Covid-19: NTF recommends 2-3 weeks worth strategic oxygen reserve

Supreme Court-appointed National Task Force (NTF) of top medical experts, set up to formulate a methodology for allocation of oxygen to states and union territories, has recommended that the country should have strategic reserves of the gas for 2-3 weeks of consumption on the lines of the arrangements made for petroleum products.

The 12-member NTF also said that all hospitals should have a buffer capacity for emergencies and they should set-up oxygen monitoring committees of senior staff.

The top court had set up the NTF on May 6 to formulate a methodology for allocation of oxygen for saving lives of Covid-19 patients and to facilitate a public health response to the pandemic.

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"We should have strategic reserves of oxygen for the country to cover 2-3 weeks’ consumption, similar to the arrangement made for petroleum products. Similarly, all hospitals should have a buffer capacity for Emergencies,” the NTF said.

Dealing with augmenting the supplies of liquid medical oxygen or LMO, based on present and projected demands during the pandemic, the panel said that about 20 per cent buffer capacity of the states' requirement should be created for allocation over and above baseline demand for allocation to states with rising cases of Covid-19.

“Efforts are to be made to further scale up LMO production in preparation of the next pandemic. There is an urgent need to increase production of LMO from about 5 per cent - 8 per cent of gaseous industrial oxygen. Government should support and subsidize concerned industries”.

The panel suggested that in an emergency, the states may actively explore setting up some field/make-shift hospitals in proximity of industrial oxygen production units which can supply piped oxygen with necessary modifications and strict quality control and technology to be put in place to convert nitrogen plants to oxygen producing plants in case of an emergency situation.

It said that focus should also be placed on cylinders, gaseous oxygen and arrangement of cylinder fillers and CO2 cylinders from beverage industries may also be converted to oxygen cylinders.

The panel said that besides cylinders & LMO, the PSA plants must be encouraged, based on actual assessment as the PSA plants have the capability to manage a 100 bedded hospital and fill cylinders for ambulances and PHC/CHC as well.

“Make Oxygen generation units (PSA) compulsory for all hospitals, including for medical colleges and district hospitals. All district hospitals should have PSA plants with compressors so that they can manage their own load as well as fill cylinders for CHC/ PHC/ Ambulances,” it said, adding that each hospital with 100 or more beds should be encouraged to have an LMO installation and a cryogenic storage tank for LMO should be insisted upon for every hospital in metropolitan areas.

For rural areas, the panel said that Oxygen supply to rural areas to be supported with new strategies including the need to shift PSA plants towards vulnerable areas with cylinder turnaround time also needs to be efficient.

“Adequate number of cylinders must be kept as a buffer. The rural and semi-urban areas preparation should be prioritized henceforth”, it said, adding that the concentrators should be used in Covid Care Centres in rural areas, and district hospitals, where patients need 5 L/min Oxygen, thereby saving about 5 per cent-7 percent of oxygen usage.

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It said that Oxygen cylinder filling and storage in rural areas is important and hence, central filling stations be considered in districts/rural areas and for smaller villages liquid oxygen cylinders of 250 litres may be considered to be parked for 10-12 bed facilities.  

“There should be a strategy to manufacture oxygen locally or in the neighbourhood for the big cities to fulfil at least 50 per cent of their LMO demand, as road transportation is vulnerable. This may be taken up in respect of Delhi and Mumbai on priority, due to their population density. All 18 metro cities will be made oxygen independent, with at least 100 MT storage in the city itself,” the panel said.

Making number of recommendations in its 163-page report submitted to the top court, the NTF suggested steps to be taken at hospital level and State level and said that in hospitals, “If oxygen saturation remains below 92 percent on 5L flow, awake-prone position may be advised to reduce oxygen requirement of patients; hence more stress on this intervention”.

On monitoring of Oxygen needs at State level, the panel said that in normal times no special arrangements are required but in emergency, implementation of management of Oxygen Grid with 10-12 regional production sites is required .  

“The storage hubs with state and district storage spokes should be in place for any emergent situation. Long haul connectivity through Rail from the production hub to the storage hubs, with the last mile connectivity as a spoke model transported by trucks. The LMO production hubs should be so located that the transport distance even by rail is preferably less than 24 hours,” it said.