Medical gas pipeline system disruption during tropical cyclone 'Fani' - a clear and present danger of tropical cyclones: Are we prepared?

Sir,

The sudden disruption of oxygen supplies due to damage to medical gas pipeline system (MGPS) during a natural disaster can adversely affect patient safety during anaesthesia. With the alarming climate change crisis, we are vulnerable to increasing frequency and severity of natural disasters such as tropical cyclones in recent years. Here, we present such a life-threatening disaster which occurred during the category five cyclonic storm Fani. On 3rd May 2019, it made landfall in the state of Odisha, India with a wind speed of more than 250 kmph creating huge devastation.[1] Anticipating any untoward event during the cyclone, the routine surgeries were deferred. However, emergency surgeries were going on. Suddenly oxygen failure alarm started ringing in the panel and the central oxygen pipeline pressure decreased to zero. The type E oxygen cylinders which were present behind the workstation were opened and the surgeries were completed uneventfully. We were informed that all the medical gas pipelines (air, oxygen, nitrous, vacuum) were disrupted as part of the chimney of the boiler unit broke during strong wind and fell down on the MGPS at its outlet near the gas manifold [Figure 1].

Figure 1

The broken medical gas pipelines (blue arrow) at its outlet from the medical gas manifold. The broken chimney of the boiler unit (white arrow). Left top inset: The broken part of the chimney of the boiler which fell over the medical gas pipelines during the cyclone. Right bottom inset: Medical gases pipelines inside the manifold

The standards while installing the MGPS system was not properly followed as found post-disaster. As a lesson learnt, we would like to highlight the concerns and safety measures which should be taken to preventing damage to the MGPS during such a disaster.

Adequate experience and knowledge of medical administration and the involved department (anaesthesia and critical care) while installing the MGPS is one of the important factors which should be taken into account while installing the MGPS and liquid oxygen plant

Pipelines in exposed areas shall be protected from physical damage

Medical gas piping must be clearly identified using non removable stickers that are colour coded according to the gas Figure 1]

Hangers should be installed as required for support of all exposed pipings

MM Kembla Kemlag sheaths are available to fit over and protect. There are 12.7 mm (1/2”) and 19.05 mm (3/4”) size copper tubes through which the pipelines pass as they traverse masonry walls, partitions or floors[2]

Pipelines are preferred to be buried in cyclone-prone areas. Buried gas pipelines are preferred to avoid physical damage to them due to high-speed winds

If buried then a sticker must be present over the ground to identify them

Buried pipelines shall be protected adequately against frost, corrosion and physical damage

Copper tubes may experience severe corrosion if buried in direct contact with extreme environments

Medical gas pipelines may be placed in the same tunnel, trench or duct with fuel gas pipelines or steam lines, provided that these medical gas pipelines are a minimum of 50 mm from other pipeline systems and combustible material and there is good ventilation

Medical gas pipelines should not be enclosed in reinforced concrete or placed under slab on ground floors.

Adequate stocks of oxygen cylinders should be available for two days in the manifold

Specifications must be followed and certified from competent authority or experts

Maintenance should be carried out at regular intervals and any damage should be repaired.[3]

Natural disasters are unavoidable. With climate change, such disasters are going to increase in future. We should take appropriate measures to protect MGPS to prevent damage during such disasters and be prepared to manage any unanticipated events.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.