A three-stage conceptual framework for post-fire recovery in operating rooms: an evidence-informed opinion based on clinical experience and international guidelines

Operating-room fires, though rare, present unique risks to patient safety, staff health, and institutional resilience. Korean regulations (Medical Service Act, Framework Act on Fire Services, and Occupational Safety and Health Act) emphasize fire prevention and immediate response but lack systematic guidance for post-fire recovery, leading to inconsistent practices, delays in recovery, and compromises in safety. This article proposes a structured, evidence-informed conceptual framework for post-fire recovery in operating rooms. The framework was developed through the integration of relevant international guidelines, toxicological and indoor air quality literature, and clinical experience. The model integrates environmental and surface-contamination assessments; heating, ventilation, and air conditioning (HVAC) and negative-pressure remediation; phased personal protective equipment (PPE) deployment; and considerations for healthcare personnel safety. The proposed framework comprises a three-stage recovery model stratified by fire severity: Stage 1 (minor fire) focuses on rapid assessment of core air quality parameters and basic safety confirmation; Stage 2 (moderate fire) expands assessment to include volatile organic compounds, formaldehyde, hydrogen cyanide, and polycyclic aromatic hydrocarbons, with continuous monitoring and environmental verification before reoccupation; Stage 3 (severe fire) requires laboratory-grade analysis, additional monitoring of asbestos and persistent pollutants, and strict criteria for reoccupation. Complementary protocols address surface-contamination assessment, HVAC remediation, and staged PPE-supported deployment, with additional considerations for healthcare personnel safety and well-being. In summary, we present a conceptual reference to support clinical judgment and interdisciplinary coordination following operating-room fires, informed by the Korean regulatory context but applicable to other healthcare systems in settings with limited post-fire recovery guidance.