# Oxygen questions



## fire1055 (Jun 5, 2009)

I'm not a totally newbie so don't lambaste me for asking this, haha

I'm a first responder, and in TN we can administer o2 so I have a question about acquiring oxygen.

This question is two part...

Part one, I have three or four of my coworkers that would be candidates to receive o2 in a medical emergency.  My employer has offered to purchase a small o2 bottle and pay to have it filled and serviced. I was told by the local medical supply company that I would need a Dr. approval to have oxygen on site here. Can anybody shed light on this?

Part two, I live a rural community about 5-10 mins from the nearest station that houses a rescue truck with an oxygen bottle. Three times in the past month I have responded to a call in my POV and would have administered oxygen if I had it, I carry NRB and NC in my jump bag. I'm not dumb enough to carry it around in my POV on a regular basis, I would however like to have a small bottle that I could keep inside my house and grab on the way out.
Legally how would I be best to do this, or would I be better off to just try and go get the truck??


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## akflightmedic (Jun 5, 2009)

In regards to Part 1....if your coworkers need oxygen every time there is a medical emergency, you may wish to consider a recruitment drive to get younger, healthier or more fit candidates on the member roster. 

Upon rereading, you are stating that on your real job you have coworkers that would need O2 in an emergency...mea culpa. My question for you is this, doesn't almost everyone require O2 in a medical emergency at the FR or Basic level?

Anyways, here is some valuable information for you. Oxygen is a DRUG. To purchase, carry or administer a drug, you need to have a doctor's prescription. (excluding over the counter meds). Wasn't there a thread about this a few months back?

So yes, you need a doctor to prescribe it and if I am not mistaken (which I often can be), your service should have to have medical control since you are now going to be carrying this drug and administering it to patients.

But to further clarify, I think your service may already have this since you said they have O2 on the truck, you are just wanting to have your own supply to be "quicker" for your coworkers or other calls, correct? Couldn't you coordinate this through your organization? It seems they are already set up to do this, so have you talked to them?

Legally, I would not carry it in my car or store it at my home. I would get the truck or wait for the truck. Why do you carry a nonrebreather and nasal cannula with no oxygen?


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## Scout (Jun 5, 2009)

Ak pretty much sums it up.


But as for your last point ak.if you are on a communal truck, it may be easyer to keep stuff you are likely to use on near every call in a personal bag.


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## VentMedic (Jun 5, 2009)

fire1055 said:


> Part one, I have three or four of my coworkers that would be candidates to receive o2 in a medical emergency. My employer has offered to purchase a small o2 bottle and pay to have it filled and serviced. I was told by the local medical supply company that I would need a Dr. approval to have oxygen on site here. Can anybody shed light on this?


 
Is this place of employment not related to any medical industry or FD?

If not, Emergency O2 access guidelines would apply just as those for the AED in places where the lay person with training can access. Emergency O2 is considered over the counter for work places but it is not meant to be carried around. 

You may need to apply to the state for a permit and a physician may be required to sign your policy and procedure that will be in place. Some use the physician of their occupational health clinic. 

As well, depending on the nature and size of the business, the other employees may need to take an Emergency O2 class for compliance with the regulations. 

The American Red Cross may be able to help you get set up. There are also various companies that will assist with record maintenance, employee training and have a physician who signs the P&P for a significant fee. 

http://www.redcrossnetn.org/index.php?page=workplace-training


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## VentMedic (Jun 5, 2009)

This is the thread we had a discussion about a business having access to emergency O2 and first-aid.

Lifeline represents one of the companies I mentioned that sets everything up for a fee. 

http://www.emtlife.com/showthread.php?t=9965


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## Melbourne MICA (Jun 6, 2009)

*Boom boom*

There are some fire related issues in carriage of O2 as well are there not? Oxygen being a well.....oxydising agent and all.

MM


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## VentMedic (Jun 6, 2009)

Melbourne MICA said:


> There are some fire related issues in carriage of O2 as well are there not? Oxygen being a well.....oxydising agent and all.
> 
> MM


 
We do have home O2 patients driving, flying and sailing with few problems.  But, they do get a decent amount of education about their disease process, O2 usage and safety which will add up to many more "hours of training" than some in EMS.


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## ResTech (Jun 6, 2009)

I have carried a "D" cylinder for many years in my car and used it often on calls I responded to with my volly EMS station.

I always filled my bottle with the O2 cascade system at the station I used to work at so that was never a big deal for me. I have taken it to a local O2 supply company before and they filled it for me knowing I was an EMS provider. 

Its not a bad idea to have... especially in a rural community. I like having it on hand for any family emergency that may arise and for when I take the family camping which is out of cell coverage and 8 miles from the hard road.


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## fire1055 (Jun 10, 2009)

thanks for the info...I'm in works with my med dir to see what I can do.  Oh and I carry NRB and NC in my bag because 1) they were available and free haha and also just incase we need an extra I can provide.  Or if I arrive on scene of a home o2 patient with nc only and they need more I can supply via NRB. But it's mainly because I got them both for free


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## VentMedic (Jun 10, 2009)

fire1055 said:


> they were available and free haha and also just incase we need an extra I can provide. Or if I arrive on scene of a home o2 patient with nc only and they need more I can supply via NRB. But it's mainly because I got them both for free


 
How are they free?    Your employer wants you to carry a NRBM and NC around just in case? 

In homecare, unless a patient has an H tank nearby which isn't always the case anymore, concentrators only go to 5 or 6 L/m.   The little portable tanks may be limited or demand flow and probably will not last very long at 10 L/m and even less if they need 15 L/m.


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## JPINFV (Jun 10, 2009)

If you need an extra it's because someone screwed the pooch when checking out the truck. I've worked in two states now and both states requried 6 NRBs and 6 cannulas for each size on the ambulance. At most, in California I had 2 sources of O2 (1 wall mounted flowmeter, one portable regulator) and in Mass I have 4 (2 wall mounted, 2 portable), so even at an MCI I have more masks and cannulas than I have sources of O2 anyways. 

Be careful with changing devices at home. Most long term care patients will have O2 concentrators and most will only reach 5-6 L/M at maximum flow rate.



edit: ...and Vent sniped me


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## djmedic913 (Jun 10, 2009)

I am not able to answer either part of your question.

I would suggest talking to your squad about permission to carry an O2 bottle in your car and keeping O2 at work.

I know some people have said it is not a good idea to carry O2 in their POV. But in a lot of areas Police cars are now carrying O2. they have an O2 mount mount in the trunk.

Is it a bad idea, I dont think so. But as someone said it is listed as a drug. 

So you need a prescription for drugs not listed as over the counter. But why don't we all need a prescription to breath, since there is O2 all around us...lol...[this last statement was not meant to be mean but an observation on the ridiculousness of medicine in general]


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## ResTech (Jun 10, 2009)

.... kinda like we have water all around us but need a prescription for the same water when its germ free (ie sterile water/saline)... kinda silly to me too.


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## VentMedic (Jun 10, 2009)

djmedic913 said:


> So you need a prescription for drugs not listed as over the counter. But why don't we all need a prescription to breath, since there is O2 all around us...lol...[this last statement was not meant to be mean but an observation on the ridiculousness of medicine in general]


 
ResTech


> .... kinda like we have water all around us but need a prescription for the same water when its germ free (ie sterile water/saline)... kinda silly to me too.


For the use of emergency O2 you do not need a prescription but even LEOs may need a physician to set policy as required in their state to carry the O2 just as health clubs must have. Also, it is a good idea to have a secure area to carry the O2 as well as all the safety standards followed. 

The air we breathe is approximately 21% oxygen. The oxygen carried in a tank for medicinal purposes is 100% O2 or very, very close to that number to qualify for medical O2. Oxygen tanks carried by welders or O2 bars do not meet the requirements to be considered for medical use.


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## Scout (Jun 10, 2009)

Just a curiosity based on that statement. 

BOC the crowd that provide medical o2 for most medical uses advertise Medical 02 as having a lesser purity that welding o2. 99.8% vs 99.9% for welding.

As far as o2 bars, do they use one of the air purifiers or a cylinder system?


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## djmedic913 (Jun 10, 2009)

VentMedic said:


> The air we breathe is approximately 21% oxygen. The oxygen carried in a tank for medicinal purposes is 100% O2 or very, very close to that number to qualify for medical O2.



And we only use 5% of the O2 in the air with each breath. This is why mouth to mask is actually an effective method.


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## VentMedic (Jun 10, 2009)

Scout said:


> As far as o2 bars, do they use one of the air purifiers or a cylinder system?


 
Purity isn't in terms of contamination by stuff that can be filtered out by a regular "filter" but rather how accurate they are in providing as close to the correct mixture of gases as possible 

Definition of United States Pharmacopoeia Oxygen:
UPS oxygen is oxygen gas that meets minimum content requirements set by the United States Pharmacopoeia of 99.0 mole % oxygen, maximum 300 ppm carbon dioxide and maximum 10 ppm carbon monoxide. There are seven different grades of USP gas of A, B, C, D, E, F and G. Each grade will have specific requirements for concentrations of oxygen (none lower than 99.0 mole %), water, methane, nitrogen, ethylene, acetylene, carbon dioxide (non higher than 300 ppm), carbon monoxide (none higher than 10 ppm), total hydrocarbons (as methane) ethane and other hydrocarbons, nitrous oxide, halocarbons and solvents as well as dew point levels.


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## VentMedic (Jun 10, 2009)

djmedic913 said:


> And we only use 5% of the O2 in the air with each breath. This is why mouth to mask is actually an effective method.


 
Now we could get into partial pressures.

If you put a person into a 16% device to simulate high altitiude, that person will notice a difference.  This is how we stress test Flight team members and pulmonary compromised patients for flight or relocation above sea level.   Some high end gyms also were using subambient O2 for athletic training instead of sending their athletes to Colarado.


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## djmedic913 (Jun 10, 2009)

VentMedic said:


> Purity isn't in terms of contamination by stuff that can be filtered out by a regular "filter" but rather how accurate they are in providing as close to the correct mixture of gases as possible
> 
> Definition of United States Pharmacopoeia Oxygen:
> UPS oxygen is oxygen gas that meets minimum content requirements set by the United States Pharmacopoeia of 99.0 mole % oxygen, maximum 300 ppm carbon dioxide and maximum 10 ppm carbon monoxide. There are seven different grades of USP gas of A, B, C, D, E, F and G. Each grade will have specific requirements for concentrations of oxygen (none lower than 99.0 mole %), water, methane, nitrogen, ethylene, acetylene, carbon dioxide (non higher than 300 ppm), carbon monoxide (none higher than 10 ppm), total hydrocarbons (as methane) ethane and other hydrocarbons, nitrous oxide, halocarbons and solvents as well as dew point levels.



That is kind of messed up. It is like knowing the FDA allows a certain amount of bugs and rat droppings in pre-packaged foods...


But seriously thank you for the info...I never knew that


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## JPINFV (Jun 10, 2009)

Congratulations, the world isn't perfect. 10 ppm of CO or 300 ppm of CO2 isn't exactly the same as contaminated food.


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## VentMedic (Jun 10, 2009)

A brief overview of oxygen:

http://www.ccmtutorials.com/rs/oxygen/index.htm


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## fire1055 (Jun 10, 2009)

I have certain connections...and I don't carry NRBs for my employer this is just my personal kit that I carry in the field


background...

I work for a small newspaper, I volly in my County Fire/Rescue Squad in my rural community.

Depending on where our medic unit is coming from it can but up to 20 minutes to arrival.


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## VentMedic (Jun 10, 2009)

fire1055 said:


> I have certain connections...and I don't carry NRBs for my employer this is just my personal kit that I carry in the field


 
Hopefully your connections are legal and a receipt can be produced. Even taking these devices from a hospital without some type accountability causes someone to pay for them as well as the loss of trust in the person supply who may be supplying them.


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## fire1055 (Jun 12, 2009)

thanks for the help guys, and my hook-up is very legit, I'd never do anything that would risk somebody their job


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## Porky1 (Jun 12, 2009)

*Oxygen*

In TN to function as a first responder you must be affiliated in some way with the local ambulance service. Hook up with them, get them to supply you with oxygen and your questions are solved. On the other hand without that affiliation you may not be able to get oxygen. Does your company have a first aid station? If so, your employer can get oxygen via the local oxygen supply company.


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## enjoynz (Jun 12, 2009)

VentMedic said:


> A brief overview of oxygen:
> 
> http://www.ccmtutorials.com/rs/oxygen/index.htm



Thanks for the heads up on this site Vent.
I remember some time back being given stick about delivery of O2
amounts, as NZ pulled back the LPM we were giving.
Folks from the States were saying that O2 is safe and it doesn't matter what amounts given to the patient.
This site proves there can be issues with the amounts give and why O2 can be toxic.
Guess it shows the old saying is right...'Too much of a good think, can be bad for you!'

Cheers Enjoynz


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## VentMedic (Jun 12, 2009)

enjoynz said:


> Thanks for the heads up on this site Vent.
> I remember some time back being given stick about delivery of O2
> amounts, as NZ pulled back the LPM we were giving.
> Folks from the States were saying that O2 is safe and it doesn't matter what amounts given to the patient.
> ...


 
We often refer to an oxygen clock when talking about toxicity. In the ICU we have protocols for getting a patient off that clock as quickly as we can but it may take every gadget and gas some of the best hospitals have access to and then it may still not be possible. As well, another protocol such as the one for sepsis may trump the other for the first few hours. 

Recently during another thread:
http://www.emtlife.com/showthread.php?t=13026&page=2

a short discussion of CO poisoning came up where another forum member saw no harm in not putting someone who had the probability of being exposed to CO. For this I would rather error on the side of caution since the O2 with only be on long enough to get COHb confirmation and if negative, it can be removed. If there was CO present, the O2 has started reducing its half life and that may result in less time on the O2 clock. However, if treatment was delay because "the SpO2 was 100%" coupled with a bad attitude from the EMS provider, organs may also suffer the affects of the CO longer. 

Dive medicine is also a fascinating specialty as is HBO.


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## medicdan (Jun 12, 2009)

VentMedic said:


> Dive medicine is also a fascinating specialty as is HBO.




Indeed!! I am a Rescue Diver, and trained (not certified) HBO operator. I love learning about the physiology and effects of pressure on human physiology. I actually had minor DCS (Decompression sickness/"The Bends") a few years ago, and took the opportunity (and some of my time in a chamber) to learn about it. 

The effects and uses of HBO (Hyperbaric Oxygen) therapy are really interesting-- everything from diving injuries, to air gas emboli, to wound care, red blood cell production, carbon monoxide poisoning, and the list continues. Really very cool therapy (and not such advanced technology).


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## wolverine (Jun 19, 2009)

Ak-Medic quick question I know of plenty EMT's in jersey who carry an O2 canister&a small jump bag in the trunk of their car. To me they are just idiots who are setting themselves for a lawsuit i.e. pulling over on an accident&trying to render aid when they have no experience or an idea what they doing i am wondering what is your objection


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