DANGER! DANGER! OXYGEN!OXYGEN!

The “Oxygen Triangle” is well known. The “Oxygen Triangle” is well known. What is forgotten is that in a high oxygen What is forgotten is that in a high oxygen concentration, almost anything can be the concentration, almost anything can be the fuel, and trivial heat or a spark can start a fuel, and trivial heat or a spark can start a fierce firefierce fire..

Danger! Oxygen!Danger! Oxygen!A fire occurred in the ICU at Royal United Hospitals, Bath, in 2012.

A CD oxygen cylinder was palce don the bed of a ptaoent about to be transferred out. Just after it was turned on, a jet of flame came out of the cylinder, and set fire to the bed, the floor and and the curtains.

All twelve patients in the unit had to be evacuated, several members of staff had smoke inhataion injury and the patient was badly burnt.

These pictures show the unit , the cylinder and the patient’s mattress afetrwards.

The cause is not known, but the AAGBI and the RCoA have issued Guidelines on the use of oxygen cylinders. Rescue Units should consider these, in particular about opening a new cylinder.

Danger! Oxygen!Danger! Oxygen!

The Apollo The Apollo One One capsule, capsule,

Even rocket scientists have forgotten this.

The capsule was filled with 100% O2, so that the pressure could be reduced to only 5psi (higher than Everest in flight).

Danger! Oxygen!Danger! Oxygen!Apollo One, Apollo One, after.after.

At a ‘dry-run’ At a ‘dry-run’ launch test, with launch test, with no fuel on board, no fuel on board, a fire started in a fire started in the capsule..the capsule..

Nylon, Velcro, Nylon, Velcro, even plastic wire even plastic wire insulation burtnt insulation burtnt fiercely in a pure fiercely in a pure oxygen oxygen atmosphere.atmosphere.

All three All three astronauts were astronauts were dead in thirty dead in thirty secondsseconds

Danger! Oxygen!Danger! Oxygen!

Article in Anaesthesia News: Article in Anaesthesia News: http://www.aagbi.org/sites/default/files/April_ANews_Web_0.http://www.aagbi.org/sites/default/files/April_ANews_Web_0.pdfpdf

Guidelines from Safe Anaesthesia Liasion Group:Guidelines from Safe Anaesthesia Liasion Group:

http://www.rcoa.ac.uk/system/files/SALG-FIRE-SAFETY_0.http://www.rcoa.ac.uk/system/files/SALG-FIRE-SAFETY_0.pdfpdf

Letter in Letter in Anaesthesia Anaesthesia :: http://onlinelibrary.wiley.com/doi/10.1111/anae.12089/http://onlinelibrary.wiley.com/doi/10.1111/anae.12089/pdfpdf

andand

Editorial in same issue: Editorial in same issue: http://onlinelibrary.wiley.com/doi/10.1111/anae.12088/fullhttp://onlinelibrary.wiley.com/doi/10.1111/anae.12088/full

Danger! Oxygen!Danger! Oxygen!Oxygen cylinder handlingOxygen cylinder handling

Guidelines on oxygen cylinder handling from AAGBI and RCoAGuidelines on oxygen cylinder handling from AAGBI and RCoA

1.1. Set up the cylinder for patient use before placing it close to the patient. Set up the cylinder for patient use before placing it close to the patient. The most likely time for an ignition to occur is either when the valve is initially turned on or when a flow The most likely time for an ignition to occur is either when the valve is initially turned on or when a flow is selected. Hence the advice is to:is selected. Hence the advice is to:

a) connect the tubing and oxygen delivery device to the cylinder;a) connect the tubing and oxygen delivery device to the cylinder; b) slowly open the cylinder valve;b) slowly open the cylinder valve; c) select the prescribed flow rate;c) select the prescribed flow rate; d) if required, check the gas is flowing;d) if required, check the gas is flowing; f) fit the oxygen delivery device to the patient.f) fit the oxygen delivery device to the patient.

2. Place the cylinder in an appropriately designed holder. 2. Place the cylinder in an appropriately designed holder. Where possible, cylinders should be placed in holders designed to be fitted, ideally, to the bottom of the Where possible, cylinders should be placed in holders designed to be fitted, ideally, to the bottom of the

bed (or to the back of wheelchairs). The position of the holder needs to take account of how close the bed (or to the back of wheelchairs). The position of the holder needs to take account of how close the cylinder is to the patient. The holder should ideally keep the cylinder upright so that if there is an cylinder is to the patient. The holder should ideally keep the cylinder upright so that if there is an ignition its impact would be minimised.ignition its impact would be minimised.

3. Avoid placing the cylinder on the bed next to the patient3. Avoid placing the cylinder on the bed next to the patientUse extra care when there is no option but to place the cylinder on the bed. There are times when there is Use extra care when there is no option but to place the cylinder on the bed. There are times when there is

no option but to place the cylinder on the bed or stretcher. If this is the only option, setting up and no option but to place the cylinder on the bed or stretcher. If this is the only option, setting up and turning on the cylinder before putting the cylinder on to the bed will minimise the potential risk of injury turning on the cylinder before putting the cylinder on to the bed will minimise the potential risk of injury to the patient to the patient