Oxygen issues during mass care: California's experience may help others respond

California, the fifth largest economy in the world with a population of nearly 40 million, experienced a medical surge during 2020-21 due to the COVID-19 pandemic. In a recent article published in the journal Disaster Medicine and Public Health Preparedness, authors from the state and several institutions describe how a collaborative, multi-disciplinary clinical and logistical solution was developed. This innovative approach helped the state support the ventilator and oxygen needs of a population during a mass surge in demand.

Oxygen consumption due to the use of high-flow nasal cannula systems in COVID-19 patients creates significant flow demands from typical liquid oxygen systems in hospitals. Depending upon the numbers of patients requiring oxygen in a given area of the facility, pipe diameters, and load, within the external coils of the liquid oxygen system, where liquid evaporates into gaseous oxygen, delivery to the hospital may freeze and suddenly diminish flow. Back-up systems are required in addition to plans for de-icing the coils.

Faced with an oxygen shortage throughout large regions of the state and the logistical challenges associated with local health systems sharing oxygen resources, a state coordinating center with a 24-hour hotline for emergency requests was created. Through a contract with a biomedical engineering team, the state emergency services authority restored deployable oxygen concentrators (DOCS) from long-term storage to oxygen depots, which is described further in the article. Power issues, concentrator supplies, and logistical solutions are described further.

According to Dr. Asha Devereaux, one of the authors of the article, "Oxygen plans are required at every level of disaster and pandemic response, from logisticians to end-users. Assumptions that oxygen is an endless supply are erroneous and oxygen conservation and supply should be part of every current and future planning efforts."