An injured or ill person can benefit greatly from receiving air with a higher oxygen concentration.
The air a person normally breathes contains approximately 21 percent oxygen. The concentration of oxygen delivered to a victim through rescue breathing is 16 percent.
Without adequate oxygen, hypoxia, a condition in which insufficient oxygen reaches the cells, will occur.
Signs and symptoms of hypoxia include
Increased breathing and heart rate.
Changes in level of consciousness.
Cyanosis (bluish lips and nailbeds).
Always provide emergency oxygen to a victim having difficulty breathing if it is available, you are trained to use it and local protocols allow.
Emergency oxygen should be considered if
An adult is breathing fewer than 12 breaths per minute or more than
20 breaths per minute.
A child is breathing fewer than 15 breaths per minute or more than
30 breaths per minute.
An infant is breathing fewer than 25 breaths per minute or more than
50 breaths per minute.
To deliver emergency oxygen, you need:
An oxygen cylinder.
A regulator with pressure gauge and flowmeter.
A delivery device, such as a nasal cannula, resuscitation mask, non-rebreather mask or a BVM (more below about these).
Some emergency oxygen systems deliver oxygen at a fixed-flow rate. (See picture on the right above.) The delivery device, regulator and cylinder are already connected, which reduces or eliminates need to assemble the equipment making it easier and quicker to deliver emergency oxygen. But you can only deliver at a pre-set rate of either 6 liters per minute with a nasal cannula or 12 liters per minute with a resuscitation mask or non-rebreather mask.
To operate this type of device, the rescuer makes sure it is turned on, checks that oxygen is flowing and places the mask over the victim’s face.
One brand will run for 90 minutes. Another quotes 40 minutes at 6 LPM (liters per minute).
In the United States, oxygen cylinders are labeled “U.S.P.” and marked
with a yellow diamond that says “Oxygen.”
U.S.P. stands for United States Pharmacopeia and indicates the oxygen is to be used for medical purposes.
In the United States, oxygen cylinders typically have green markings. However, the color scheme is not regulated, so different manufacturers and other countries may use different color markings.
Oxygen cylinders contain gas under high pressure. If mishandled, cylinders can cause serious damage, injury or death.
Oxygen cylinders come in different sizes and have various pressure capacities. Cylinders are identified by letter according to their size. Manufacturers stats vary, some say D cylinders (the most common size) hold 300 to 350 liters, others 415. E = 625/682 M = 3,000/3,450, 1723 G = 5,300, H = 6,900.
At 12 LPM a 415 liter tank will run for an average of 35 minutes. Another source says a D tank, with 300-350 liters will run for 50 minutes at six liters per minute, or 35 minutes at 10 LPM, or 30 minutes at 10 LPM. An E tank, with 600 liters would run for 1 and 3/4 hours at 6 liters per minute, one hour ten minutes at 10 LPM (liters per minute) or one hour at 10 LPM.
The regulator reduces the pressure of the gas coming from the cylinder to a level that is safe for delivering oxygen to a victim.
The pressure gauge shows the pressure in the cylinder in pounds per square inch (psi).
The O-ring gasket makes the pressure gauge seal tight.
A flowmeter controls the amount of oxygen administered in liters per minute (LPM).
Oxygen should be delivered with properly sized equipment for the respective victims and appropriate flow rates for the delivery device.
- Nasal cannula: flow rate 1-6 LPM, 24-44 percent oxygen concentration, (one source says 25-45%) victims with difficulty breathing, sometimes used for victims unable to tolerate a mask. Available in adult and pediatric sizes.
Resuscitation mask: flow rate 6 -15 LPM, 35-55 percent oxygen concentration, victims with difficulty breathing and non-breathing victims
Non-rebreather mask: flow rate 10-15 LPM, up to 90 percent oxygen concentration, (one source says 60 to 95%) breathing victims only
BVM: flow rate 15 LPM or more, 90+ percent oxygen concentration, victims with difficulty breathing and non-breathing victims
A nasal cannula is a plastic tube, held in place over the victims ears, with two small prongs that are inserted into the victim’s nose. This device is used to administer oxygen to a breathing victim with minor breathing problems.
Oxygen is normally delivered through a nasal cannula at a low flow rate of 1 to 6 LPM, giving about 25 to 45% oxygen.
Nasal cannulas also can be used if the victim does not want a mask on his or her face.
A resuscitation mask with an inlet valve may be used with emergency oxygen to give rescue breaths to breathing and nonbreathing victims.
The recommended flow rate when using a resuscitation mask is 6 to 15 LPM.
A non-rebreather mask is an effective method for delivering high concentrations of oxygen to a breathing victim.
Non-rebreather masks consist of a face mask with an attached oxygen reservoir bag and a one-way valve, which prevents the victim’s exhaled air from mixing with the oxygen in the reservoir bag. Flutter valves on the side of the mask allow exhaled air to escape freely. As the victim breathes, he or she inhales oxygen from the bag.
Because young children and infants may be frightened by a mask being placed on their faces, consider a blow-by technique. The rescuer, parent or guardian should hold a non-rebreather mask approximately 2 inches from the child’s or infant’s face, waving it slowly side to side. This will allow the oxygen to pass over the face and be inhaled. Or the end of the tube from the tank can be placed next to or even in a toy/stuffed animal, and held close enough to the child’s mouth/nose.
The reservoir bag should be sufficiently inflated (about two-thirds full) by covering the one-way valve with your thumb before placing it on the victim’s face. If it begins to deflate when the victim inhales, increase
the flow rate of the oxygen to refill the reservoir bag.
The flow rate when using this device is 10 to 15 LPM (liters per minute).
A non-rebreather mask can deliver an oxygen concentration of 90 percent or more.
A BVM can deliver up to 100 percent oxygen to a breathing or non-breathing victim when attached to emergency oxygen.
Squeezing the bag as the victim inhales helps deliver more oxygen. BVM flow rates should be set at 15 LPM or more.
Take the following precautions when using oxygen:
Always make sure that oxygen is flowing before placing the delivery device over the victim’s mouth and nose.
Do not use oxygen around flames or sparks. Oxygen causes fire to burn more rapidly. Do not smoke or let anyone else smoke around oxygen in transport, in use or on standby.
Do not use grease, oil or petroleum products to lubricate or clean the pressure regulator or any fitting hoses, etc. This could cause an explosion.
Do not stand oxygen cylinders upright unless they are well secured.
If the cylinder falls, the regulator or valve could become damaged or cause injury.
Do not hold onto protective valve caps or guards when moving or lifting cylinders.
Do not deface, alter or remove any labeling or markings on the oxygen cylinder.
Do not attempt to mix gases in an oxygen cylinder or transfer oxygen from one cylinder to another.
Never use oxygen without a safe regulator that fits properly.
When the tank is not in use keep valves closed even if the tank is empty. Store oxygen tanks below 125°F.
If defibrillating, make sure that no one is touching or is in contact with the victim or the resuscitation equipment.
Do not defibrillate someone when around flammable materials, such as gasoline or free-flowing oxygen.
Never drag or roll cylinders.
Carry a cylinder with both hands and never by the valve or regulator.
Do not store oxygen cylinders near flammables or hot water heaters, near electric or phone boxes, where they can have something heavy fall on them, where they could be tipped over or exposed to heat or direct sunlight.
When transporting oxygen cylinders: do not store them in the trunk; secure then in case of a sudden stop, acceleration or sharp turn, when they could become a serious projectile hazard; immediately remove them from the vehicle rather than risk heat exposure which could cause a potentially hazardous release of gas.
Regularly check for cylinder leaks, bulging, and defective valves. Also check for rust or corrosion on the cylinder or cylinder neck or regulator assembly. No adhesive tape should be put around the cylider neck, oxygen vale or regulator assembly as it can hamper oxygen delivery and might also have the potential to cause a fire or explosion.
Oxygen tank capacities
Capacities of small fixed rate cylinders vary. They all are supposed to have at least a 15 minute supply. Two major brands offer 40 or 90 minutes at 6 LPM.
A larger variable rate tank (the kind you use a regulator with) will hold much more. A typical D size tank, such as the ones we use for training in my classes, would hold 350 to 425 to 415 liters (different manufacturer’s stats), and have an average run time of 138 minutes at 3LPM (liters per minute) or 35 minutes at 12LPM.
A larger E size would hold 625 to 682 to 684 liters and have an average run time of 227 minutes at 3LPM or 57 minutes at 12LPM.
You can figure out how much more run time you have left on a given cylinder by using the mathematical equation:
(Gauge Pressure minus Safe Residual Pressure) times Cylinder
Factor divided by Flow Rate
Tanks start out with 2000 PSI (pounds per square inch) pressure. Most authorities will tell you to refill a tank before it gets down to 200 PSI, the safe residual pressure.
The cylinder factor for a 400 liter D tank is 0.16, for a 625 liter E tank it’s 0.28.
To use the equation: at your pool you have the usual D cylinder. When you start to use it you see a cylinder pressure of 800 PSI. You set the flowmeter for the non-rebreather mask for your breathing victim to 15 liters of oxygen per minute.
How many minutes of oxygen do you have left?
(800 minus 200) times 0.16) divided by 15 = just under 6 and a half minutes
In this instance you might want to get out another tank and get it ready.
(According to the Red Cross, in late 2006, “In Santa Clara County, for example, the average emergency response time from the call to 911 to arrival is about 7 minutes. (Times may vary due in part to traffic delays and the logistics of getting to victims in high-rise buildings.)” )
Some students ask:
Isn’t oxygen a prescription item? Can a trained lifeguard or first responder administer oxygen without a doctor’s order?
The Red Cross says:
“Emergency oxygen does not require a prescription. The Food and Drug Administration (FDA) regulation of oxygen is defined by the dose and duration of the oxygen administration. According to the FDA, to be classified as emergency oxygen, it must be delivered at a dose of at least 6 liters per minute or run for a duration of more than 15 minutes. In this case it is considered first aid use and does not require a prescription. When the dose of oxygen is delivered for less than 6 liters per minute or for a duration of less than 15 minutes, a prescription for oxygen is required. State and local regulations may differ and should be consulted before allowing lifeguards to administer emergency oxygen.”
The following is an Oxygen administration skills checkoff list including steps for use of an oxygen tank and the main things to remind students of as they are being tested. This is not complete instruction in the use of oxygen. These steps do not apply to all makes/models of tanks/bags. Everyone should follow manufacturers instructions and local protocals.
(remind the student that the tank is a potential hazard and must not be left standing up by itself, they should direct the working end away from others when working with it, if lying flat on the floor it can be placed on a towel so it won’t roll)
_____check to see if labeled Oxygen (green with yellow diamond)
_____ clear valve by first removing protective covering (remove covering and save plastic gasket if present)
(REMIND student: Do not point it at anyone, or look into it or put hand over it)
_____ open cylinder for about one second (counterclockwise / lefty-loosy = removes and dirt or debris)
Attach oxygen pressure regulator
_____ (check to be sure pressure is at zero and flow meter off)
_______ replace plastic O ring gasket into the large valve opening at the top of the cylinder – if needed
_______ check if regulator is for use with oxygen (see labeling)
______ place regulator on cylinder (slip it down)
_____ find the prongs on the regulator and seat them into the valve
_______ hand-tighten the screw until the regulator is snug (fairly tight)
(REMIND student: do not look closely at meter at this point in case it comes off)
________ SLOWLY open the cylinder one full turn (should not hear air leaking- release pressure on dial if you have to undo it)
________ check the pressure gauge to determine how much pressure is in the cylinder
(full – 2000 psi to go out on a call, above 500 is okay, 200 is ’empty’)
____ attach delivery device and tubing to the flowmeter
_______adjust the flowmeter (clockwise) to the appropriate rate on dial or in window
(Review w/student: cannula 1 to 6 lpm (use only if victim can’t tolerate mask on face- in emergency they need more oxygen), Pocket mask 6-15 , Non-rebreather mask = 10 -15 = conscious victim, BVM 15 or more, infant = no mask, wave in front of nose = ‘blow-by’ delivery)
____ verify O2 flow by listening and feeling for oxygen flow thru the delivery device
______(If non-rebreather – inflate the reservoir bag by putting finger over the one-way valve in the mask)
________ place device on victim
________(did student explain to conscious victim first?)
(If claustrophobic have them hold on to mask instead of using elastic around head)
(If BVM If victim is breathing at (adult) less than 12 breaths per minute or more than 20 per minute needs assistance of rescuer squeezing bvm as victim breaths (child 15 – 30, infant 25 -50) (IF NON-rebreather – bag should not collapse fully while in use)
____ remove from face (____ did student first explain to conscious victim?)
____ turn off flowmeter
____ close the cylinder (righty-tighty)
___ turn on flowmeter at bleed line (turn it back to zero)
____ remove regulator
________Be sure the oxygen cylinder is not standing upright unless on a cart –
remind student: do not use with AED,
Do not use around open flame or sparks (oxygen causes fires to burn more rapidly)
Do not use grease, oil or petroleum products to lube any pressure regulator parts (oxygen does not mix with these and a severe chemical reaction could cause an explosion)
Simple secondary survey study sheet
more details of the SAMPLE questions
Times to suspect a spinal injury: (and use a jaw thrust instead of a head tilt, chin lift).
Reasons why a person might become unconscious or semi-conscious (AEIOU TIPS)
causes of altered mental status, fainting, seizures,
Signs and symptoms of a concussion
care for a stroke
normal respiration, pulse, temperature
and a detailed simple secondary survey (SAMPLE, opqrst)
pages 268-269 are the administering emergency oxygen skills sheets.