From the August 26, 2004 issue

Sadly, we must report another surgical fire associated with ethyl chloride spray. We last wrote about this in the March issue of the newsletter (WorthRepeating... Extreme caution needed with flammable products, ISMP Medication Safety Alert! March 11, 2004). In this latest case, a physician applied ethyl chloride spray to an area on a girl’s forehead and waited for it to dry. He then turned on the cautery device as he proceeded to drain an abscess. Due to hair loss, the teenager was wearing a flammable synthetic wig, which soon ignited after the heat source was applied to her forehead. The flames were quickly extinguished
but the patient sustained first degree burns to her ear.

As we stated in our March publication, ethyl chloride containers may have poorly visible warnings about flammability. The reporter pointed out that one could clearly read “topical anesthetic skin refrigerant - relieves pain” but easily miss statements about it being flammable because they are set in a small type size. There is an icon on the bottle to indicate that it is flammable, but it looks more like a flower than a flame. Please don’t let this happen again. Take time now to ensure that someone at your location notifies physicians, nurse practitioners, and all other healthcare workers about the dangers of ethyl chloride spray and the potential for burns when these products are used in conjunction with a heat source. Even static discharge may ignite it! Reevaluate the need for flammable products in your facility, as there are often safer alternatives, especially for topical anesthetics. At the least, add an auxiliary label to warn about flammability before these products are dispensed to units.