Approximately 100 operating room fire occur each year in the United States. Although rare, fire in a perioperative setting can be disastrous for both patients and staff members. It is crucial that all perioperative departments have a well thought out and previously rehearsed fire plan in place. Multidisciplinary planning and implementation of regularly scheduled and scripted fire drills are essential to prevent adverse outcomes. Fire drills ensure that all staff members are familiar with the use and location of fire pull stations, fire extinguishers, and fire blankets. Fire drills also prepare staff members to evacuate the OR area if necessary. This article provides the information and framework necessary to develop and implement comprehensive OR fire safety plans that could make the difference between life and death in a fire emergency.