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

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

3. 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.

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

5. 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.

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

9. 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.

10. Why Test and Qualify?

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

12. 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.

13. 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.

14. 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.

15. 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

18. 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.

20. 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.

22. 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.

23. 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.

24. Newly installed check valve.

25. Emergency Oxygen Fill Port Connection, located on 67th Street

26. Emergency Oxygen Fill Port Connection, located on 68th Street

27. Now, To Vent a Bit …

28. 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.