Ambulance needs oxygen in India.

For Ambulance…There are no standard norms.

In India, country where health and related problems are just neglected unless something panicky situation do not comes.

Take examples of ambulance… To securitize the ambulances for their efficiency will be the topic for thesis.

Majority of ambulances are of like show type…To shift an ordinary patient.

There are rules and regulations for Blood banks. Is there any regulatory authority which can have control or supervision like activity on ambulances?

Does anyone see to it whether ambulance is being used for right purpose?

Is provision of emergency oxygen and well trained staff should not be the compulsion for ambulance?

Here also much handy and easy to use, oxygen cylinders are the options…rather than ordinary oxygen cylinders which are commonly used by all.

Need is to think on this health related issue seriously.

Background:

In cases or complaints against doctors for medical negligence or in cases of physical attack on doctor or his property in India, the most common fact is which people in general or media highlight is about oxygen.

1. Oxygen cylinder was empty.

2. Oxygen tubing was connected but with no oxygen.

3. Delay to start oxygen.

4. Patient was transferred without oxygen.

Who are responsible?

Doctors are responsible.

For any above condition the soul responsible is concerned doctor. He though has got decision in favor of him against a case of…empty gas cylinder or delay to start oxygen.

In case of ‘Jacob Mathews verses state of Punjab’ in 2005 the judgment was in favor of doctors. Empty oxygen cylinder or delay to start it not be considered as criminal offence or medical negligence.

As it was not intentional and so was not medical negligence.

But still many other doctors had faced a problem related to it…though not legal problems every time.

Who are guilty?

All Health related persons are guilty.

For the drawbacks of present commonly used oxygen cylinder in India…all the person concerned with health should be considered as guilty.

As no one is taking initiative to improvise the standard of oxygen cylinders…though everybody is well aware of it.

For whom everybody is waiting?

This question is wrong one.

No body is waiting for smooth and easy use modern oxygen cylinders.

The reason for this answer is the persons involved in health are not making sincere efforts to update their equipments unless some non medical engineer or technology gives or offers them modern things best for investigation or treatment.

Drawbacks of oxygen cylinder

What are the drawbacks of oxygen cylinder used commonly in India?

1.Un opened Cylinders are found empty when needed.

Oxygen cylinders some times are with minor unnoticed leakage…and result of which it is found to be in empty stage when opened to start oxygen. This leakage may be at nozzle or in valve of it.

2.Once opened cylinder is found empty when needed second time.

Oxygen cylinders valves are closed tightly but no standardization of closing it once opened it…so chance of improper or incomplete closure…results into leakage of gas.

3.Faulty oxygen flow meters.

Flow meter having pressure gauze reader stops working after few days…and no standardization of it.

It is not possible to inspect the leakage from flow meter periodically.

4.How to open oxygen cylinder?

The process which I have learned by ward boy during my post graduation and practiced under his supervision.

You may be weak hearted person but to open oxygen cylinder you need to be strong handed.

Revise the knob / nozzle opens in anticlockwise rotational movement and closes in opposite of it.

Be fast to keep opener spanner into nozzle quickly…so it is must that you should know where it is.

After keeping or inserting opening spanner into nozzle in full complete depth…shout for a rod or any metal like rod or rod like object of any hard metal.

By one hand you fix opener spanner and by another hand stoke the spanner by rod like thing.

Cylinder does not open in one attempt as it is closed tightly after last use…so you have go on hitting it till it gets loosened.

Do not make to hit first stroke with full force in panicky…as this may result into sudden gush of oxygen…and the attached tube may give up…with large noise like blast due to pressured and forced gas come out…that can spoil your all connections including flow meter tubing.

So even in dam emergency need is to keep cool and to follow the rules.

Now you opened a main valve or nozzle.

Your job is not yet over. Start rotating wheel of flow meter in anticlockwise direction…looks for bubbles…rate of bubbles and the connect the rubber tubing or mask to patient.

All the steps are to be done in stepwise manner. You can have option of somebody helping you by putting rubber tube inside the nostrils of patient before you opened a cylinder. No…it can not be like that.

Now you are little bit relaxed and think of flow rate and regulate it according to your guidelines.

5.After use take care to close the main valve also…to avoid leakage…but do not hit hard…as that may damage the valve.

What is the need?

The basic need is of oxygen cylinder is to have regulator…which can be opened and closed smoothly and quickly in simple manner with out risk of leakage.

Questions in my mind

1. If the cooking gas has easy and safe option of opening and closing the gas flow …why not having in oxygen cylinder?

2. Under which department medical oxygen comes?

3. Why the industrial oxygen and medical oxygen has not been differentiated as far as make of valve is concerned?

4.The cost of medical oxygen is approximately 10000 Indian rupees…then also why the regulator is complicated and old one?

How to send patient with oxygen?

If necessary patient should be shifted with flowing oxygen gas cylinder.

No health person will argue on this issue.

How to send patient with oxygen?

1.In speedy ambulance one person is required to hold oxygen cylinder even though you have cylinder trolley having three wheel legs

2.Medical staff should be efficient and qualified.

My experience:

In my 18 years of medical practice…I have shifted seven patient including neonate along with oxygen. In some of the case I personally accompanied the patient.

All the seven occasion it was ambulance with no oxygen or any emergency equipments.

Three times flow meter was broken while returning back…as empty unsupported cylinders felled down.

Intention is not to mention the fact of broken equipments…but to think on basic facilities we provide and we maintain are not up to mark yet.

It is bitter truth.

Ambulance means the only vehicle to shift the patient …not more than that.

If ambulance is for just shifting the patient…any big vehicle can work as vehicle.

I have seen ambulances …written as cardiac ambulance… with out oxygen cylinder in it.

Ambulance has lost it’s urgency

When I was a boy I had seen road was getting cleared by sound of siren of ambulance by drivers taking their vehicles to side of road.

The ambulance is so much neglected in India…now a days…no vehicle gives chance to overtake…no vehicle intend to give side to ambulance.

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