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During the COVID-19 pandemic of 2020, we have seen how to do things differently, such as riding in elevators, working from home, and how health-care facilities are utilizing their medical equipment.
I got to thinking about the medical gas source equipment and how we can prepare those systems for pandemics or crises that can crop up on what feels like a moment’s notice.
How do facilities cope with the instant high demand on a system? As part of the emergency preparedness, each facility must understand its existing medical gas systems capabilities. They can determine how much they can safely push them and how much they need to add.
The 2015 NFPA 99 Section 220.127.116.11.7 Auxiliary Source Connections describes, “All source systems shall have an auxiliary source connection,” which is to be located on the patient-side of the source valve.
The 2018 NFPA 99 Section 18.104.22.168.7 Auxiliary Source Connections was revised to be only for “cryogenic fluid central supply.” An Emergency Oxygen Supply Connection (EOSC) is such a connection.
I believe these connections should not be relegated to just cryogenic fluid but should be applied to all medical gas systems. I placed a few of these connections on some of my projects over the years; I hope they came into consideration during the pandemic.
In one instance, I placed an auxiliary connection for the medical air and medical vacuum skids at an exterior wall where a portable trailer could be parked and powered up with supplemental power sources. The auxiliary piping system is full-size back to the main and connected on the patient-side of source equipment. These extra connections typically come into play when the facility wishes to replace aging equipment in the future.
Since the COVID-19 pandemic, though, they have come into play in another way. These connections can still be connected using portable skids and auxiliary power to provide additional support temporarily.
The auxiliary source connections are only dealing with the source equipment. What about the pipe sizes for areas such as critical care or intensive care units?
It is imperative to discuss with the facility emergency preparedness team how it intends to use areas within the facility and successfully take on more and different types of patients. As we have seen (and are still seeing today), many facilities will use their ICU rooms for standard ICU practices and use other areas such as pre-op PACUs because most, if not all, elective surgeries are on hold.
As trusted partners, we need to work with the facility to identify appropriate areas for certain patients to be placed, depending on the severity of their needs.
In my last column, we discussed flow rates for COVID-19 patients. Since then, there have been some additional items to consider.
Back in August, I witnessed severe COVID-19 patients being treated using a ventilator at 60 liters/minute at 100 percent oxygen, ECMO unit at 15 lpm and Nitric at 5 lpm, which is considerably more than the 40 to 60 lpm we discussed in the previous column. For the most serious COVID patients, treatment could see up to 80 lpm and 100 percent oxygen.
This is a perfect example of why we need to continually check back in with the facility to monitor how they are treating critical patients so we can guide them on how to use their medical gas system effectively. Granted, many of you may never see this level of use, but it is important to know these conditions exist.
So how do these auxiliary connections come into play?
They occur when something such as a pandemic or other significant local event creates a situation where the facility’s normal medical gas usage transforms into extreme usage levels.
Many facilities’ medical gas source equipment is not equipped to handle the additional loads to the levels of what we have seen this year due to COVID-19 hospitalizations. Depending on the facilities' loads, they may need to bring in additional equipment to support the increased demand.
In the current pandemic, some health-care facilities used additional cylinder manifold systems or added cryogenic manifolds able to tap into the EOSC, or even increased the pressure to the building from the bulk oxygen tank farm.
As designers, we need to think about how we can best serve our clients’ needs in times of crisis. The auxiliary connections are simple concepts that can be easily incorporated into a system when the need arises. Yes, this is considered above code minimum, but worth it for the peace of mind knowing that my facility is ready for anything.
When the time comes, the facility can pull up a portable medical air compressor and a medical vacuum skid, along with portable generators (connected for emergency backup power) to these auxiliary connections and begin providing additional capacity to the primary source equipment.
Keep in mind, when placing these auxiliary connections, you still need to locate them as you would if installing a permanent system, i.e., exhaust and fresh air intakes.
Do your research on the portable compressor skid connections. And don’t forget to look at how far you will need to run a flex hose or pipe to reach the auxiliary connection, as this will likely increase your friction losses and, in turn, will negatively impact the flow rates you had intended.