Rescue Resuscitators

BREATHING ON DEMAND

By Cindy Freiman

One of your co-workers has collapsed in a toxic or oxygen-deficient environment and you have to act fast to get him out of there in order to start him breathing again, right? Yes, and no.

Traditional confined space rescue calls for an attendant or emergency response team member equipped with self-contained breathing apparatus to enter the space to effect a rescue. If the victim is still breathing, a standard escape ventilator can be put on the victim to give him oxygen to breathe, and/or to prevent him from inhaling more of the contaminated air.

But what if the victim is not breathing? Simply supplying air or oxygen would have no effect, since the victim is not in a position to breathe it in. Mouth-to-mouth resuscitation would be nearly impossible in a toxic atmosphere. CPR would have to wait until the victim is removed from the space -- an operation that would eat into the vital four minutes an average person can go without breathing before brain damage begins to occur.

While it is still important to get the victim out of the toxic environment as soon as possible, there is another option available: an IDLH, or "immediately dangerous to life and health" rescue resuscitator will enable you to enter the confined space, place a face mask on your co-worker, start him breathing again and then get him out of there safely. Sound too simple? As long as you stay abreast of the standard first aid and CPR practices, using such a device is virtually foolproof.

The difference between "rescue resuscitators" and standard "escape respirators" or other sources of supplied air is simply that the rescue device will ventilate a person who is not breathing on his own. It will actually inflate the lungs with a safe level of oxygen, allow the patient to exhale and continue a natural breathing cycle.

Currently, there are at least two types of rescue resuscitators available that are portable enough to be easily brought into a confined space, as well as effective in getting a downed worker breathing again. One is made by O-Two Systems International -- a Canadian manufacturer of emergency medical equipment -- manufactures these devices; the other is made by U O Equipment Company, based in Houston, Texas.

The Genesis II IDLH Rescue Resuscitator from O-Two allows a worker to enter a toxic space, slap a facemask on a downed worker and quickly administer oxygen through a hose attached to a compressed air cylinder, says Kevin Bowden, general manager of O-Two Systems and co-inventor of the Genesis II IDLH. The hose can either be hooked up to the rescuer’s cylinder or a separate cylinder. Either way, the pneumatic device -- which is powered by the release of compressed air from the cylinder -- starts delivering a precise, regulated amount of air into the patient’s lungs.

The device is designed for use by people with minimal training, adds Bowden. A CPR course is recommended, but anyone can use it as long as he or she knows how to hold a facemask in place, check a person’s airway and tilt the worker’s head. The device does everything else.

The Genesis II IDLH was specifically designed to meet criteria set out by Shell Canada Ltd., says Bowden. The primary problem in confined spaces found in the petrochemical industry is hydrogen sulfide – a colourless gas that knocks out the breathing centre in the brain with very small concentrations, he notes, adding that a patient only has about four minutes to start breathing before brain damage occurs. And, when dealing with confined spaces, it is virtually impossible to get someone out of the area in time for successful resuscitation. As such, the Genesis II IDLH can mean the difference between body extraction and saving a life, says Bowden.

In 1991, Shell Canada issued specifications to several manufacturers in order to find a product that could handle the spontaneous breathing patterns of downed workers as well as supply a positive pressure in the mask to ensure that any toxic gases in the confined space were not permitted to enter the worker’s airway, says Ann Campbell, Shell Canada’s occupational health and safety coordinator. Other specification requirements for the device included that it be easy-to-use, lightweight and portable.

Shell Canada field-tested two rescue resuscitator prototypes, says Campbell. The Genesis II IDLH proved to be the most effective, portable, and easiest unit to use, she concludes. The key to its success rests mainly with the fact that front-line Shell Canada workers were involved during all of the device’s developmental stages from creating the specifications, to field-testing, to tailoring the training needs and developing specific courses for Shell Canada staff members, she says.

"It automatically starts ventilating," says Bowden of the Genesis II IDLH. "There is no need to turn any switches or anything, and it ventilates at a normal respiratory rate for an adult." There isn’t a need for an "on/off" switch -- as soon as the hose is plugged into the air source, the device is in use (provided the oxygen source is on). The device is also smaller and more portable than any other rescue resuscitator, Bowden emphasizes.

Should the victim start to breathe on his or her own, the device automatically stops pumping air. And, if the patient stops breathing again, the device simply kicks in after a few seconds if no oxygen has been drawn from the unit, and starts delivering oxygen again.

The worst thing that can happen when a patient spontaneously starts to breathe is that the ventilator pump will give the patient another breath. Excessive amounts of oxygen can cause hyperventilation, where the blood becomes over-oxygenated and can result in dizziness and even fainting. This, however, is much better than having someone fall into a state of unconsciousness.

Thanks to preventive measures, however, knockdowns in the petrochemical industry are becoming a lot less frequent, says Campbell, who claims the Genesis II IDLH has yet to be used in a life-or-death situation at Shell Canada. "We’ve been fortunate that we’ve never had to use one in a real life situation," she explains. "But, we’ve had them in place since 1993 and we train on them every year and are confident that they would meet our needs." Still, the first line of defence for workers performing rescue scenarios is to remove the person from that environment as soon as possible, Campbell adds.

Bob Wright, president of U O Equipment Company, agrees that minimal training is required with rescue resuscitators. However, he notes, many companies in the United States shy away from allowing their employees to perform such rescues due to the fear of civil liability.

The Model 10600T Resuscitator/Fixed Flow Inhalator (single cylinder unit), available from U O Equipment, was designed with industrial safety in mind, says Wright. It is equipped with an LSP Toxic Atmosphere Demand Valve (TADV) and is to be used while performing external cardiac compression. If the patient is not breathing, a special demand valve is used. However, if the person is breathing, a "quick-connect" fitting on the inhalation mask hose is plugged into the regulator socket. A constant flow of oxygen fixed at six litres per minute is then delivered to the downed worker and the rescuer has no adjustments or decisions to make.

The TADV is designed to deliver 100 per cent oxygen to a breathing or nonbreathing patient in a toxic environment, says Wright. A slight positive pressure is always maintained at the outlet of the valve to ensure that no outside gases are entrained, he adds. The resuscitator can be used with a mask, an endotracheal tube or a tracheotomy tube. The valve can be used in conjunction with a portable oxygen cylinder equipped with a pressure regulator or with a central oxygen source.

In the "standby" mode, the resuscitator can be connected to an oxygen supply and be made ready for use. When switched to the "resuscitation" mode, oxygen will automatically begin to flow, purging the resuscitator and the patient adapter of the toxic gases. When the manual control button is pushed, a flow of oxygen inflates the lungs. This pressure is maintained until the button is released. The contents of the lungs are then expelled through the exhalation valve. If the patient is breathing, this inhalation effort will produce an oxygen flow that varies directly with the demand and stops during exhalation.

The LSP AutoVent is also available with an anti-inhalation valve for use in toxic environments, Wright notes. It uses pneumatics to assure a reliable, time-cycled, constant flow of ventilation is acquired while using minimal source gas. Each AutoVent is equipped with a bright green visual breath indicator, a built-in pressure limit alarm and Intermittent Mandatory Ventilation that provides gas flow for spontaneous breathing patients.

The AutoVent’s air volume can be adjusted depending on the breaths per minute that are required for a specific downed worker. Made up of two components, the AutoVent has a control module and a patient valve assembly, which houses the facemask.

U O Equipment’s largest customer for rescue resuscitators is US Steel Group -- one of the United State’s largest manufacturers of steel products. Initially, US Steel Company began using the resuscitators because it encountered situations where two or three employees would go down in a toxic environment before anyone would realize there was a problem, Wright explains, since life-threatening scenarios can develop quite rapidly.

Costs

The Genesis II IDLH costs about $2,200 in Canadian funds, and the U O Equipment models run anywhere from $700 US for the Model 10600T to $2,000 US for the AutoVent. The AutoVent is comparable with The Genesis II IDLH, says Wright. Typically, the more automated and easy-to-use the device is, the higher its price tag.

The importance of using a rescue resuscitator in a confined space rescue can be compared to the importance of using an automatic external defibrillator, otherwise known as an AED, during a cardiac arrest. Both devices require minimal training and while an AED will not issue a shock to a patient unless absolutely necessary, a rescue resuscitator won’t pump air into a patient unless it is essential to the health of the fallen worker. Another common factor shared by the two devices is the short margin of time in which rescuers have to put the units to work.

Sidebar: What makes rescue resuscitators different?

Since a downed worker only has perhaps four minutes to start breathing again before brain damage starts to occur, rescue resuscitators must possess several features that allow them to be easily brought into and out of a confined space, as well as be capable of starting someone breathing as soon as possible, without allowing toxic gases to enter the worker’s airway. Important features to look for in a toxic environment rescue resuscitator include:

Portability – the easier the unit is to transport, the better;

Compactness – lightweight devices are easier to control and carry (e.g., the Genesis II IDLH weighs less than 370 grams);

Ease of use – automated units that require little training are ideal;

Spontaneous breathing capabilities – it is vital for a rescue resuscitator to be capable of starting and/or regulating a worker’s breathing as soon as possible, as it may be too late to begin CPR once the worker has been removed from the dangerous atmosphere; and,

Positive pressure inside the mask – this ensures that none of the ambient air enters the victim’s airway and causes further problems.

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