrier, which did not allow for any oxygen contamination but created the longest time to return to 21% oxygen concentration at the underdrape site after cessation of oxygen delivery. Surgical drapes have varying oxygen permeability and can lead to high concentration underdrape oxygen pooling. Oxygen contamination of the surgical site varies widely based on drape material and may reach dangerously high levels, especially with the cotton OR towel. Surgical drape selection may impact OR fire risk.

Virtual reality operating room with AI guidance: design and validation of a fire scenario.

Operating room (OR) fires are uncommon but disastrous events. Inappropriate handling of OR fires can result in injuries, even death. Aiming to simulate OR fire emergencies and effectively train clinicians to react appropriately, we have developed an artificial intelligence (AI)-based OR fire virtual trainer based on the principle of the "fire triangle" and SAGES FUSE curriculum. The simulator can predict the user's actions in the virtual OR and provide them with timely feedback to assist with training. We conducted a study investigating the validity of the AI-assisted OR fire trainer at the 2019 SAGES Learning Center. Fifty-three participants with varying medical experience were voluntarily recruited to participate in our Institutional Review Board approved study. All participants were asked to contain a fire within the virtual OR. Participants were then asked to fill out a 7-point Likert questionnaire consisting of ten questions regarding the face validation of the AI-assisted OR fire simulator. Shapiro-Wilk tests were conducted to test normality of the scores for each trial. A Friedman's ANOVA with post hoc tests was used to evaluate the effect of multiple trials on performance. On a 7-point scale, eight of the ten questions were rated a mean of 6 or greater (72.73%), especially those relating to the usefulness of the simulator for OR fire-containing training. 79.25% of the participants rated the degree of usefulness of AI guidance over 6 out of 7. The performance of individuals improved significantly over the five trials, χ2(4) = 119.89, p < .001, and there was a significant linear trend of performance r = .97, p = 0.006. A pairwise analysis showed that only after the introduction of AI did performance improve significantly. The AI-guided OR fire trainer offers the potential to assess OR personnel and teach the proper response to an iatrogenic fire scenario in a safe, repeatable, immersive environment.

Prevention and Management of Operating Room Fire: An Interprofessional Operating Room Team Simulation Case.

Operating room (OR) fire can be a devastating and costly event to patients and health care providers. Prevention and effective management of such fires may present difficulties even for experienced OR staff. This simulation involved a 52-year-old man presenting for excisional biopsy of a cervical lymph node to be performed under sedation. Participants were expected to identify and manage both contained and uncontained fires resulting from ignition by electrosurgical cautery. We conducted weekly multidisciplinary simulations in the mock OR at Massachusetts General Hospital. Participants included surgery and anesthesiology residents, certified registered nurse anesthetists, registered nurses, and surgical technicians. Participants were unaware of the scenario content. Each 90-minute session was divided into three parts: an orientation (10 minutes), the case with rapid cycle debriefing (65 minutes), and a final debriefing with course evaluations (15 minutes). Equipment consisted of a simulation OR with general surgery supplies, general anesthesia equipment, a high-fidelity Laerdal SimMan 3G simulator, a code cart, a defibrillator, dry ice for smoke effects, and a projector with a fire image. From April to June 2015, 86 participants completed this simulation. Participants reported that the simulation scenario was realistic (80%), was relevant to their clinical practice (93%), changed their practice (82%), and promoted teamwork (80%). Prevention and management of OR fire require collaboration and prompt coordination between anesthesiologists, surgeons, and nurses. This simulation case scenario was implemented to train multidisciplinary learners in the identification and crisis management of such an event.

Operating room fire prevention - preventive measures for safe eyelid surgery

Resumo Fogo em campo cirurgico durante cirurgia palpebral e uma complicacao intra-operatoria que e dramatica tanto para o paciente quanto para a equipe medica. Relatamos um caso de acidente cirurgico durante cirurgia palpebral onde o paciente sofreu queimadura de supercilio. Houve interacao entre o oxigenio usado para sedacao (mascara aberta) e uma fonte de ignicao representada pelo cauterio monopolar. Embora o paciente tenha apresentado boa evolucao clinica com recuperacao total da lesao cutânea, este caso e um alerta para se evitar tais tipo de ocorrencia. Ressaltamos neste trabalho quais as condicoes implicadas e o modo de prevencao.

Surgical Smoke Evacuators Reduce the Risk of Fires From Alcohol-Based Skin Preparations.

Surgical smoke evacuators may reduce the concentration of alcohol vapors from skin preparations at the site of electrosurgical device activation, decreasing operating room fire risk. Our aim was to compare the incidence of flames with and without smoke evacuation in a porcine ex vivo model. A monopolar device was activated after application of either 70% isopropyl alcohol/2% chlorhexidine gluconate (CHG-IPA) or 74% isopropyl alcohol/0.7% iodine povacrylex (iodine-IPA) skin preparations. No suction was compared with standard wall suction and 2 monopolar devices with built-in smoke evacuators. Flames were generated in 60% of CHG-IPA and 47% of iodine-IPA tests without suction. Wall suction did not significantly reduce fires (CHG-IPA 43% vs. 60%, P=0.30; iodine-IPA 57% vs. 47%, P=0.61). Use of both smoke evacuation devices reduced fires for CHG-IPA (17% vs. 60%, P=0.001 and 20% vs. 60%, P=0.004) but not for iodine-IPA. Smoke evacuation devices reduce fire risk when used with a chlorhexidine-alcohol skin preparation.

Anesthetic Challenges During Laser Surgery of the Larynx Part 2. Operating Room Fire

Theoretical basis: Laser is an acronym for light amplification by stimulated emission of radiation-a highly collimated beam of photons at a single frequency. Lasers are ubiquitous in the modern world and are increasingly used in the operating room. The Aim of the study is to determine different anesthetic techniques and complications during laser surgery of the larynx. Results: The ignition and propagation of fire requires a triad of components: ignition source, fuel and oxidizer. All parts of the fire triad are ubiquitous in operating room and may be in close proximity of each other during laser surgeries. When laser use is planned, the concentration of inspired oxidizers must be considered. When the surgical site is within or near the airway, coordination between the anesthesia and surgical teams is essential to consider the need for an ETT, which tube type to use, the oxygen enrichment plan, and mode of ventilation. Standard polyvinyl chloride (PVC), red rubber, and silicone ETTs are candidates for use during laser procedures near the airway, but all are ignitable and require protective measures. Conclusion: Lasers are increasingly used in the operating room. Understanding the technology is important to safe anesthetic practice.

The Current Situation of Operating Room Fires and Preventive Measures：Comparison between the United States and Japan

The Current Situation of Operating Room Fires and Preventive Measures：Comparison between the United States and Japan

Response to a Fire Incident in the Operation Room: A Cautionary Tale.

Health care facilities are always seen as places of haven and protection for managing external incidents, but situations become difficult and challenging when such facilities themselves are affected by internal hazards. Such incidents are arguably more disruptive than external incidents, because patients are dependent on supportive measures and are neither in position to respond to such crisis situation nor do they know how to respond. Operating room fires are rare but potentially catastrophic, involving loss of costly resources and possibly lives. This case report details a true operating room fire incident in an emergency operating room and details the real-life challenges encountered by operating room staff in preserving both life and property. As a result of this work, precautionary measures may be implemented to mitigate such incidents. Careful coordination, continuous training, and fire drill exercises can improve the overall outcomes and minimize the possibility of these potentially fatal problems, thereby making a safer health care environment for every worker and patient.

Carbon dioxide can eliminate operating room fires from alcohol-based surgical skin preps.

Surgical fires are a rare event that still occur at a significant rate and can result in severe injury and death. Surgical fires are fueled by vapor from alcohol-based skin preparations in the presence of increased oxygen concentration and a spark from an energy device. Carbon dioxide (CO2) is used to extinguish electrical fires, and we sought to evaluate its effect on fire creation in the operating room. We hypothesize that CO2 delivered by the energy device will decrease the frequency of surgical fires fueled by alcohol-based skin preparations. An ex vivo model with 15 × 15cm section of clipped, porcine skin was used. A commercially available electrosurgical pencil with a smoke evacuation tip was connected to a laparoscopic CO2 insufflation system. The electrosurgical pencil was activated for 2s at 30 watts coagulation mode immediately after application of alcohol-based surgical skin preparations: 70% isopropyl alcohol with 2% chlorhexidine gluconate (CHG-IPA) or 74% isopropyl alcohol with 0.7% iodine povacrylex (Iodine-IPA). CO2 was infused via the smoke evacuation pencil at flow rates from 0 to 8L/min. The presence of a flame was determined visually and confirmed with a thermal camera (FLIR Systems, Boston, MA). Carbon dioxide eliminated fire formation at a flow rate of 1 L/min with CHG-IPA skin prep (0% vs. 60% with no CO2, p < 0.0001). Carbon dioxide reduced fire formation at 1L/min (25% vs. 47% with no CO2, p = 0.1) with Iodine-IPA skin prep and fires were eliminated at 2L/min of flow with Iodine-IPA skin prep (p < 0.0001). Carbon dioxide can eliminate surgical fires caused by energy devices in the presence of alcohol-based skin preps. Future studies should determine the optimal technique and flow rate of carbon dioxide in these settings.

Simulation training results in improvement of the management of operating room fires-A single-blinded randomized controlled trial.

Operating room (OR) fires are a preventable danger. Our aim is to examine the effectiveness of OR fire simulation scenarios as a supplement to classroom-based training for managing OR fires. Eighty-two participants were randomly divided into 14 groups. Eight groups (Group S) participated in two simulations: one prior to the classroom-based fire training and another after the classroom. Six groups (Group D) participated in the identical classroom training, but only one simulation, which followed the classroom session. Confidence surveys were completed before classroom training and after the final simulation. All simulations were assessed by a blinded evaluator. Competency scores within Group S were significantly higher after the second simulation. Competency scores for Group S were significantly higher than Group D for the final test scenario. Prior to the classroom-based training, confidence scores regarding fire safety-related OR tasks were significantly higher in S group. Simulation training significantly improves both the competency and confidence of medical professionals in managing fires in the OR, with more simulation training showing a greater degree of benefit.

Acquisition of Fire Safety Knowledge and Skills With Virtual Reality Simulation.

Prelicensure nursing students seeking to enter perioperative nursing need preparatory fire safety knowledge and skills training to participate as a member of an operating room (OR) team. This pilot study examined the effectiveness of the Virtual Electrosurgery Skill Trainer (VEST) on OR fire safety skills among prelicensure nursing students. An experimental pretest-posttest design was used in this study. Twenty nursing students were randomized to a control or an intervention group. Knowledge and skills acquisition of OR fire safety were assessed. There were no statistically significant findings in knowledge for either group. Fisher exact test demonstrated significant relationships between the skills performance criteria of following emergency procedures for a fire and demonstrating PASS (pull-aim-squeeze-sweep) technique (P = .001). Academic and hospital educators may consider incorporating virtual reality simulation to teach fire safety education or reinforce general fire safety practices to nursing students and novice nurses.

Operating Room Fires.

Operating room fires are rare but devastating events. Guidelines are available for the prevention and management of surgical fires; however, these recommendations are based on expert opinion and case series. The three components of an operating room fire are present in virtually all surgical procedures: an oxidizer (oxygen, nitrous oxide), an ignition source (i.e., laser, "Bovie"), and a fuel. This review analyzes each fire ingredient to determine the optimal clinical strategy to reduce the risk of fire. Surgical checklists, team training, and the specific management of an operating room fire are also reviewed.

Simulation-Based Communication Training for General Surgery and Obstetrics and Gynecology Residents

There is a critical relationship between team communication and patient safety in the operating room (OR), but limited opportunities are available to help OR trainees develop the communication skills needed to be good team players. The purpose of this study was to evaluate the effectiveness of a simulation-based communication-training program developed for general surgery and obstetrics and gynecology residents. Following a group lecture on diagnostic laparoscopy, 34 residents independently completed a laparoscopy case on a patient simulator followed by a structured debrief that targeted team-based communication skills. Integrated into the case were 2 events (bradycardia and OR fire) that provided additional opportunities for the resident to communicate with his/her team. The mean Likert scale score for 11 post-training survey questions were calculated to determine residents' reaction to the training. Additionally, mean scores of observer ratings of communication performance after the simulation were calculated and analyzed using separate Wilcoxon Sign-Rank tests and kappa statistics. Of the 41 GS and ObGyn residents, 34 (83%) participated in the training. 18 (53%) residents completed the simulation once and 16 (47%) completed it twice. Overall, residents had a positive reaction to the training program (average survey score = 4.56 of 5) and participation in the program improved their ability to use effective communication techniques during the bradycardia and OR fire events (p < 0.05, κ = 0.61). Residents had a positive reaction to the training program and participation in the program improved their ability to use effective communication techniques throughout the procedure.

Abstract QS27: Utilizing Statistical Process Control to Study the Progression of Institutional Situational Awareness Through Anonymous Incident Reporting

PURPOSE: The impetus for widespread focus on patient safety reached its apex in the early 1990s when the Institute of Medicine sent shockwaves with their report, To Err is Human. They estimated nearly 100,000 deaths occurred from preventable medical errors every year. Bagian and colleagues took the lessons learned from industries such as aviation and introduced them to healthcare. As a result, anonymous incident reporting (AIR) was implemented in Healthcare to foster a culture of safety. Pioneers like Sutcliffe and Singh took this a step further by studying factors like situational awareness (SA) and its role in creating High Reliability Organizations (HRO). The purpose of this project is to determine if the application of statistical process control (SPC) can be applied to anonymous incident reporting to study institutional situational awareness. METHODS: Our institution’s AIR protocol begins with any employee filing an anonymous online safety report. This report is assessed and directed to the appropriate manager by patient safety officers. An action aimed at systemic safety improvement is undertaken, and the feedback is shared at workgroup meetings. The Veterans Administration National Center for Patient Safety (NCPS) maintains a database of all AIR reports. All AIR reports from our institution from December 2012 to October 2016 were collected and trended. Critical events were tracked utilizing VASQIP’s Critical Incident Tracking Notification System (CITNs). VASQIP defines CITNs as: death in operating room (OR), death from hemorrhage within 24hours, incorrect surgery, retained surgical item, OR fire, and OR burn. Data was evaluated by month and by quarter for percent change and compared to observed critical events (CITNs). Events were trended as a statistical process control (SPC) chart and a logarithmic regression was performed for progression of AIRs per month. RESULTS: There was an exponential increase in total AIRs (1st mo-1, 6th mo-6, 12th mo-706, 18th mo-914, 24th mo-1156). The reporting rate peaked at 9 months (1425% increase from prior quarter). In contrast, the highest number of CITNs were observed early and significantly decreased over time (1st year-5, 2nd year-2, 3rd year-1, 4th year-1). The course of our AIR program began slowly, but as feedback to reporters increased, reporting and situational awareness increased exponentially. This result demonstrates the fruits of a successful AIR program in establishing situational awareness. CONCLUSIONS: SPC analysis can be applied to anonymous incident reporting to study the progression of institutional situational awareness. Application of our model can give other institutions a method to evaluate not only their AIR program but also their situational awareness. S. Kurapati: None. T. King: None.

Operating Room Fires in Oculoplastic Surgery.

This study was performed to characterize the frequency, causes, and possible risk factors of operating room (OR) fires experienced by members of the American Society of Ophthalmic Plastic and Reconstructive Surgery. An online questionnaire was distributed to American Society of Ophthalmic Plastic and Reconstructive Surgery members, collecting data on surgical fires experienced by respondents throughout their careers. In addition, the questionnaire investigated viewpoints on OR fire safety, current practice patterns with oxygen delivery and surgical device usage, and management of patients referred after previous surgical fire exposure. There were 258 participants in the survey. Eighty-three surgeons (32.2%) experienced at least 1 surgical fire in their careers. Most OR fires occurred during monitored sedation cases with oxygen delivered by nasal cannula underneath drapes completely covering the head and use of a monopolar or battery-operated device. Patient hair and skin were the most common fuel sources, and most of the injuries were limited to singing of facial hair. Regarding current practice patterns, monopolar, bipolar, and battery-powered disposable devices were the most frequently used electrosurgery and electrocautery tools. Patients seen after an OR fire with another surgeon generally experienced more severe burns requiring hospitalization and subsequent procedures. Many oculoplastic surgeons have experienced OR fires during their careers. Certain surgical and anesthetic techniques, particularly the delivery of supplemental oxygen underneath surgical drapes and the use of monopolar electrosurgery and battery-powered electrocautery, may be associated with increased fire risk. While most of the reported OR fires did not result in significant patient injury, caution must be taken to prevent these potentially devastating events.

The safe use of surgical energy devices by surgeons may be overestimated.

Surgical energy injuries are an underappreciated phenomenon. Improper use of surgical energy or poor attention to patient safety can result in operating room fires, tissue injuries, and interferences with other electronic devices, while rare complications can be devastatingly severe. Despite this, there is no current standard requirement for educating surgeons on the safe use of energy-based devices or evaluation of electrosurgery (ES) education in residency training, credentialing, or practice. The study aimed to assess the current baseline knowledge of surgeons and surgical trainees with regards to ES across varying experiences at a tertiary level care center. Surgeons and surgical trainees from seven surgical specialties (General Surgery, Cardiothoracic Surgery, Vascular Surgery, Obstetrics/Gynecology, Orthopedic Surgery, Urology, and Otorhinolaryngology) at a tertiary level care hospital were tested. Testing included an evaluation regarding their background training and experiences with ES-related adverse events and a 15 multiple-choice-question exam testing critical knowledge of ES. A total of 134 surveys were sent out with 72 responses (53.7%). The mean quiz score was 51.5 ± 15.5% (passing score was 80%). Of staff surgeons, 33/65 (50.8%) completed the survey with mean and median scores of 54.9 and 53.3%, respectively (range 33.3-86.7%). Of surgical trainees, 39/69 (56.5%) completed the survey with mean and median scores of 48.6 and 46.7%, respectively (range 13.3-80.0%). There were no statistically significant differences based on training status (p = 0.08), previous training (p = 0.24), number of cases (p = 0.06), or specialty (p = 0.689). Surgeons and surgical trainees both have a significant knowledge gap in the safe and effective use of surgical energy devices, regardless of surgical specialty and despite what they feel was adequate training. The knowledge gap is not improved with experience. A formal surgical energy education program should be a requirement for residency training or credentialing.

Immersive virtual reality-based training improves response in a simulated operating room fire scenario.

SAGES FUSE curriculum provides didactic knowledge on OR fire prevention. The objective of this study is to evaluate the impact of an immersive virtual reality (VR)-based OR fire training simulation system in combination with FUSE didactics. The study compared a control with a simulation group. After a pre-test questionnaire that assessed the baseline knowledge, both groups were given didactic material that consists of a 10-min presentation and reading materials about precautions and stopping an OR fire from the FUSE manual. The simulation group practiced on the OR fire simulation for one session that consisted of five trials within a week from the pre-test. One week later, both groups were reassessed using a questionnaire. A week after the post-test both groups also participated in a simulated OR fire scenario while their performance was videotaped for assessment. A total of 20 subjects (ten per group) participated in this IRB approved study. Median test scores for the control group increased from 5.5 to 9.00 (p = 0.011) and for the simulation group it increased from 5.0 to 8.5 (p = 0.005). Both groups started at the same baseline (pre-test, p = 0.529) and reached similar level in cognitive knowledge (post-test, p = 0.853). However, when tested in the mock OR fire scenario, 70% of the simulation group subjects were able to perform the correct sequence of steps in extinguishing the simulated fire whereas only 20% subjects in the control group were able to do so (p = 0.003). The simulation group was better than control group in correctly identifying the oxidizer (p = 0.03) and ignition source (p = 0.014). Interactive VR-based hands-on training was found to be a relatively inexpensive and effective mode for teaching OR fire prevention and management scenarios.