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Possibilities for Mass Casualty Oxygen Systems in Search and Rescue Missions Part 1: the VIASYS Hi-Ox80tm

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Possibilities for Mass Casualty Oxygen Systems in Search and Rescue Missions Part 1: the VIASYS Hi-Ox80tm Defence Research and Recherche et développement Development Canada pour la défense Canada & DEFENCE DÉFENSE Possibilities for Mass Casualty Oxygen Systems in Search and Rescue Missions Part 1: The VIASYS Hi-Ox80TM F. Bouak D.J. Eaton Defence R&D Canada – Toronto Technical Report DRDC Toronto TR 2005-207 November 2005 Possibilities for Mass Casualty Oxygen Systems in Search and Rescue Missions Part 1: The VIASYS Hi-Ox80™ F. Bouak D. J. Eaton Defence R&D Canada – Toronto Technical Report DRDC Toronto TR 2005-207 November 2005 Abstract An experiment was carried out at Defence R&D Canada – Toronto to recommend an efficient oxygen breathing system for multiple casualties in remote areas. The objective was to improve the oxygen therapy capability and efficiency of the Canadian Forces Search and Rescue Technicians as well as any military organization that may potentially need to dispense oxygen to survivors of a mass casualty scenario such as in a field hospital or during submarine escape and rescue. Twenty-four trials were completed using twelve male and female volunteers (30- 55 years) to compare the VIASYS Hi-Ox80™ mask to a simple facemask. Measurements were made with the subjects at rest in seated and supine positions to simulate an injured person 80™ being administered oxygen (O2). The Hi-Ox delivered significantly higher O2 concentrations to the subjects at lower flow rates than the simple facemask. Given the high O2 concentrations, low O2 flow rates, low levels of inhaled carbon dioxide, constant levels of the exhaled carbon dioxide and low breathing resistance, the Hi-Ox80™ could be an efficient breathing unit for mass casualty treatment in a remote area. If an O2 concentration of 80% is adequate for treatment, the duration of a pressurized tank or the number of patients treated can at least triple with a flow rate of 4 litres per minute when compared to the currently used O2 systems. Furthermore, this O2 flow rate can allow the use of portable O2 concentrators, thereby increasing the efficiency while minimizing risks. Résumé RDDC Toronto a mené une expérience dans le but de recommander un appareil respiratoire à oxygène efficace dans le traitement d’un grand nombre de blessés dans les régions éloignées. Cette expérience visait à améliorer l’efficacité des soins d’oxygénothérapie offerts par les techniciens en recherche et sauvetage des Forces canadiennes ainsi que par toute autre organisation militaire qui pourrait être appelée à administrer de l’oxygène aux survivants d’un incident faisant de nombreuses victimes (p. ex. hôpital de campagne ou lors d’évacuation et sauvetage d’un sous-marin). On a mené 24 essais sur un échantillon de 12 volontaires des deux sexes (âgés de 30 à 55 ans) en vue de comparer le masque VIASYS Hi-Ox80MC avec un masque facial simple. Les mesures ont été prises alors que les sujets étaient au repos, en position assise ou couchée sur le dos, afin de simuler une personne blessée recevant de l’oxygène. Les résultats ont démontré que le masque Hi-Ox80MC est nettement supérieur au masque facial simple en ce qui concerne l’administration d’oxygène. Le masque Hi-Ox80 MC a permis d’administrer aux sujets des concentrations élevées d’oxygène à des débits plus faibles que le masque facial. Étant donné les concentrations élevées d’oxygène administrées, les faibles débits d’oxygène utilisés, les faibles concentrations de dioxyde de carbone inspiré, les concentrations constantes de dioxyde de carbone expiré et la faible résistance respiratoire, le masque Hi-Ox80MC pourrait constituer un appareil respiratoire efficace dans le traitement d’un grand nombre de blessés dans une région éloignée. Si une concentration d’oxygène de 80 % convient pour le traitement, la durée d’utilisation des bouteilles sous pression ou le nombre de patients traités pourrait être au moins triplé par rapport à la situation actuelle en réglant le débit à 4 litres par minute. De plus, ce débit d’oxygène rendrait possible l’utilisation de concentrateurs d’oxygène portables, augmentant ainsi l’efficacité tout en réduisant les risques. DRDC Toronto TR 2005-207 i This page intentionally left blank. ii DRDC Toronto TR 2005-207 Executive summary Introduction. In considering emergency response to major air or marine disasters, one of the most important initial actions is the dispensing of normobaric oxygen therapy (NBO) to survivors. Most of the available oxygen breathing systems used for oxygen (O2) therapy provide a very limited time on oxygen because of extremely inefficient oxygen use. Only two percent of the provided gas is actually used by the patient. The rest is exhaled into the atmosphere with each breath. This may be acceptable for treating accident victims in urban areas; however, to treat survivors in a remote area means more oxygen must be transported which increases weight, volume and risk to unacceptable levels. Defence R&D Canada – Toronto received support from the Search and Rescue (SAR) New Initiative Fund (NIF) to recommend an efficient oxygen breathing system for multiple victims. The objective was to improve the oxygen therapy capability of the CF Search and Rescue Technicians in remote areas. A review of the state-of-art [1] identified promising solutions for the CF, such as the 80™ ™ VIASYS Hi-Ox mask and the DAN REMO2 rebreather. These two breathing units were selected for manned evaluation. This report presents results for the Hi-Ox80 mask and compares its performance to the commonly used simple facemask. A second report [2] describes the evaluation of the REMO2. Methods. Twelve male and female volunteers (30-55 years) were recruited. The procedure for testing the Hi-Ox80 and simple facemask consisted of five breathing periods of 15 minutes each separated by 10-minute air-breaks. Oxygen flow rate was either 4, 7, 8, or 9 litres per minute (L·min-1) during each breathing period. Subjects were at rest breathing calmly at their own resting respiratory rate in seated and supine positions to simulate an injured person being administered oxygen. Inhaled and end-tidal O2 and carbon dioxide fractions (CO2), blood oxygen saturation, mask pressures, exhaled gas volume for the Hi-Ox80 and inhaled gas temperature were continuously measured. Subjects rated their perceived breathing effort and mask discomfort. Results. Twenty-four trials were carried out. Although both breathing units increased mean arterial oxygen saturation from 94.8% to over 98.2% (98.4% with the Hi-Ox80 and 98.2% with 80 80 the simple facemask), the Hi-Ox delivers more O2 at lower flow rates. With the Hi-Ox , the -1 inhaled O2 fraction (fIO2) was above 0.91 for flow rates greater than 7 L·min and was 0.80 -1 even at an O2 flow rate of 4 L·min while the highest fIO2 delivered by the simple facemask was just 0.60 at 9 L·min-1. Also, the Hi-Ox80 had low breathing resistance and maintained normal CO2 levels which would prevent excess CO2 elimination especially at high ventilation. There were no statistically significant differences in all variables between seated and supine positions. Significance. If an fIO2 of 0.80 is adequate for treatment, the duration of a pressurized tank or the number of patients treated simultaneously can at least triple with an O2 flow rate of -1 4 L·min when compared to the currently used O2 systems. Furthermore, the combination of a 80 modified Hi-Ox and a portable O2 concentrator could greatly increase the efficiency and safety of O2 delivery. It would replace the need for bulky, dangerous compressed oxygen supplies and thereby make sustained mass casualty NBO feasible in the field. This would benefit SAR and other military emergency operations such as submarine escape and rescue. Bouak, F. and Eaton, J. D. 2005. Possibilities for Mass Casualty Oxygen Systems in Search and Rescue Missions, Part 1: The VIASYS Hi-Ox80™. DRDC Toronto TR 2005-207. Defence R&D Canada – Toronto. DRDC Toronto TR 2005-207 iii Sommaire Introduction. L’une des interventions d’urgence initiales les plus importantes en cas de catastrophe aérienne ou maritime consiste à administrer de l’oxygène (O2) aux survivants. Toutefois, la plupart des appareils respiratoires à oxygène servant à l’oxygénothérapie ne permettent généralement qu’un traitement de très courte durée en raison de l’utilisation excessivement inefficace de l’oxygène. Seulement 2% d’O2 administré est effectivement utilisé par le patient. Bien que ce type d’appareil puisse convenir dans les régions urbaines, le traitement des survivants dans les régions éloignées nécessite le transport de grandes quantités d’O2, ce qui entraîne une augmentation inacceptable du poids, du volume et du risque. RDDC Toronto a reçu le soutien du Fonds des nouvelles initiatives de recherche et de sauvetage pour recommander un appareil respiratoire à oxygène efficace dans le traitement d’un grand nombre de blessés. On visait à améliorer l’efficacité des soins d’oxygénothérapie offerts par les techniciens en recherche et sauvetage des Forces canadiennes dans les régions éloignées. On a examiné les solutions de pointe [1] potentielles pour les Forces canadiennes, telles que le 80MC MC masque VIASYS Hi-Ox et l’appareil respiratoire à circuit fermé DAN REMO2 . Les deux systèmes ont été sélectionnés en vue d’un essai sur des sujets. Le présent rapport présente les résultats obtenus à l’aide du masque Hi-Ox80 et compare l’efficacité de ce dernier avec celle du masque facial simple couramment utilisé. Méthodologie. On a recruté 12 volontaires des deux sexes âgés de 30 à 55 ans. La procédure d’essai du Hi-Ox80 et du masque facial simple consistait en cinq périodes de respiration de 15 minutes, chacune étant suivie d’une pause de 10 minutes.
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