The Health and Safety Authority (HSA) is issuing this Safety Alert following a recent tragic fatal accident involving the use of a Portable Medical Oxygen Integral Valve Cylinder (hereafter referred to as Portable Medical Oxygen Cylinder) in an ambulance situation. Oxygen is non-flammable but strongly supports combustion and under high pressure with certain conditions can cause common materials to ignite spontaneously (including some materials which do not normally burn in air). It is highly dangerous when in contact with oils, greases, tarry substances and many plastics.

Portable Medical Oxygen Cylinders are utilised throughout the healthcare system to provide a temporary uninterrupted portable oxygen supply to patients. They may be used where, for example, a patient is being moved on a stretcher from an ambulance to a hospital trolley /bed or vice versa.

Although rare, portable medical oxygen cylinder fires can occur, particularly when the cylinder valve is initially opened. Operatives need to be mindful to this possibility and treat the cylinder with due care and attention at all times.

The HSA is providing the following advice to augment increased awareness and vigilance in the safe preparation of Portable Medical Oxygen Cylinders to reduce the risk of oxygen supported combustion and mitigate the consequences should an oxygen fire occur.

Important General Advice

• At all times adhere to the manufacturers “Instruction for Use” to ensure safe preparation set up and safe oxygen therapy delivery.
• Never use oil or grease on oxygen cylinder systems and ensure that hands are clean before handling the cylinder or associated equipment. If you have been using alcohol based gels or liquids to decontaminate your hands make sure the alcohol has totally evaporated.
• When selecting the cylinder for use, check that the cylinders is clean and free from any damage. Ensure the cylinder is free from oil and grease, particularly around the Schrader and fir tree outlets.
• Check the expiry date of the cylinder. Do not use Medical Oxygen after the expiry date which is stated on the cylinder label.
• Oxygen cylinders should be prepared for use in a vertical position to limit any consequences should a fire occur; the operators continued vigilance during preparation is of critical importance.
• Before use, the on / off hand wheel on the valve must be opened slowly until it comes to a complete stop.
• All relevant patient trolleys/ stretchers/ beds should use a suitable cylinder holder to secure the cylinder whilst in use adjacent to the patient. The portable medical oxygen cylinder should, where practicable, be placed in this cylinder holder.
• The Fir tree / Schrader outlet must face away from the bed / trolley / stretcher.
• Do not place the oxygen cylinder on the patient’s bed / trolley /stretcher unless there is no alternative. If this is required ensure that the cylinder is operating correctly before placing it on the bed / trolley / stretcher.
• Never place the Portable Medical Oxygen Cylinder on the bed / trolley / stretcher when the changeover of oxygen supply is being carried out. 
• When medical oxygen is in use, ensure all possible sources of ignition in the vicinity are identified, risk assessed and controlled.

Risk Assessment

Under Health and Safety legislation, every employer must prepare a written risk assessment of the hazards at the place of work.

The information contained in this safety alert as well as information supplied by the medical gas supplier should be taken into account by employers as appropriate when preparing written risk assessments and safe systems of work.

Training

All relevant medical staff should be trained in the safe use of Portable Medical Oxygen Cylinders.

The training should include for example;

• Properties of the gas.
• Manufacturers “Instructions For Use”
• Correct handling, care, storage and operation of oxygen cylinders to reduce the risk of fire.
• Actions to be taken in the event of an emergency.