Got Gas? A Planned Oxygen Shutdown February 13, 2018 Jake Neufeld, MPA ABCP Environmental Health and Safety Emergency Management Enterprise Resiliency Manager www.mskcc.org

Regulatory requirements changed. New Regs Regulatory requirements changed. Upgrades required complete shutdown of O2 distribution system.

Scope of Work Reconfigure existing EOSC piping arrangement at liquid bulk storage facility 67th street. Requires a breach of the main oxygen supply. Redesign of the G-50 tertiary reserve to allow for portable 02 gaseous cylinder storage.

The O-Team Emergency Management Plant Operations Respiratory Therapy Environmental Health and Safety Anesthesiology & Critical Care Nursing Perioperative Services Vendors (Linde, Techair, Praxair, Medigas)

Phased Work Phase I: Component testing and qualification, data logging of the Oxygen consumption. Phase II: Additional pre-qualifications. Conduct mandated modifications as per scope of work.

Sequence of Operations EM Requested Sequence of Operations Assess potential risk at each step in the process. Mitigate those risks.

Phase 1 – Component Testing & Data Logging Determine amount of 02 used per day. Measure O2 consumption on a high census, high volume day. Prior to actual work, tested valves in the area of work.

Why Test and Qualify?

Phase 1 – Component Testing & Data Logging One valve did not qualify. Alter plan to account for valve failure. Valve failure required tube trailer.

All inpatient areas served by trailer (3000gal of liquid O2). Shutdown Impact All inpatient areas served by trailer (3000gal of liquid O2). O2 delivery disrupted to some areas of the hospital due to locations of valves. Portable O2 delivered to areas not served by trailer.

Clinical Preparations Work on Sunday – no surgeries, lowest census, lowest O2 consumption. Review of O2 orders Duplicate orders Open ended orders Appears more Px on O2 than actually are. Some Px get more O2 than they need. Ventilators backed up by tanks. H (282 ft3) & E Tanks (24.9ft3) deployed.

Phase 2 – Additional Pre-Qualifications Day of work pre-qualifications. Re-test all valves to ensure 100% seal Ensure the seamless delivery of O2 from tube trailer once main supply is shut off.

Command Center Modified HICS HICS Activation Did not activate full HCC RT Conference room as modified command center w/additional comms. Modified HICS Incident Action Plan Communications Plan

Needed permits from DOB, DOT, and FDNY. Trailer Logistics Trailer cannot move with O2 inside. Must be delivered empty and then filled on site. Needed permits from DOB, DOT, and FDNY. Sidewalk shed, must maintain pedestrian access. Site survey from ConEd.

Ran hospital off of trailer O2 for 72 hours. Clinical Logistics Tanks delivered Thursday prior to work on Sunday. Stored and deployed by RT. Ran hospital off of trailer O2 for 72 hours. RT brought in extra staff to work the shutdown days. Dedicated staff to critical care areas.

All Gassed Up and Ready to Go Nothing is ever easy … 11/12/17 – original date of work Night before was coldest night of the year Trailer vent froze open, vented off half the liquid O2 in the trailer. Not enough left for worst case scenario. Facilities Mgt made decision to postpone one week.

8:00a – Shutoff of main O2 distribution The Work 11/19/17 8:00a – Shutoff of main O2 distribution Run on the trailer for 1 hour to ensure seamless delivery of O2. 9:00a – Cut the pipe! 10:00a – Work completed 10:00a – 11:00a – Reopen main O2 distribution. Test for purity. 11:30a – Work completed.

Newly installed check valve.

Emergency Oxygen Fill Port Connection, located on 67th Street

Emergency Oxygen Fill Port Connection, located on 68th Street

Now, To Vent a Bit …

The need for additional drills for disruption of medical oxygen. Lessons Learned The need for additional drills for disruption of medical oxygen. Clarification of roles and responsibilities. Better notification when project ends. Have agreements in place for emergency oxygen cylinder and oxygen supply trailer delivery.