Patient Safety Tip of the Week Archive

Patient Safety Tip of the Week

October 8, 2024

First Responders and MRI

From our very first columns on MRI safety, we’ve always recommended training not only your staff on MRI safety but also training those outsiders, like first responders, who might enter an MRI suite. That includes the need to train police, firemen, prison guards, paramedics, and others who might have need to be at your MRI unit for one reason or another (see our October 24, 2023 Patient Safety Tip of the Week “Serious MRI Accident at Unregulated MRI Center” and our October 21, 2014 Patient Safety Tip of the Week “The Fire Department and Your Hospital”).

A recently filed lawsuit details an incident in which a police officer entered an MRI suite and had his rifle pulled from his hand and sucked into the MRI machine (Black 2024, O’Driscoll 2024, Kiszla 2024). The incident occurred during an October 2023 police raid for suspected illegal cannabis cultivation.

The officers detained the lone female employee while they searched the business, the lawsuit said. However, they didn’t find a single cannabis plant. The officers then released the employee and told her to call a manager, while they continued to wander around various rooms of the facility, according to the lawsuit. At one point, an officer walked into an MRI room, past a sign warning that metal was prohibited inside, with his rifle “dangling… in his right hand, with an unsecured strap,” the lawsuit said. The MRI machine’s magnetic force then allegedly sucked his rifle across the room, pinning it against the machine.

An officer then allegedly pulled a sealed emergency release button labeled, “Caution, Emergency Use Only”'. That action caused the MRI's magnet to "rapidly lose superconductivity, leading to the evaporation of approximately 2,000 liters of helium gas and resulting in extensive damage to the MRI machine." The officer then grabbed his rifle and left the room, leaving behind a magazine filled with bullets on the office floor, according to the lawsuit.

Fortunately, the rifle did not discharge, and no one was injured. But this could have been worse. Our January 2024 What's New in the Patient Safety World “Guns and MRI Don’t Mix” noted cases in which guns discharge during similar incidents, including one with a fatal outcome.

So, whose job is it to educate and train all those first responders or other outsiders who might come to your MRI unit? The answer is that it is the responsibility of both the healthcare facilities and the first responder organizations. If you are the major trauma center in your region or you have a lock-up unit for dealing with prisoners, you may want to do such training yourself. However, since most cities and communities have many MRI units, it makes more sense to use a consortium approach to such training. Your local hospital association might be a good organization to convene such sessions, but non-hospital-owned MRI units need to be included and all need to be involved in developing content for the training.

There are many examples of such training on the internet (just search “MRI safety for first responders”), some with videos and others with slides. Our advice is to go easy on the physics part of any training. You’ll simply lose the attention of many attendees (the only “tesla” they are interested in is one they can drive!). Focus on the “emotional’ elements that will hit home. Show them a picture of a projectile thrust into an MRI bore and tell them about fatalities related to MRI accidents. Don’t forget to tell them about the dangers of hypoxia from a quench. You need to let them know the magnet is on 24 hours a day every day. They need to be shown what areas/zones of the unit they can enter and which they cannot enter without screening and accompaniment by MRI personnel. Of course, you need to educate them about metallic and ferromagnetic items that cannot be taken into the zone with the MRI machine. Make your examples relevant to their jobs. For example, one of the gun incidents might be used for the police and prison guards and one of axes or oxygen cylinders might be used for firefighters and one with a non-MRI-safe gurney for the EMT’s. Don’t forget to include items they may have inside their own bodies (e.g. pacemakers) that might preclude them from entering Zone 4. Stress the need to pay attention to signage and any alarm systems. Let them know about MRI-compatible fire extinguishers and where they are likely to be located.

The outside organizations (police and fire departments, EMS systems, prison systems) need to ensure that anyone they have who might respond to your facility gets the orientation and training (probably with annual updates). That means any new hires or volunteers need to get such orientation and training prior to going into the field.

Rural areas are especially problematic. In some rural areas, the only MRI units are the mobile MRI units that are housed in trailers (see our November 5, 2019 Patient Safety Tip of the Week “A Near-Fatal MRI Incident” for an example of an incident taking place in a mobile MRI unit). Moreover, many of the first responders in rural areas are also volunteers, making ongoing training more difficult. Local, county, and state officials should require a specific training plan before any mobile MRI units are given approval.

Yes, such incidents involving outside personnel are, fortunately, quite rare. But they can, and do, happen. Would your MRI facility be vulnerable to such an incident?

Some of our prior columns on patient safety issues related to MRI:

· February 19, 2008 “MRI Safety”

· March 17, 2009 “More on MRI Safety”

· October 2008 “Preventing Infection in MRI”

· March 2009 “Risk of Burns during MRI Scans from Transdermal Drug Patches”

· January 25, 2011 “Procedural Sedation in Children”

· February 1, 2011 “MRI Safety Audit”

· October 25, 2011 “Renewed Focus on MRI Safety”

· August 2012 “Newest MRI Hazard: Ingested Magnets”

· October 22, 2013 “How Safe Is Your Radiology Suite?”

· October 21, 2014 “The Fire Department and Your Hospital”

· August 25, 2015 “Checklist for Intrahospital Transport”