Oxygen Crisis: How Hospitals Run Out Of Air

Hospitals typically rely on large oxygen tanks, which are periodically refilled by trucks. During the COVID-19 pandemic, hospitals in Southern California experienced oxygen shortages due to the high demand for oxygen therapy. Similarly, hospitals in New Delhi, India, faced oxygen shortages despite the country's increased exports of processed oxygen. These shortages may be attributed to various factors, including increased demand, inadequate infrastructure, and poor governance.

Hospitals' oxygen supply is impacted by exports

Hospitals' oxygen supplies are impacted by a multitude of factors, including exports and local demand. In the context of the COVID-19 pandemic, the oxygen supply chain has been strained globally, and this has been exacerbated by the surge in demand from hospitals treating critically ill patients.

During the COVID-19 pandemic, India's oxygen supply chain was severely impacted. Between April 2020 and January 2021, India's exports of oxygen reached 9,301 metric tonnes, almost double the previous year's exports. This was primarily industrial oxygen, but it caused confusion and concern as it was reported as medical oxygen. Medical oxygen accounts for less than 0.4% of India's total oxygen exports, and the majority of these exports occurred when medical oxygen consumption was lower. Nevertheless, the Indian government ordered the diversion of oxygen supplies from industries to hospitals to meet the rising demand from hospitals treating COVID-19 patients.

Hospitals typically receive their oxygen supply from large tanks located outside the building, which are periodically refilled by medical suppliers. These tanks are connected to the hospital's plumbing system, delivering oxygen to patient beds, operating rooms, and other areas as needed. However, during periods of high demand or disruptions in the supply chain, hospitals may face challenges in maintaining adequate oxygen levels.

In Delhi, for example, a report revealed that several government-run hospitals lacked proper oxygen supplies, with some hospitals having only enough oxygen reserves for a few hours. This situation is not unique to Delhi, as other parts of India, such as Maharashtra, also faced similar challenges in meeting the oxygen demands of hospitals. The oxygen supply chain is critical for hospitals to effectively treat patients, especially during public health crises like the COVID-19 pandemic.

Hospitals' oxygen shortages are caused by staffing issues

Hospitals can run out of oxygen due to a multitude of reasons, and staffing issues are a significant contributing factor. Staffing shortages in hospitals have been a long-standing issue, with the COVID-19 pandemic exacerbating the problem. The pandemic placed an unprecedented burden on healthcare systems worldwide, and staff shortages only added to the strain.

One example of how staffing issues have impacted oxygen supply in hospitals is through the underutilization of resources. In some cases, hospitals have had to deal with a lack of qualified staff to operate specialized equipment, such as ECMO machines, which provide life-saving oxygen treatment for COVID and non-COVID patients. High hospital intake during the pandemic further exacerbated this issue, as there were not enough trained professionals to deliver the necessary treatments.

Staffing shortages have also led to a reduction in the overall capacity of hospitals to provide essential services. A report on Delhi's public healthcare system revealed that several hospitals lacked basic amenities, including a proper oxygen supply. The report highlighted that out of 27 hospitals reviewed, eight were operating without a proper oxygen supply, which can be attributed, at least in part, to the lack of adequate staffing.

Additionally, staffing issues have resulted in an increased workload for existing healthcare workers, leading to burnout, emotional exhaustion, and mental health challenges. This, in turn, has caused further staff shortages, creating a vicious cycle. The impact of these staffing issues on patient care is significant, with patients waiting longer for treatment or even being turned away, as highlighted by ECRI, a patient safety organization.

The issue of staffing shortages in hospitals is complex and multifaceted. It is important to address these staffing issues to ensure patient safety and provide adequate access to essential medical services, including oxygen therapy. Without proactive solutions and interventions, the situation could worsen, jeopardizing the quality of healthcare provided to patients.

Oxygen is stored in large tanks outside hospitals

Oxygen is typically stored in large tanks outside hospitals. These tanks are often located at the back of the hospital, and they contain hundreds of gallons of liquid oxygen. The oxygen is stored as a liquid in a vacuum-insulated evaporator, also known as a LOX tank, and it is then converted into a gas that can be piped into the hospital at regulated pressure. This system is advantageous because it does not rely on power to operate, as the tank pressure propels the oxygen through the lines.

The liquid oxygen in these outdoor tanks is obtained through the fractional distillation of air. This process involves cooling the air and then slowly heating it back up to separate out the oxygen and other gases. The oxygen is stored under pressure in the tanks, and it is released through pipes at the bottom of the tank. The pipes are typically made of copper and deliver oxygen to patient beds, operating rooms, and other areas of the hospital.

In addition to the large outdoor tanks, hospitals may also have smaller tanks of liquid oxygen, known as dewars or cyros, located inside the building in a specialised room. These smaller tanks function similarly to the large outdoor tanks but provide flexibility and backup oxygen supply. Hospitals are required to have at least one day's supply of oxygen on hand and an additional backup supply to sustain patients in case of any issues with the primary oxygen supply.

The oxygen supply in hospitals is crucial, especially for patients requiring oxygen therapy or those with breathing difficulties. The large tanks outside the hospitals ensure a steady and reliable source of oxygen, which is distributed throughout the building via a network of pipes and regulated through control valves and gauges. This centralised oxygen supply system allows for easy refilling and maintenance, ensuring that hospitals have the necessary oxygen reserves to meet the needs of their patients.

Oxygen is distributed through pipes in hospital walls

Hospitals require a constant and reliable supply of oxygen, which is used for a range of treatments, including respiratory therapy, anaesthesia, and life support. Oxygen is typically delivered to hospitals in bulk, in liquid form, through a process called fractional distillation of liquefied air. This liquid oxygen is stored in large tanks, which are periodically refilled by specialist trucks from production plants.

Oxygen is then distributed throughout the hospital through pipes in the walls. Hospitals are built with medical gases in mind, and the oxygen is piped to where it is needed, such as patient beds and operating rooms. This method of oxygen distribution is advantageous as it does not require power to run; the tank pressure delivers the oxygen through the lines.

Some hospitals may also have individual oxygen tanks for patients who need to be moved from their rooms. These tanks are attached to the patient's bed and can be transported with them. Additionally, hospitals may have backup oxygen cylinders in case of emergencies or power outages.

Oxygen is a critical resource in healthcare settings, and hospitals must ensure a stable and continuous supply to meet patient needs and avoid shortages.

Oxygen shortages can lead to rationing

In some cases, hospitals have had to scramble to find alternative solutions to meet oxygen demands. For instance, local companies in El Paso set up pop-up tents with new oxygen pipes in hospital parking lots when the hospital's pipes froze. Additionally, Dhulikhel Hospital in Kathmandu, Nepal, operated an onsite pressure-swing absorption (PSA) oxygen plant. However, it could not generate enough oxygen to meet the demand, producing only 60 of the required 150-200 oxygen cylinders per day.

Oxygen shortages are not a new problem, particularly in settings across sub-Saharan Africa and South America. However, the COVID-19 pandemic has severely worsened the situation, resulting in untold numbers of deaths. Oxygen is critical not only for COVID-19 patients but also for neonatal, maternal, and surgical care. Direct Relief, an organization working to improve healthcare infrastructure, has invested over $15 million to respond to COVID-19-related oxygen shortages, providing more than 33,000 oxygen concentrators to healthcare providers in 52 countries.

To address oxygen shortages, hospitals can implement several measures. These include sourcing additional oxygen tanks, setting up temporary oxygen supply systems, and investing in onsite oxygen generation plants. However, it is essential to recognize that oxygen concentrators may not be suitable for treating the sickest patients and that onsite plants may operate below capacity, requiring additional oxygen sources.

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