Technical Information Sheet

Transcription

1 Technical Information Sheet TIS No 14: 2007 Safety Precautions and Risk Management When Dealing With Domiciliary Oxygen Incidents TIS No 14 British Compressed Gases Association Page 1 of 21

2 CONTENTS 1. Introduction 2. Scope 3. Purpose 4. Definitions / Description 5. Assessment of relevant risks and hazards 5.1 Emergency Services Notification 6. Risks and Associated Precautions 6.1 Uncontrolled Release of Energy from Medical Oxygen Cylinders and Containers Involved in Fires Compressed Oxygen Cylinder Supplies Liquid Oxygen Container Supplies Concentrator Supplies 6.2 Fire Risks Associated with the Release of Stored Oxygen 6.3 Risks Associated with Oxygen Enrichment 6.4 Risks Associated with Handling Cryogenic Liquids 7 General Advice to be given to Patients of Actions to be taken in the Event of an Incident 8 Emergency Services Recommendations (at the time of an incident) 8.1 Cylinder Supplies Fire 8.2 Liquid Oxygen Container Supplies Fire 8.3 Oxygen Major Leak or Spillage Oxygen Enrichment 8.4 Personal Protective Equipment 9 Recommended Course of Actions after an Incident 10 References 11 Typical Oxygen Therapy Equipment TIS No 14 British Compressed Gases Association Page 2 of 21

3 SAFETY PRECAUTIONS AND RISK MANAGEMENT WHEN DEALING WITH DOMICILIARY OXYGEN INCIDENTS 1 Introduction Thousands of patients suffering from respiratory diseases receive oxygen therapy at home in order to maintain their quality of life and to allow them to have mobility and to spend time with their family and friends at home. As a consequence, the presence of oxygen at home is relatively common. The homecare oxygen therapy service is well regulated in the UK and Ireland. The MHRA have carried out a risk assessment of oxygen therapy at home, which was used as the basis for their technical recommendations in their Homecare documents. This risk assessment utilised documents prepared by EIGA and a copy of the MHRA Homecare Risk Assessment is available on the NHS PaSA website The Medical Oxygen Homecare Service Provider provides a full service to the patients, by either delivering gaseous or liquid oxygen to the patient s home or by installing oxygen concentrators. It also carries out the preventative maintenance and repair of the equipment and is responsible for the replacement of consumables. The Medical Oxygen Homecare Service Provider is also responsible for training the patient / carer in the safe operation of the equipment and in the requirements for maintaining the equipment in a suitable condition. Specific advice is also given to the patient on how to deal with their oxygen supplies in the home should an incident occur. Many of the incidents are related to patients smoking whilst using their oxygen. All the training and advice is described in patient manuals and procedures, together with the appropriate warning labels and the provision of a 24/7 emergency telephone number for assistance. The volumes of oxygen stored in private homes for medical use are extremely low, compared to oxygen stored in industrial or medical healthcare facilities. A patient is likely to have either only one liquid base unit and portable vessel or a small number of portable cylinders which will be stored in the home. Oxygen, when managed in accordance with the appropriate procedures, is safe. 2 Scope This document covers the supply of medical oxygen for homecare use which is provided to patients in their home or in the healthcare facility. This includes oxygen supplied from cylinders, cryogenic containers or oxygen concentrators. TIS No 14 British Compressed Gases Association Page 3 of 21

4 It provides advice to the Medical Oxygen Homecare Service providers as well as the Emergency Services on how to treat incidents in the patient s home or healthcare facilities involving domiciliary oxygen. Such incidents can include : Oxygen enrichment Liquid oxygen spillage House fires This document excludes advice on dealing with medical oxygen incidents outside the home. Specific advice on this requirement can be found in the EIGA document IGC89/02 (available from EIGA website). 3 Purpose This document provides guidance to the Medical Oxygen Homecare Service Provider supplying oxygen to either Healthcare Service facilities or to patients at home and to the Emergency Services (predominantly the Fire Service but also to the Ambulance Service) to assist in the preparation of their own procedures related to dealing with domiciliary oxygen incidents. These procedures are:- Identify the safety issues related to the three modes of supply of medical oxygen. Provide recommended safety precautions. Recommend the course of action to be taken following a domiciliary oxygen incident. 4 Definitions / Description MHRA EIGA NHS PaSA Homecare Domiciliary Oxygen Patient Carer Medicines and Healthcare Products Regulatory Agency. European Industrial Gases Association. National Health Service Purchasing and Supply Agency. A patient, primarily treated in their own home, suffering from a respiratory disease / complaint that requires additional oxygen to be provided to maintain their oxygen blood levels. A person who has the responsibility for looking after or supporting a Homecare Domiciliary Oxygen Patient TIS No 14 British Compressed Gases Association Page 4 of 21

5 Medical Oxygen Homecare Service Provider Healthcare Facility Domiciliary Oxygen Supply - Cylinders An organisation / company that provides the medical oxygen and the medical oxygen equipment for treating patients either in their home or supplied direct to the Healthcare Facility treating the patient. An organisation / company, such as a nursing home, that provides medical oxygen therapy to the patient on their premises, where they are responsible for the care of the patient. Conventional Medical Oxygen cylinders are either manufactured from high tensile steel or aluminium alloy. Composite cylinders, used where patients require mobility, are manufactured from high tensile steel or aluminium alloy and are hoop or fully wrapped with carbon, glass or aramide fibres, to provide high strength at a lower weight. Medical Oxygen cylinders can either be fitted with a standard cylinder valve, that requires the use of an additional regulator to reduce the pressure to the required level, or with an integral cylinder valve that has a built-in pressure regulator. (Note: the MHRA has taken a policy decision to move to integrated cylinder valves and away from the use of separate pressure regulators for oxygen home therapy). The typical size of the cylinders supplied for static use is 10-litre water capacity (700 mm x 140 mm diameter). The typical size of the cylinders supplied for ambulatory use is 2 litres water capacity (500 mm x 100mm diameter). The oxygen gas is compressed in the cylinder at pressures up to 300 bar (dependant on the cylinder design). TIS No 14 British Compressed Gases Association Page 5 of 21

6 Domiciliary Oxygen Supply Liquid Medical liquid oxygen systems comprise a base unit and, where ambulatory oxygen is required, a portable unit. These portable units are designed to allow the patient to refill them from the larger base unit. Liquid oxygen is a liquefied gas and will evaporate quickly when spilt. Liquid containers are constructed from stainless steel and utilise a super-insulated double skinned vessel. Cryogenic liquid oxygen is stored at a low temperature and pressure and is vaporised to a gas using an internal ambient vaporiser. The vessel is fitted with two pressure relief devices. The liquid containers are designed to supply gaseous oxygen to the patient at 2 bar maximum. The typical size of the base unit is 800mm x 350mm diameter and is designed to hold up to 50 litres of liquid oxygen. The typical size of the portable unit is 350mm x 130mm diameter and is designed to hold up to 1 litre of liquid oxygen. Domiciliary Oxygen Supply - Concentrators Domiciliary Oxygen Administration Equipment Oxygen concentrators are electrically powered medical devices designed to produce oxygenenriched air. They produce a continuous flow of oxygen-enriched air, up to 8 litres per minute by separating the oxygen and nitrogen in air by passing it through a molecular sieve. This method of supply produces approximately 93% oxygen. The concentrator has no means of storing oxygen. It is normal to have at least one back up 10-litre cylinder available as a means of reserve in the event of failure of the machine or the electricity supply. The oxygen from the supply source is administered to the patient at ambient pressure via 6mm PVC oxygen tubing fitted either with a nasal cannula or a facemask. The flow of oxygen is controlled at the prescribed flow rate to the patient, typically between 2 and 4 litres per minute. Fire breaks can be fitted into the oxygen delivery tubing to shut off the supply of oxygen in the rare event of the tubing catching fire. Oxygen conserving devices can also be used to control the supply of oxygen to the patient when inhaling. They prevent the flow of oxygen through the tubing when the patient is exhaling and when the breathing system is not in use. TIS No 14 British Compressed Gases Association Page 6 of 21

7 5 Assessment of relevant risks and hazards Hazards The basic hazards associated with oxygen supplies are that it is an oxidising agent and that materials will burn at a more vigorous rate in concentrations above that in ambient air. The hazards associated with the use of oxygen from concentrators, cylinders or liquid vessels in the treatment of patients include: Fires in the home (not caused by the oxygen being used Fires caused by inappropriate use of the product (such as smoking whilst using oxygen) Propagation of the fire along the tubing (should the hose be ignited Enrichment of clothing and soft furnishing type material caused by letting the oxygen flow when not in use Electrical connection to the concentrator There are some additional hazards associated with the storage of oxygen which include: Compressed Oxygen The stored energy of the gas The volume of the gas stored in the cylinder(s) Liquid Oxygen Spillage of the liquid oxygen The extremely low temperature of the liquid, The cold gas being heavier than air The volume of the gas stored in the liquid oxygen container(s). one volume of liquid oxygen converts to 860 volumes of gas Risks The basic risks associated with the use of oxygen in the home and the healthcare facility are: When the oxygen equipment is engulfed in the fire, this may lead to: The uncontrolled release of stored energy due to rupture of the cylinder The uncontrolled release of oxygen from the equipment which will lead to the acceleration of the fire Localised vigorous fire caused by oxygen coming into contact with hydrocarbon rich materials. TIS No 14 British Compressed Gases Association Page 7 of 21

8 Oxygen enrichment of the local atmosphere Oxygen saturation of absorbent materials, such as clothing and soft furnishings Cold burns or embrittlement of materials caused by contact with liquid oxygen Electrical shock from concentrators 5.1 Emergency Services Notification It is recommended that the Medical Oxygen Homecare Service Provider should prepare information regarding the location, number and type of the oxygen equipment within the premises for use in the event of an incident. In the event of any domiciliary oxygen supply system being involved in a fire, the Medical Oxygen Homecare Service Provider should be informed as soon as possible. 6 Risks and Associated Precautions 6.1 Uncontrolled Release of Energy from Medical Oxygen Cylinders and Containers Involved in Fires The patient s premises are assessed by the Medical Oxygen Homecare Service Provider at the initial installation stage and at periodic intervals to ensure that the equipment storage and usage areas are not normally subjected to high temperatures. The patient / carer is trained and assessed to ensure that they are competent to handle and use cylinders safely. They also receive additional operational and safety information concerning the safe use of their medical oxygen equipment Compressed Oxygen Cylinder Supplies A risk associated with high-pressure medical oxygen cylinders is the stored energy in the cylinder that, if released under uncontrolled conditions (especially when venting or rupturing from the heat of the fire), could lead to serious personal injury and damage to the property. The mitigating factors for the risks associated with high pressure cylinders are : Cylinders are designed and manufactured to EN and/or ISO standards and design codes which have multiple safety factors which ensure that the cylinder will withstand pressures of at least 2.4 times its maximum working pressure at ambient temperatures. Cylinder valves and integrated cylinder valves are designed to EN and/or ISO standards to withstand at least the same pressure as the cylinder to which they are fitted. In the event of the cylinder being subjected to high temperature, the soft seat of the valve spindle may fail and could allow TIS No 14 British Compressed Gases Association Page 8 of 21

9 high pressure gas to be vented. A useful effect of this is that it could reduce the risk of the cylinder rupturing and the subsequent release of the contents into the fire Liquid Oxygen Container Supplies The major risk associated with medical liquid oxygen containers (both base units and portable unit) is the potential volume of gas that can be released through the relief system. This venting of gas could be released into a fire and act as an accelerant to the fire. The mitigating factors for the risks associated with liquid oxygen containers are: Liquid Oxygen containers are designed to EN and/or ISO standards and design codes. The stainless steel inner vessel of the container is fitted with two relief devices, whose venting capacity is designed to relieve pressure from the container in the event of flame engulfment. In addition, the container s double skin also reduces the rate of heat transfer from an external heat source to the product. In the event of the relief devices operating, the gas will be vented under controlled conditions but the oxygen vented will add to the intensity of any fire (see 6.2). The patient / carer is trained and assessed by the Medical Oxygen Homecare Service Provider to ensure that they are competent to refill the portable unit in a safe manner Concentrator Supplies There are no stored energy implications with oxygen enriched air concentrator supply systems. Where cylinders are associated with concentrators the risks are the same as in Fire Risks Associated with the Release of Stored Oxygen Where the cylinder is subjected to high temperatures, such as if engulfed in a fire, the pressure of the gas in the cylinder will increase and the material strength of the cylinder will decrease. This may lead ultimately to cylinder failure. This failure will result in a sudden increase of pressure in a confined space and the subsequent release of oxygen will add to the intensity of the fire. Another possible risk associated with cylinders being involved in a fire is the possible fragmentation of the cylinder. TIS No 14 British Compressed Gases Association Page 9 of 21

10 The release of oxygen from a container will result either in the increased intensity of an existing fire or the increased likelihood of a fire starting. The more rapid the release of oxygen, the greater its effect on an existing fire. The mitigating factors for the risks associated with domiciliary oxygen supply systems are : There is only a finite quantity of oxygen stored either in compressed gas cylinders or liquid oxygen containers. A typical 300 bar 10 litre capacity cylinder holds approximately 3000 litres of gas at atmospheric pressure. A 2 litre cylinder can hold up to 600 litres of gas. A 30 litre liquid oxygen container holds approximately 25,000 litres of gas at atmospheric pressure. A 1 litre container holds approximately 860 litres of gas. A concentrator is designed to only supply oxygen continuously at up to 6 litres per minute. The release of oxygen at this rate into an existing fire will have minimal impact on its intensity. 6.3 Risks Associated with Oxygen Enrichment The release of oxygen from a container or concentrator, either during normal use or under extreme conditions, can lead to materials, such as clothing or bedding, becoming enriched with oxygen and making them highly flammable. Once this material has become enriched with oxygen, it is more susceptible to sources of ignition and, when alight, will burn more vigorously. An inadvertent release of oxygen could include the supply being left running whilst not being breathed or the accidental release of oxygen from a cylinder or container by leaving valves open or during the transfilling process if the operation is not carried out correctly. A concentrator supply can lead to a significant increase in the oxygen enrichment of adsorbent materials as it may be left running indefinitely. The mitigating factors for these risks associated with the domiciliary oxygen supply systems are : The limited quantities of oxygen available from the supply sources (see 6.2). The limited flowrates of gas from the delivery systems and the ability of oxygen to mix quickly with ambient air when the room is suitably ventilated Conserving devices, where fitted, will stop the flow of gas when it is not being used by the patient The stability of the liquid oxygen containers to reduce the risk of spillage by tipping over the base unit Fire break(s) fitted to the system will stop the flow of gas in the event of a fire in the delivery tubing TIS No 14 British Compressed Gases Association Page 10 of 21

11 The design of the installation to ensure that the tubing is leak free, any trailing tubing to allow the patient mobility are kept to a minimum length and kept away from absorbent materials where possible Training of the patient/carer to ensure that any oxygen connections are maintained in a clean condition (free from oil and grease) and leak free. Maintenance of the equipment by the Medical Oxygen Homecare Service Provider to ensure that the equipment is maintained in a leak free condition. Training of the patient / carer to keep the oxygen tubing, mask and cannula away from high temperature heat sources and sources of ignition ( especially sources associated with smoking ) and to keep the room suitably ventilated Note : natural ventilation of a room should be sufficient to avoid oxygen enrichment of the air space around the oxygen supply equipment during normal use. 6.4 Risks Associated with Handling Cryogenic Liquids Liquid oxygen is stored as a cryogenic liquid (at around -185 O C) in the Liquid Oxygen container and any spillage or loss of product could lead to: Cold burns Material damage due to embrittlement Oxygen enrichment of the local area. Leakage could occur due to the container being toppled over allowing liquid to reach the relief device leading to a liquid spillage, though this is very rare because the base unit is designed for stability and certain portable units can be used normally in horizontal position. Leakage is also possible during the transfilling process if the portable container is not connected correctly to the base unit or if the transfilling valve sticks open due to freezing of the valve. The mitigating factors for these risks associated with domiciliary oxygen supply systems are : The stability of the liquid oxygen containers to reduce the risk of spillage by tipping over the base unit Training of the patient/carer to ensure that transfilling is carried out correctly and condensation is removed from the transfilling connector after it has thawed The patient s premises are assessed by the Medical Oxygen Homecare Service Provider at the initial installation stage and are periodically reviewed to ensure that base container is stored correctly and used in a suitable location. TIS No 14 British Compressed Gases Association Page 11 of 21

12 There are also risks of cold burns from touching sections of the container which are subjected to cryogenic liquid. These issues are mitigated by the design of the containers where shrouds are fitted to prevent accidental contact with any cold surfaces. The safety valves should only relieve gaseous oxygen. If fire fighters (or any other person(s)) clothing is subjected to oxygen enrichment, then they should move into free air to let the oxygen escape from their clothing for a recommended period of 15 minutes. This in itself is not dangerous and only becomes so if they were exposed to a source of ignition. If the container has been heated in a fire, it is recommended that it should be cooled by the application of a water mist, allowing water running down over the outer wall of the unit, where it is safe to do so. This allows the unit to cool indirectly rather than with a water jet being applied directly at it as this may affect the safe operation of any safety devices. If the fire brigade sprays the liquid containers directly with water (as they do with a compressed cylinder) it could freeze and cause the safety valves to stick. This could lead to an increase in the risk of an over pressure failure. Water should not be sprayed over the plastic shroud as the safety valves are installed underneath it. 7 General Advice to be given to Patients of Actions to be taken in the Event of an Incident The Medical Oxygen Homecare Service Provider should provide the patient / carer with training on the appropriate actions to be taken in the event of an incident with their oxygen supply. The training should at least include incidents resulting from the loss of supply, malfunction of the unit or the involvement of the equipment in a fire The likelihood of an incident in the home with medical oxygen is very remote provided: Smoking is strictly prohibited in the vicinity of medical oxygen The equipment is installed correctly The user is adequately trained The user is warned about the potential hazards of using medical oxygen The safety procedures adhered to Where incidents do occur, they are often caused by external events that affect the medical oxygen supply system. The patient / carer should be instructed to contact their Medical Oxygen Homecare Service Provider immediately if they have any doubt about the safety of any situation. TIS No 14 British Compressed Gases Association Page 12 of 21

13 Where the medical oxygen supply system is involved in a fire, the patient / carer shall be instructed to: Initially contact the fire brigade, ensuring they are informed that medical oxygen is in use. Not touch the equipment and to leave the property immediately if there is any doubt about the safety of the situation, Isolate the oxygen supply only when it is safe to do so, before following any other instructions. Where there is a major leak of gas from medical oxygen supply system the patient / carer shall be instructed to: Close the cylinder or liquid vessel valve only if it is safe to do so. Ensure that external windows and doors are opened to ventilate the area. Inform the Medical Oxygen Homecare Service Provider immediately to obtain advice The leak could be caused by a cylinder falling over and the attached pressure regulator sheering off, a large leak developing between the cylinder valve and the regulator or where a liquid oxygen vessels develops a major gas or liquid leak. In the event of a cylinder or liquid vessel falling over, where there is no other apparent damage, the Medical Oxygen Homecare Service Provider should still be notified immediately to allow assessment of possible damage and to obtain advice as to the appropriate actions to be taken. If there is any evidence of the medical oxygen concentrators running hotter than usual, the patient / user should be advised to isolate the equipment at the mains supply and to inform the Medical Oxygen Healthcare Service Provider immediately. Where it is essential for the patient to receive oxygen they should be instructed to use their back-up cylinder supply. In all cases the patient / carer should be advised to contact the Medical Oxygen Healthcare Service Provider whenever they are concerned that any unusual event may have occurred that they believe could lead to a failure of the medical oxygen supply. 8 Emergency Services Recommendations (at the time of an incident) The patient/carer should be advised by the Medical Oxygen Homecare Service Provider that if they need to notify the Emergency Services of a fire or major leak or spillage in the home that they are responsible for informing the Emergency Services that medical oxygen is present. TIS No 14 British Compressed Gases Association Page 13 of 21

14 The Emergency Services should ascertain from the patient/carer: What equipment in the home is affected by the incident and where it is located The condition of equipment (turned on/off etc) The quantity of oxygen in the home Dependant on the type of medical oxygen supply, the Emergency Services should consider the specific actions listed below when dealing with medical oxygen in the patient s residence. The following specific advice on oxygen related accidents at a patient s home can be given to the emergency services attending the scene. It does not cover emergency actions required in cases where people are injured. 8.1 Cylinder Supplies - Fire Having identified where the cylinders are located, if they are not involved in the fire or they are situated in an area that is unaffected by the fire, they should be: Checked to ensure that the all cylinder valves are closed. Moved away from the source of the fire Where the cylinders are situated in a part of the property that is affected by the fire the Emergency Services should: Warn other personnel in the area that medical oxygen is present Review whether local inhabitants should be evacuated to a safe area Cool cylinders by spraying them with water from a safe distance, where practical Review the temperature of cylinders using thermal imaging equipment Inform the Medical Oxygen Homecare Service Provider that cylinders need to be put into a safe condition and removed. 8.2 Liquid Oxygen Container Supplies - Fire Having identified where the liquid oxygen containers are located, if they are not involved in the fire, heat affected or they are situated in an area that is unaffected by the fire, they should be: Checked to ensure that the valves are closed. Moved away from the source of the fire Where the cylinders are situated in a part of the property that is affected by the fire the Emergency Services should: Warn other personnel in the area that medical oxygen is present Review whether local inhabitants should be evacuated to a safe area Cool containers only by the application of a water spray, allowing the water to run down over the outer wall of the container and not over the plastic shroud. This allows the unit to cool indirectly rather than by applying a water jet directly at the container. TIS No 14 British Compressed Gases Association Page 14 of 21

15 8.3 Oxygen Major Leak or Spillage Oxygen Enrichment Where the emergency services have been alerted of a severe leak of oxygen gas, without the implications of a fire, the important issue is to increase the ventilation of the property. This may be achieved by opening doors and windows. Any oxygen enriched materials in the vicinity of an excessive leak of gas, such as curtains and bedding, will be highly flammable. Any sources of ignition should be eliminated from the immediate area until the items have been thoroughly ventilated. Oxygen enriched materials or materials suspected to be oxygen enriched should be allowed to ventilate for at least 30 minutes and clothing for at least 15 minutes. Beds should be stripped of all bedding material, and this should be thoroughly ventilated before re-use. In all circumstances contact the Contact the Medical Oxygen Healthcare Service Provider for additional assistance. In summary: Evacuate all persons from the area. Stay out of the vapour cloud* and immediate surrounding area. Remove any sources of ignition from the room where possible Close cylinder or container valve or concentrator electric supply, if safe to do so Open windows / doors to freely ventilate area Where it is suspected that clothing or furnishings have been saturated in oxygen, either: Remove clothing if being worn or drench with water or Ventilate clothing for 15 minutes and furniture and bedding for 30 minutes * Note: when the oxygen gas is cold (from a liquid supply) the ambient humidity will condense. The condensation is seen as a vapour cloud although oxygen gas itself is invisible. The vapour cloud will only have a higher oxygen concentration immediately around the liquid oxygen supply equipment because oxygen is quickly dispersed and mixed with air to the normal oxygen concentration in air. Therefore you should not assume that the vapour cloud is a dangerous concentration of oxygen and that the clear air around the cloud is at normal ambient air concentrations. TIS No 14 British Compressed Gases Association Page 15 of 21

16 8.4 Personal Protective Equipment Using fire retardant clothing can be useful but many so-called non-flammable textile materials will burn fiercely when enriched with oxygen. Where you believe that your clothing is oxygen enriched either remove the clothing or ventilate it for 15 minutes before returning to the fire Clothing should always be kept free from oil and grease. Specifically when handling liquid oxygen the following personal protective equipment clothing should be worn: Non-absorbent leather gloves, which should be loose-fitting so that they can be removed easily Sleeves should cover the ends of the gloves ensuring no unprotected skin is visible. Goggles or a face mask should be used to protect the eyes and face where spraying or splashing of liquid may occur Overalls or similar type of clothing should be worn, preferably made without open pockets or turn-ups where liquid could collect Trousers should be worn outside boots to reduce the likelihood of liquid collecting in the boots. The F&RS shall decide themselves what is the appropriate level of personal protection equipment to wear when entering an area with oxygen-enriched air. 9 Recommended Course of Actions after an Incident In order to allow an assessment of an accident to take place based on facts, the following actions are recommended: Identify and segregate all the domiciliary oxygen equipment, oxygen cylinders and cryogenic containers. Inform the Medical Oxygen Homecare Service Provider if not already done so. The Medical Oxygen Homecare Service Provider should: Upon release of the domiciliary oxygen equipment, cylinders and containers, collect these and store them as evidence during the investigation phase Obtain all necessary data on the accident, such as timings, accident reports, witness records, location & situation of the fire and the oxygen equipment/containers, etc. Contact the medical device equipment manufacturer to provide them with relevant information. Carry out a root cause analysis (or equivalent) in order to establish cause(s), possible actions for equipment or processes improvement and preventative actions. TIS No 14 British Compressed Gases Association Page 16 of 21

17 10 References MHRA Domiciliary Risk Assessment Available on NHS Purchasing and Supply Agency website stm Medical Gas Pipeline Systems Operational Management NHS HTM 02 BCGA website is The Probability of Fatality in Oxygen Enriched Atmospheres due to Spillage of Liquid Oxygen BCGA TR Managing Gas Cylinders Involved in a Fire BCGA GN15 EIGA website is Safe Use of Medical Oxygen Systems for Supply to Patients with Respiratory Disease. EIGA - IGC Doc. 89/02/E Safe Supply of Transportable Medical Liquid Oxygen Systems by Healthcare Service Providers EIGA - IGC Doc. 98/03/E Design and Operation of Vehicles used in medical oxygen Homecare Services. EIGA - IGC Doc. 128/04/E Fire Hazards of Oxygen and Oxygen Enriched Atmospheres. EIGA - IGC Doc. 04/00/E TIS No 14 British Compressed Gases Association Page 17 of 21

18 11 Typical Oxygen Therapy Equipment Cylinder with separate pressure & flow regulator Cylinder with integrated pressure & flow regulator TIS No 14 British Compressed Gases Association Page 18 of 21

19 Integrated pressure & flow regulator valve TIS No 14 British Compressed Gases Association Page 19 of 21

20 Base unit Portable unit TIS No 14 British Compressed Gases Association Page 20 of 21

21 Concentrator BRITISH COMPRESSED GASES ASSOCIATION 4A Mallard Way Pride Park Derby DE24 8GX Tel: Fax: Website: TIS No 14 British Compressed Gases Association Page 21 of 21