**5. Operating room fire: true magnitude of the problem**

According to the Emergency Care Research Institute (ECRI), approximately 200–240 surgical fires occur each year in the United States [28]. Other sources provide a much wider range of occurrences, ranging between 100 and 2260 annually [2, 24, 29, 30]. Generally speaking, the incidence of ORF appears to be similar to that of wrong-site surgery or retained surgical items [28], some of the most prominent categories of surgical "never events" [31–33]. As outlined in previous sections, the simultaneous presence of key components required for the ignition of a fire is the single biggest risk determinant (**Table 1** & **Figure 1**). Therefore, it is not surprising that surgical fires involve electrosurgical equipment in approximately 67–90% of all cases, and that supplemental oxygen administration was nearly universally present [2, 34]. Of importance, the operative environment is defined as being "oxygen-enriched" when the oxygen concentration is greater than 21% [17]. Most commonly and not surprisingly, given the previously outlined risk factors, ORFs result in burns to the head, face, neck, and upper chest [22]. Thankfully not all ORFs involve patients, operating room staff, or result in significant injury [2].
