**6. The fire triangle: focus on education and knowledge**

As discussed earlier in the chapter, the initiation (and propagation) of ORF is dependent on the simultaneous presence of an ignition source (e.g., surgical energy device), fuel (e.g., paper drapes, alcohol-based skin prep), and an oxidizer (e.g., oxygen, nitrous oxide) [22]. **Figure 1** lists common types of items and categories within the "fire triangle" paradigm. Although beyond the scope of the current discussion, it is also important to mention that non-anesthetic causes of ORFs have been reported, including flammable gastrointestinal gases (mentioned earlier in the chapter) [35, 36] and surgical lights [37].

The final component is an oxidizer [38]. Although most people realize that oxygen greatly enhances the rate of combustion, many do not know that nitrous oxide supports combustion in roughly similar manner. Oxidizers reduce the fuel ignition temperature, thus elevating the risk of a fire and its continued propagation [39].
