fire safety valve for oxygen in stock

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The Sunset Healthcare OxySafe Firesafe Cannula Valve Helps protect against oxygen tubing fires using a thermal fuse designed to stop the flow of gas in the event that the downstream oxygen tubing is ignited. Thereby, the product helps to improve patient safety by tremendously reducing the impact of oxygen-aided fires with the Firesafe Cannula Valve.

Install two OxySafe valves per patient, one as close to the patient as possible and one as close to the oxygen source as possible. This way, both the patient and the source of oxygen are protected, minimizing risk of a disastrous fire. When installing the OxySafe close to the patient, we recommend using a cannula without a built-in supply tube so the valve can be as close to the patient as possible.

The Firesafe™ MKII Cannula Valve acts like a thermal fuse protecting both patient and oxygen source from propagating fire. To prevent incorrect installation, the valve is bi-directional, allowing it to be fitted in either direction.

With the increasedsupply ofoxygen cylinders worldwide due to the COVID-19 pandemic,more people than ever are handling and storing oxygen cylinders. While oxygen is usedfor first aid and medical assistance, it is also essential for an array of applications includinglaboratory tasks,welding and cutting,food preservation and packaging, water treatment, chemical productionand steel works.However, it’s important to remember thatoxygen is a very reactive gas andhas the potential tocause or intensify fires when in contact with incompatible substances or heat.Here, we outline the risks involved with using oxygen cylinders and discusshow you cansafely storeO2cylindersin the workplace.

Oxygen cylinders are vessels that contain oxygen under pressure. When the cylinder is depleted of the gas, the pressure gauge will gradually fall off. While oxygen is classified as a Class 2.2 (5.1) non-flammable, oxidizing gas, cylinders can cause serious injury and damage if they are not handled and stored correctly.

As the air we breathe contains around 21% oxygen, even a small increase to the oxygen levels in an environment can be enough to create a potential hazard.

Oxygen enrichment is the term used when extra oxygen is leaked into the atmosphere. In an oxygen rich environment, there is the increased potential for fires to occur as the extra oxygen allows fires to ignite easier and burn hotter. It also creates a situation where fires are almost impossible to put out.

Workers are extremely vulnerable in an oxygen enriched atmosphere, with the potential for hair and clothing to easily catch fire and cause 2ndand 3rddegree burns — which are often fatal.

As outlined in the previous section, oxygen gas leakspose a very realthreat to workers and their work environment. A leaking gas cylindercanrapidlycreate apotentiallydangerousoxygen enriched environment, especially in confined spaces and rooms with poor ventilation.

The mishandling and lack of maintenance for oxygen cylinders can cause an oxygen leak. Cylinders and equipment should be inspected regularly for leaks and serviced by qualified staff or contractors.

When materials such as oil, grease, certain metal and plastics come into contact with pure oxygen under pressure, they can react explosively or spontaneously catch on fire.

Workplaces shouldonlyuse materials and components that have been tested and certified safe for use with oxygen gasto avoid the potential for an explosion of fire.

Oxygen cylinders have caused fires, explosions and serious injuries when workers have incorrectly substituted oxygen for compressed air or other gases.Organisations should always ensure that the equipment used in your workplace is specifically designed for oxygen service.

Remember:AS4332-2004 - The storage and handling of gases in cylindersclearly states that gases must only be used for the purpose for which they were intended.

Explosions and catastrophic fires can occur when there is the careless handling of oxygencylindersin the workplace. If staff accidently expose cylinders to heat or drop oxygen cylinders while they work, there is a chance that the bottle will explode. Impact and heat can adversely affect O2cylinders which can cause serious damage to both people and property.

It’s a requirement underAS4332-2004that workers must fully understand the risks and hazards of using oxygen gas in cylinders and be trained in safe handling and storage methods.

To illustrate the dangers associated withhandling and storing oxygen cylinders, we outline just four recent workplace disastersthat have caused irrevocable damage.These real-life examples highlight how crucial it is forworkplacestoproperlymanagetheircompliance and safetyobligations.

While on the road, the acetylene vapour and air mixed and exploded in the back of the vehicle. The gas bottle fire caused extensive damage to the driver, the vehicle and the surrounding environment. A worker was permanently disabled by the explosion, while fire damaged nearby cars and overhead powerlines.

The Indian Expressreported that the exploded cylinder had a technical fault and was not capable of holding the full pressure of the oxygen when it was filled. The cylinder"s intended use was for medical oxygen for a COVID patient.

Oxygen cylinders must be handled with extreme care to avoid risk in the workplace. It is important that O2cylinders are kept on apurpose-built gas bottle trolleywhile they are being used at a workplace.

Keep O2cylinders away from flammables and toxic gases: contacting flammables and incompatible toxic gases can create catastrophic fires, explosions and chemical reactions.

Oxygen cylinders should be stored according to the guidelines ofAS 4332-2004 - The storage and handling of gases in cylinders. Some of the requirements include:

If youuse oxygen and other compressed gases at your worksite, why not download our FREE eBook; Gas cylinder storage: Compliance and safety requirements?This resource will help you learn how tosafely store O2cylindersin the workplaceand give you a broaderunderstanding of how tomanage the risks and hazardsassociated with O2. Thisfree eBookalsointroduces our dangerous goods risk management methodology - IDENTIFY - ASSESS - CONTROL - SUSTAIN which you can implement into your workplace.Get itnow by clicking on the image below.

All of these tragedies shared two commonalities: The fires were caused or suspected of being caused by issues related to oxygen-rich environments, oxygen storage or oxygen ventilation devices, and each disaster occurred during the COVID-19 pandemic — an event that, in most of these examples, exacerbated the fire risks.

“There have actually been dozens of fires in hospitals treating COVID-19 patients around the world since the pandemic began in the spring of last year, and nearly 200 people have died in those blazes,” says Angelo Verzoni, associate editor of NFPA Journal, the membership publication of the Quincy, Mass.-based National Fire Protection Association (NFPA). “For the most part, those incidents have occurred in countries where code compliance is often lacking, and they provide a sobering reminder of the critical importance of implementing and adhering to codes and standards in the health care setting.”

While none of these recent fires have occurred at U.S. hospitals, they have demonstrated that, when it comes to protecting against fires, vigilance is paramount to ensure patient safety, says Jonathan C. Willard, PMP, CHC, AP, MBE, owner of Acute Medical Gas Services Inc. in Goffstown, N.H.

“It’s critical to approach health care management with continuous improvement at the heart of our policies and procedures,” says Willard, who is a principal member of the technical committee on medical gas and vacuum piping systems, which is responsible for the applicable sections of NFPA 99, Health Care Facilities Code; and a principal member of the technical committee on industrial and medical gases, which is responsible for the NFPA 55, Compressed Gases and Cryogenic Fluids Code. “Managing oxygen systems in hospitals requires a robust operation management program to make sure they remain safe and reliable continuously.”

Fortunately, codes and standards like NFPA 99 and NFPA 101®, Life Safety Code®, provide comprehensive guidance on managing this hazard in American health care facilities.

“Stringent regulations, as well as oversight from the Centers for Medicare & Medicaid Services and other organizations, have helped U.S. hospitals remain safe,” says Chad Beebe, AIA, CHFM, CFPS, CBO, FASHE, deputy executive director for the American Society for Health Care Engineering (ASHE) in Chicago. “The rules, guidelines and codes we follow have been developed and further improved based on incidents like these fires in other countries. Our industry looks to see if there are any vulnerabilities in our regulations, and we usually respond quickly to those by adding new codes or providing clarity to existing codes.”

“Our country has an excellent track record of preventing deaths in fires in health care facilities due to a robust, multilayered system of code enforcement,” Verzoni says. “But it wasn’t always that way. Some of the world’s deadliest hospital fires occurred in the U.S. in the past century, including the Cleveland Clinic fire of 1929 that killed 120 people and the St. Anthony’s Hospital fire that claimed 74 lives in Illinois in 1949. We’ve come a long way in eliminating deaths by enforcing compliance with our codes.”

In fact, per NFPA data, fewer than one death occurred, on average, each year in fires in United States hospitals from 2014 to 2018 (see table on this page). Still, the physical environment in hospitals is forever evolving, with patient care spaces constantly being changed, moved, added or removed.

“Even though hospitals in the U.S. have enjoyed excellent fire safety over the past several decades, the risks are always there,” says Jonathan Hart, PE, SASHE, CHC, the NFPA’s technical lead and principal engineer.

Although oxygen itself is not a flammable gas, it’s an oxidizer, which means it can cause a fire to spread more easily and faster. And the significant increase in oxygen usage to treat coronavirus patients raises the odds of combustion, according to Jonathan Flannery, MHSA, FASHE, FACHE, ASHE’s senior associate director of advocacy. “There is no consensus on what oxygen percentage fosters an oxygen-enriched atmosphere,” Flannery says. “However, when the oxygen concentration in the air rises merely 3% higher than the naturally occurring 21% concentration, it’s sufficient to intensify the hazard of materials becoming easier to ignite and to burn more vigorously.”

Annual average estimates of structure fires in health care facilities between 2014 and 2018 as derived from fires reported to local fire departments through the U.S. Fire Administration’s National Fire Incident Reporting System and the NFPA Fire Experience Survey.

Fires by occupancy or property type, accessed from National Fire Protection Association data on May 25, 2021. Sums may not equal totals due to rounding errors. Fires that were not reported to the fire department are not included.

Willard explains that there are two types of oxygen systems employed in the health care setting that need to be fully understood. “The first is a centralized source of supply, which in most medium and large hospitals is a cryogenic liquid oxygen system, usually located outside of the hospital in an insulated storage vessel. These systems are connected to pipeline distribution systems that deliver the oxygen to the various locations of the hospital where it is needed for proper patient care,” Willard says. “They operate at very low pressures — 50-55 pounds per square inch gauge (psig), are monitored to ensure proper operation and are generally accepted as needing to be available at all times without fail because patients may be relying on them for survival.”

“Cylinders and containers store oxygen at very high pressures, up to 4,500 psig. If they are not stored or handled properly, they can be extremely dangerous,” Willard says. “An added fire concern arises when adiabatic heating occurs — the rapid pressurization of a system. When an oxygen cylinder is connected to a medical device, the device is usually not pressurized. After connecting the cylinder, the cylinder valve is opened to equalize the pressures. If this pressurization occurs too quickly, the temperature of the gas molecules rises; at a point of compression in the system, this heat could be sufficient enough to ignite a material it comes in contact with.”

With the increased need for respiratory therapy in the current pandemic, many systems have resorted to elevating the pressures in the systems to ensure adequate flow for the treatment areas.

“This can lead to failures in sensors, gaskets and joints,” says Mark Chrisman, Ph.D., PE, health care practice director and principal for Henderson Engineers, a national building systems design firm based in the Kansas City, Mo., area. “Furthermore, facility staff can be increasingly busy attending to the immediate needs of the facility and hospital staff, so there isn’t any bandwidth to attend to and monitor these systems. These factors aggregate to an elevated risk of oxygen-fueled fires.”

In addition to oxygen, the pandemic has forced health care facilities around the globe to store and use other potential fire hazards like hand sanitizer. “Complicating these issues is the fact that this storage and use sometimes occurs in spaces that were repurposed for patient care or created from scratch to deal with the surge in COVID-19 patients,” Verzoni says.

“The three elements a fire needs to ignite — heat, fuel and an oxidizing agent — are present in virtually all surgical procedures. Oxidizers, oxygen or nitrous oxide, heat sources, lasers or cauterizers, and fuel such as drapes or towels provide these elements,” Flannery says. “Optimal outcomes depend on all operating room (OR) staff being familiar with their roles in fire prevention and management and assuring that staff have the proper training, supplies and equipment.”

Recent hospital fire catastrophes outside the U.S. are a reminder of the importance of collaboration and engagement from the entire hospital team when evaluating risks during the pandemic and thereafter.

“Doctors, nurses, respiratory therapists and infection control professionals; maintenance, construction and safety personnel; and architects, engineers and vendors/manufacturers need to work together,” says Chrisman, who recommends collective efforts like performing risk assessments, drills and exercises, implementing and following procedures and best practices, and emphasizing proper fire safety training.

Recently, after performing increased ventilator load assessments at hospitals, Chrisman and his team identified several outlets with flow meters that were not completely shut throughout these facilities. “Not only is this oversight a wasteful and unnecessary draw on the system, but it elevates oxygen levels within the localized space, which can increase the risk of fire,” he says.

Also, many of the utility systems in older hospitals “are just not up to the current design standards for these systems. Even if maintenance has been routinely performed on them, they could still pose a fire hazard,” Willard says. “And some old systems and equipment might be leaky, adding oxygen to the environment even when not in use.”

For instance, ventilators and other respiratory devices, needed during the coronavirus crisis to administer oxygen to patients, are prone to leak without proper inspection, testing and maintenance. “Booms in ORs that have flexible hoses with threaded connections that are not easily accessible can also leak and create a hazard,” Willard says. “Oxygen can build up in housings where the flex connectors are installed, creating very high concentrations of oxygen in the small enclosures.”

Beebe says it’s unfortunate that the Centers for Medicare & Medicaid Services (CMS) continues to require the implementation of an older edition (2012) of NFPA 99 by U.S. hospitals that participate in Medicare and Medicaid. “Until CMS updates and begins utilizing newer editions of the code, we are not afforded any of the latest protections,” he says. “CMS needs to speed this up and adopt newer code standards. The NFPA updates its codes every three years; CMS is more than a decade behind the curve now.”

Flannery reiterates that sentiment. “The adoption of the NFPA’s most recent codes and standards by CMS would provide greater safety to patients in U.S. hospitals,” he says.

Consider that some requirements in the 2012 edition are in direct conflict with the most recent edition. “The 2012 edition does not allow for patient transport equipment to be placed in front of medical gas emergency shutoff valves,” Willard says. “However, the 2021 edition does allow for it. This conundrum exists with many more of the requirements hospitals are expected to follow.”

Several U.S. governmental health care authorities, such as the Department of Veterans Affairs and the Indian Health Service, already have implemented the latest NFPA standards and codes, as these authorities are allowed to do. “Yet non-federal government health care facilities are required by CMS to use the 2012 editions of the Life Safety Code and Health Care Facilities Code,” Flannery says.

Organizations seeking to improve fire prevention efforts and better safeguard patients, staff and visitors are recommended to adopt the following best practices:Review and follow relevant codes and standards like NFPA 99 and NFPA 53, Recommended Practice on Materials, Equipment, and Systems Used in Oxygen-Enriched Atmospheres. These provide guidance on the safe storage, handling and administration of medical gases like oxygen and nitrous oxide. “In particular, adhere to the requirements of Chapter 5 and Chapter 11 of NFPA 99,” Hart says.

Develop policies and procedures around medical gases that are based on Chapter 5 and Chapter 11 of NFPA 99 and tailored for the actual use and needs of the facility. “Also, ensure that storage locations comply with the code based on the volume of gas being stored in that location,” Hart says.

Implement operation and management programs that address all critical systems and activities. “Perform daily rounds, conduct inventories of critical components and systems, operate inspection and maintenance programs with frequencies based on manufacturer recommendations, conduct boom inspections and leak testing as required by NFPA 99, and develop a permit-to-work system for medical gas and vacuum systems,” Willard says.

Confirm that all oxygen delivery equipment is functioning properly to minimize oxygen leakage and reduce the chance of an oxygen-enriched atmosphere occurring. Also, increase ventilation or exhaust to any area of concern to prevent the creation of an oxygen-enriched atmosphere.

During emergencies like the COVID-19 pandemic, it’s important for health facilities managers to be flexible and responsive to the needs of patients while also ensuring that the physical environment is safe and healing.

“This is the essential function of health care facilities managers,” Flannery says. “It is times like these that they must be able to assess all risks and provide the appropriate level of safety that will help protect patients but also allow for needed care and services.”

Sources for the accompanying article suggested several resources health care facilities professionals can use to properly size medical gas systems, store oxygen, address medical gas-related fire hazards and help prevent oxygen-related fires. They include:“Piped Medical Gas Consumption Evaluation Tool” by the American Society for Health Care Engineering, which helps hospitals and health systems evaluate piped medical gas system capacity and show the usage of a particular medical gas system while different types of therapies are in use.

“Medical Air and Oxygen Capacity” paper by Kaiser Permanente National Facilities Services, which provides ventilator capacity based on piping sizes to assist in determining how many ventilators can be served by an existing medical gas system in a given patient care area.

“Temporary Compliance Options for Code Modifications, Alternate Care Sites, and Facilities Related to Health Care” white paper by the National Fire Protection Association (NFPA), which covers provisional compliance options when it comes to medical gas, sprinkler systems, changes in physical spaces and more.

“Considerations for Temporary Compliance Options in Health Care Environments During COVID-19” white paper by NFPA, which includes provisional compliance options meant to address challenges related to medical gas storage and other issues in health care facilities.

“Oxygen tank storage regulations” article by Health Facilities Management, which covers considerations to help ensure compliance with NFPA 99, Health Care Facilities Code.

Oxygen, either piped in a closed system or as a compressed gas in cylinders, plays an important role in health care facilities for treatment in many patients.

While it is not considered a flammable gas, oxygen is an oxidizer, which means that it will accelerate a fire if introduced at a higher content than exists in air (the normal oxygen content in air is 21%).

While piped oxygen systems are typically fixed infrastructures, design and compliance for oxygen cylinders and their enclosures (where required) can be a challenge for staff, designers and facilities personnel.

Regulations for oxygen cylinders are based on the volume of gas present (designated in cubic feet in the U.S.). As expected, the more volume of gas present, the more requirements that apply.

There are many different sizes of cylinders utilized for oxygen in health care facilities ranging from an E-cylinder (approximately 23 cubic feet of oxygen) to an H-cylinder (approximately 244 cubic feet of oxygen). Other cylinder sizes include A, B or D.

As required by the Centers for Medicare & Medicaid Services (CMS), health care facilities must comply with the 2012 edition of the National Fire Protection Association’s NFPA 101®, Life Safety Code®, and the 2012 edition NFPA 99, Health Care Facilities Code.

The following considerations help facilities professionals explore the requirements for oxygen being stored in cylinders in a health care occupancy and how they can be sure their facilities comply:

Full, partial or empty. A critical aspect of oxygen use and storage is related to identifying each cylinder as full or empty. In an emergency, it is critical for staff to easily identify which cylinders are full. NFPA 99 section 11.6.5.3 specifically requires that empty cylinders be “marked to avoid confusion and delay if a full cylinder is needed in a rapid manner.”

This can be accomplished through an integral pressure gauge, individual signage or separated group signage (for cylinders being stored together). In the past, some accreditation organizations have recommended separation or signage to meet the “rapid manner” requirement. NFPA 99 section 11.6.5.2 requires that empty and full cylinders are segregated from each other when stored in the same enclosure.

While NFPA 99 does not specifically address partial cylinders, The Joint Commission (TJC) provides some guidance in this area. They allow an organization to perform a risk assessment leading to a policy that identifies how the organization will identify and store partial cylinders. If the organization deems fit to store full and partial cylinders together in the same enclosure, TJC will allow it as long as it is identified in the hospital policy.

If this is not desirable, another option might be to utilize a separate storage rack for full, partial and empty cylinders with appropriate identification if a facility has the space for it. The facility’s local or state authority having jurisdiction (AHJ) should also be consulted during the risk assessment stage to determine if they have specific concerns or requirements that may vary from NFPA 99, such as those that exist in the International Fire Code.

In-use versus storage.Another important aspect of dealing with oxygen cylinder compliance is determining what is in-use versus what is storage. NFPA 99-2012 section 11.3.3.3 answers that small size oxygen cylinders (A, B, D or E) that are securely mounted to a cylinder stand or to medical equipment designed to receive and hold compressed gas cylinders are considered in-use and not subject to the storage provisions.

Similarly, section 11.3.3.4 addresses cylinders available for immediate patient use in patient care areas (e.g., an individual cylinder located in a patient room) that are secured to prevent tipping or damage and are also considered in use. CMS confirmed this position in a memorandum (S&C-07-10) in January 2007. Other oxygen cylinders not fitting one of the descriptions discussed previously will be considered storage.

Storage of less than/equal to 300 cubic feet. In patient care areas, NFPA 99 section 11.3.3 will allow up to 300 cubic feet (approximately 12 E-size cylinders) of nonflammable gas, which includes oxygen, in 22,500 square feet of floor area outside of a storage enclosure.

While the code specifically states 22,500 square feet of floor area, this aligns with the requirements for the maximum size of a smoke compartment required by NFPA 101 for health care occupancies. The cylinders shall be secured against tipping or damage, and other general precautions outlined in NFPA 99 shall be followed.

CMS confirmed this position in the S&C-07-10 memorandum as well. It is likely during an accreditation survey managers have seen surveyors counting oxygen cylinders not considered “in-use” within a smoke compartment to confirm compliance.

Storage greater than 300 cubic feet but less than 3,000 cubic feet.NFPA 99-2012 section 11.3.2 addresses requirements for storing nonflammable compressed gases greater than 300 cubic feet but less than 3,000 cubic feet (up to approximately 120 E-size cylinders or 12 H-size cylinders of oxygen).

The cylinders can be stored outdoors in an enclosure or in an enclosed interior space using non- or limited-combustible construction with doors capable of being secured. If storing oxygen cylinders outdoors, NFPA 99 section 11.6.5.4 will require protection from weather including water, snow and ice accumulation, to prevent rusting, as well as temperature extremes. A cover/roof for the exterior enclosure, as well as some separation between the ground and the cylinders, is often helpful in meeting these requirements.

Oxidizing gases such as oxygen shall be separated from combustibles or materials in the same enclosure by one of the following options: a minimum of 20 feet, a minimum of 5 feet in a fully sprinklered storage room or enclosed in a gas cabinet with a minimum 30-minute fire rating.

The enclosure will require regulation of temperature to prevent the oxygen cylinders from reaching 130 degrees Fahrenheit. If other compressed gases are located in this room with different requirements (e.g., nitrous oxide or carbon dioxide), the worst-case temperature requirements will apply. Oxygen-cylinder valve protection caps shall remain until placed in use. Smoking, open flames and electric heating elements shall be prohibited from the interior storage rooms and within 20 feet of the exterior enclosures.

Other general safety precautions for cylinders outlined in NFPA 99 will apply as well, including protection against tipping or damage. NFPA 99 section 11.3.4.2 will also require precautionary signage indicating the presence of oxidizing gases that is readable from 5 feet away on each door to the enclosure. Additional signage may be required as applicable for other medical gases that may be present in the enclosure.

The enclosures shall be designed to allow access for hand trucks or carts to move cylinders and equipment in and out of the space, and the space access (e.g., doors, gates or other method) shall be secured.

If oxygen cylinders are stored outside, the enclosure shall be constructed of non- or limited-combustible materials with a minimum of two entries/exits. If the cylinders are stored inside, the enclosure shall be provided with a one-hour fire barrier rating including 60-minute-listed opening protectives (e.g., doors, dampers of other penetrations).

Subsequent editions of NFPA 99 has updated the opening protective requirement fire rating to 45 minutes. This should be discussed with the appropriate AHJ.

Interior finishes in the interior enclosure shall be non- or limited-combustible types. The enclosures shall comply with NFPA 70®, National Electrical Code®, for ordinary locations and shall be provided with electrical power from the essential electrical system.

Other general safety precautions for cylinders outlined in NFPA 99 and other requirements previously discussed as well as appropriate signage dependent on what other gases may be stored within the enclosure will also apply.

Ventilation.Outdoor enclosures equal to/greater than 3,000 cubic feet of gas storage will require ventilation per NFPA 99 section 5.1.3.3.3.3. Outdoor storage locations surrounded by solid (impermeable) walls shall have protected ventilation openings at the base of each wall to allow for free air circulation. Walls that are shared with other enclosures or buildings do not require openings.

Interior enclosures equal to/greater than 3,000 cubic feet of gas storage will require ventilation per NFPA 99 section 5.1.3.3.3 using either natural or mechanical exhaust. If using the natural ventilation option, NFPA 99 section 9.3.7.5.2 will require that two non-closeable louvered openings shall be provided, each having 24 square inches of opening for each 1,000 cubic feet of gas to be stored within the enclosure.

Each louver shall be a minimum of 72 square inches. One louver shall be located within one foot of the floor and the other within one foot of the ceiling, located to allow for crossflow. Openings shall be direct to the outside without any ductwork.

As discussed previously, other considerations for design include a maximum and minimum temperature within the enclosure. If the enclosure has wet sprinkler protection, consideration should be given to maintaining the minimum 40 degrees Fahrenheit required by NFPA 13, Standard for the Installation of Sprinkler Systems, for an automatic sprinkler system. Other considerations can be given to enclosures utilizing a dry barrel sprinkler, dry sprinkler system or anti-freeze sprinkler system.

As in the previous discussion, maximum and minimum temperatures must be considered depending on other medical gases or systems (e.g., fire sprinkler systems) present in the enclosure.

Other considerations. Some other general NFPA 99 requirements when dealing with oxygen cylinders include: using cylinders in the order in which they were received; and protecting the cylinders from contact with oil or grease, or contamination from dirt/dust, and following the Compressed Gas Association (CGA) G-4, Oxygen, requirements.

Oxygen cylinder storage and use can be a very involved process, and it often takes a team within each health care facility to help regulate compliance.

In addition, health care facilities often store and use many other nonflammable gases, oxidizers and flammable gases that require attention. While an increase in volume of oxygen cylinder storage comes with increased requirements, often so does adding other medical gases to the same enclosure.

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Store oxygen cylinders and fuel gas cylinders separately. Indoors, separate oxygen from fuel gas cylinders by at least 6.1 m (20 ft), or by a wall at least 1.5 m (5 ft) high with a minimum half-hour fire resistance. (From: CSA W117.2-19 "Safety in welding, cutting and allied processes". Local jurisdiction requirements may vary.)

Cylinders must also be separated away from flammable and combustible liquids and from materials that easily ignite (such as wood, paper, oil, grease, etc.), including calcium carbide, by similar requirements as oxygen cylinders (6.1 m, or a fire wall at least 1.5 m high with ½ hr fire resistance).

If oxygen cylinders are stored in an outdoor acetylene generator house, the cylinders must be separated from the generator and carbide storage room by a non-combustible barrier with a fire resistance rating of at least 1 hour, that has no openings and is gas tight.

In 2019, an EMS crew was completing a patient transport to an emergency department in Norwalk, Conn., when the oxygen tank on their transport stretcher apparently caught fire and/or exploded. Follow-up reports from Norwalk Fire Department confirmed that there were burn marks on the walls and ceiling of the room but that the fire had been put out with a fire extinguisher. The fire department also reported that one EMT suffered minor injuries and that the patient and other EMT were uninjured.

Considering how many tens of thousands of times oxygen tanks are used in the United States every day, these fires and explosions are extremely rare, but when they do occur, they can be extremely serious. (Photo/MaxPixel)

My first thought when reading this story was, “Wow, this can really happen!” I remember being taught about the possibility of an oxygen tank explosion in EMT school many years ago, but thought it was just one of those textbook things that instructors are required to tell us. A quick search found that not only has it happened, but that the FDA produced a safety video about it several years ago.

The FDA video highlighted several EMS providers that had been injured in an oxygen tank explosion/fire and cited at least one death. Considering how many tens of thousands of times oxygen tanks are used in the United States every day, these fires and explosions are extremely rare, but when they do occur, they can be extremely serious.

I also remember being taught in EMT class that oxygen itself does not really burn, but that it supports the combustion of other fuels. You may have learned the fire triangle: heat, oxygen and fuel. So, what could be the fuel in these cases?

As it turns out, most instances involve the regulators and not the oxygen cylinders. Contamination in and around the regulators, or the regulators themselves are catching fire. Due to the presence of oxygen, the fires burn very quickly and appear explosive.

The details of exactly what happened in the Norwalk case have not been released, but a review of what has caused other regulator fires might help prevent more in the future.

There are two general causes of oxygen regulator fires, adiabatic heating and particle ignition. In adiabatic ignition, the increase in pressure within the regulator when the tank is opened causes a sudden, severe increase in temperature, which is transferred to the components of the regulator.

Particle ignition may also cause a fire within a regulator. When the oxygen tank is opened, minuscule bits of debris get blasted up into the regulator with such force that they are heated to the point of ignition.

Both of these types of ignition can be complicated when other contaminants are present in and around the regulator. Tiny amounts of oil, grease, dirt or dust can also ignite and feed a regulator fire.

“Crack” the oxygen tank briefly before putting the regulator on. This blasts any dust or other contaminants away, rather than introducing them into the regulator.

Once the regulator is applied, open the oxygen cylinder slowly. It might not seem like much, but increasing the time it takes for the pressure to build in the regulator allows the heat to dissipate safely.

Keep your regulators clean. Minimize the risk of contamination with any oils, grease or dirt. Keep any wrenches or tools used on tanks and regulators separate from any that may be used for other work.

Use oxygen tanks that have been properly maintained, filled and stored. The company that fills your oxygen tanks should be following DOT guidelines for inspecting and testing the tanks. These tests check for structural strength of the tank metal as well as the internal cleanliness and condition of the cylinder. They must then fill the tanks will oxygen that is tested for impurities and moisture. Store your full and used oxygen tanks in an area that limits their exposure to oils, greases, dirt, dust and other grime.

Avoid the use of two O-rings or yoke washers when putting a regulator on a tank. Whether it is done in an attempt to fix a leaky connection or inadvertently when the first O-ring was not noticed, having two can cause a leak. The high-pressure oxygen then seeps out between the washers and can create a fire if combined with a fuel and exposed to a source of heat such as a static spark.

Oxygen tank related fires are more common in oxygen therapy at home users. In an article for the COPD Foundation, BPR Medical’s Richard Radford shared the following statistics: each year in the U.S., there are more than 180 home fires involving oxygen therapy at home equipment, resulting in more than 70 deaths and 1,000 burns treated in emergency departments – most of these (more than 70%) are caused by tobacco smoking.

Radford noted the risks of oxygen at home therapy fires can be minimized by avoiding smoking and naked flames, and by implementing fire safety valves, called thermal fuses or firebreaks into oxygen supply tubing, which prevent fire from spreading. The Veterans Health Administration implemented steps to make thermal fuses mandatory in home oxygen equipment for veterans in 2018.