Respiratory Solutions

Oxygen Transport: The Importance of Safety

• By Justin Schuster
• Apr 01, 2009

In the last century, the medical field has appeared to advance further than any other area of science. While oxygen is of great therapeutic value, it is also highly regulated and can be extremely dangerous if not handled correctly. As with all drugs, the first step is to understand oxygen's intended use, how much is needed and how to take care of it.

The American Society of Mechanical Engineers (ASME) sets the standards for the construction of the vessels in which oxygen is stored. Oxygen is usually stored in one of two ways: under high pressure as a gas or as a cryogenic liquid. Both forms can be dangerous if not handled properly.

High-pressure oxygen in a gaseous state is typically used for those who have been prescribed oxygen for therapeutic purposes. The high-pressure cylinders are small, easy to carry and easy to use. As a result of their size and weight, cylinders are the preferred method of providing portable oxygen to patients. The two main areas of concern when handling cylinders are the content's ability to increase the size and strength of an existing flame and its high pressure. High pressure can be extremely dangerous because cylinders can become projectiles if the exterior is compromised.

The cryogenic liquid form is the most economical choice because it expands as it turns from a liquid to a gas. As a result, less storage space is needed for liquid oxygen, allowing for the transportation of higher volumes of oxygen at one time.

While liquid oxygen may be more economical, providers tend to shy away from using it because of the associated regulations and safety concerns. The three main safety concerns are its stored temperature (-287 degrees) — which causes severe frostbite if it touches skin — its ability to increase a flame's strength and size, and when mixed with oil-based products, its tendency to spontaneously combust.

The transportation, storage and distribution of oxygen are heavily regulated by the Department of Transportation (DOT) as a result of the associated hazards. The DOT requires specially licensed drivers to haul certain measurable volumes of oxygen. Specific markings and paperwork also must be used during transit. The markings, called placards, are used to quickly identify what the vehicle is hauling in case of an accident. The paperwork consists of logs that record how much product is being carried, how much has been distributed from the original manifest and how long the driver has been on the road.

Because oxygen is considered a drug, it also falls under the jurisdiction of the FDA. The FDA regulates the manufacturing and distribution of oxygen and requires manufacturers to log the process. Tracking the manufacturing process ensures that the oxygen is being distributed in its purest form and allows for the product to be located in case of a recall.

In 2000, the FDA created a document — "The Fresh Air Act" — in part, to warn providers of the dangers associated with oxygen. The following is an excerpt from the document:

"A hospital located in Idaho discovered a large cryogenic vessel of industrial-grade nitrogen had been connected by the supply firm's driver to their oxygen system, which supplied the operating rooms, labor and delivery rooms, and the emergency room. The delivery driver was an inadequately trained college student who had failed the firm's driver certification test. When the driver was unable to connect the incompatible nitrogen vessel outlet fitting, he disconnected the nitrogen fitting and replaced it with the appropriate oxygen fitting so that it could be connected to the oxygen system. Unfortunately, two deaths are associated with the administration of the toxic industrial product."

As a driver with a CDL license and Class C endorsement, it was apparent to me from the beginning that driver safety and attention to detail were of the utmost importance. Procedures, such as pre-trip vehicle inspections and frequent roadside tire checks, help to make everyone safe.

My precautionary safety training played a large role in avoiding a potentially serious accident not long ago. While hauling oxygen on a major highway, the person in front of me lost control of his vehicle and turned sideways. Driver training teaches that my traveling speed was dramatically increased because of the oxygen’s weight. Therefore, I was trained to always maintain a safe distance.

Training also teaches that as a placarded driver, I must be aware of my surroundings, keep my radio at low volume, keep my windshield and mirrors clean at all times, and never allow myself to get tired to the point that it may affect my ability to drive safely. As a result of my training, I was able to avoid becoming part of the accident. Instead, I was able to pull over to the side of the road and radio for help.

This article originally appeared in the Respiratory Management April 2009 issue of HME Business.