Filler Christmas 2013: Aggravations

Operating room safety: 10 point plan to safe flinging

BMJ 2013; 347 doi: (Published 17 December 2013) Cite this as: BMJ 2013;347:f7363
  1. Richard L Hutchison, hand surgeon1,
  2. Maureen A Hirthler, emergency medicine physician2
  1. 1Children’s Mercy Hospitals, Orthopaedic Surgery, Kansas City, MO 64108, USA
  2. 2University of Missouri-Kansas City, Kansas City, MO, USA

Working in a hospital operating room is stressful, and stress can lead to adverse events.1 Several factors contribute to a surgeon’s stress, especially equipment malfunction.2 The traditional way for surgeons to deal with flawed surgical instruments is to fling them across the operating suite. This action is expedient, acts to alleviate stress, and follows the safety guidelines for hands-free passing of instruments.

However, we can find no peer reviewed publications to guide safe operative instrument flinging. To help fill this void, we have adapted recommendations from other safety oriented organisations.3 4

The fundamental rules for safe instrument flinging are:

  • 1. “Think first. Fling second.”

  • 2. Before flinging, identify your target and the area beyond it.

  • 3. Aim for the corner farthest from the operative field.

  • 4. Do not fling at a person.

  • 5. Never fling an instrument that is unfamiliar.

  • 6. Never use alcohol or over the counter, prescription, or other drugs before flinging.

  • 7. Be sure you know how to safely close the instrument.

  • 8. Always wear proper eye protection.

  • 9. Be aware that certain instruments require special precautions, such as those tethered by cords or tubing.

  • 10. Never fling an instrument straight up into the air.

We hope that this or a similar policy will be adopted by your hospital, and that following these suggestions will allow you to perform the rapid elimination of faulty instruments in a quick and safe manner.


Cite this as: BMJ 2013;347:f7363


  • Competing interests: We have read and understood the BMJ Group policy on declaration of interests and have no relevant interests to declare.