When the pandemic first hit in the United States in 2020, hospitals began to see an influx of patients requiring respiration assistance. As hospitals began to put more and more patients on oxygen and ventilators, medical gas systems were stretched to their limits of performance — bulk oxygen system vaporizers began to freeze up, standby medical air compressors began to run continuously, and pressures below 50 PSI were delivered to patients on a consistent basis. In many health care facilities, the reason for these issues was that many of the assumptions that underline the design of oxygen and medical air systems did not account for the elevated medical gas usage that resulted from a global respiratory pandemic.
Over the last year, I’ve spoken frequently on the topic of plumbing resiliency. Plumbing resiliency, in certain light, is the understanding that plumbing systems have unique challenges that exceed the requirements of bouncing back from a sudden striking disaster (such as an earthquake or tornado). Plumbing systems also must worry about efficiency, quality, safety, sustainability, affordability, and equity. As AWWA CEO David LaFrance said, “People think that water is simple, but it is highly complex.” I’ve modified this quote myself to apply to plumbing in general: “People think that plumbing is simple, but it is highly complex.” Part of what makes plumbing resiliency and plumbing systems complex is that you can’t solve for one thing in a plumbing system without having something else potentially impacted. Holistic thinking and expertise are needed to solve these problems. Naturally, this idea of resiliency extends to medical gas systems, which is a sub-discipline of plumbing.
Some of the assumptions that will be reevaluated include the probability of multiple outlets being in use simultaneously. For a given pipe size, as flow increases pressure drop increase (see red arrows in Fig. 1). One possible solution is to increase the size of the pipe to minimize pressure drop (see blue arrow in Fig. 1). Another solution may be to increase the delivery pressure (see green lines in Fig. 1) from 55 to 75 PSI. Similar to natural gas, by increasing pressure, the system may be able to handle larger shifts in flow more easily. But this would mean that pressure regulators may need to be used to reduce pressure to the standard 50 to 55 PSI range. Installation of these regulators may need to occur at zone valve boxes. Additionally, self-contained regulators may be a good idea to eliminate vent piping.
Some other concepts that require exploration are oxygen concentrators. Recommendations on how to properly size them and space requirements are needed. Some remote critical access facilities had issues with oxygen delivery during the pandemic. Concentrators have typically been used in crowded city healthcare facilities, but does it make sense to use these in rural areas to alleviate supply-chain issues? In that vein, does it also make sense to add auxiliary medical air and medical vacuum connections for mobile air compressors/vacuum pumps to connect to over-taxed facilities? Perhaps. At the very least, these types of discussions are needed. But these discussions are also going to be hard.
The International Association of Plumbing and Mechanical Officials (IAPMO) has created a Medical Gas Resiliency Task Group to respond to these issues. The scope of the Medical Gas Resiliency Task Group is to develop modifications to medical gas design/installation guidance to allow medical gas systems to be more responsive in handling variable loads, such as those seen during the COVID-19 pandemic.
The task group will also look at:
- Using concentrators to help mitigate oxygen supply issues, especially for remote critical care facilities
- Using oxygen pressure regulators near the zone valve box to expand/reduce pressure losses through the system as demand increases or decreases
- Providing peer-reviewed elevated pressure charts for oxygen and medical air to provide better guidance for designers/engineers to use in conjunction with pressure regulators
- Incorporating auxiliary connections for quicker source system expansion
- Idea generation with task group members
Task group members will participate via conference call or web meeting, provide their perspective on the code, and assist in drafting recommendations for action by the Uniform Plumbing Code® (UPC) Technical Committee, and other medical gas industry codes, standards, and guidelines. Applicants are not required to be members of the UPC Technical Committee. It is anticipated that all meetings will be virtual, but if travel is required, meetings would be held at IAPMO World Headquarters in Ontario, Calif.
Those interested in participating on the Medical Gas Resiliency Task Group may apply at: https://forms.iapmo.org/iapmo/committee/app_innovation_taskgroup.aspx.
Interest Categories for Medical Gas Resiliency Task Group:
- Manufacturer: A representative of a maker or marketer of a product, assembly or system, or portion thereof, that is affected by med gas systems (e.g., manufactures of particular products and association of manufacturers).
- User: A representative of an entity that is subject to the provisions of med gas systems or that uses med gas systems (e.g., educator, skill-trade trainer, skill trades person and academia).
- Installer/Maintainer: A representative of an entity that is in the business of installing or maintaining a product, assembly or system affected by med gas systems (e.g., contractors, subcontractor, and construction labor organization).
- Research/Standards/Testing Laboratory: A representative of an independent research organization; an organization that develops codes, standards or other similar documents; or an independent testing laboratory (e.g., code development organizations, certification agency, testing laboratory).
- Enforcing Authority: A representative or an agency or an organization that promulgates and/or enforces standards (e.g., regulatory agency, inspectors and enforcers).
- Consumer: A person who is, or represents, the ultimate purchaser of a product, system, or service (e.g., end user of a product and distributor).
- General Interest: A person or organization interested in the products or topic addressed by the Task Group, who is qualified to serve on the committee, and who does not fall under the other categories (e.g., consultants, special experts, or engineers).
Considerable effort, devotion and hard work will be expected of each Task Group member. Task Group membership carries an obligation to participate actively in all work of the Task Group including the contribution and generation of information, prompt reply to draft reports and ballots, attendance and participation at Task Group meetings and prompt completion of assigned tasks.
