Dave, thank you very much. I didn’t know you were talking before me, and you were going to set me up and tell the whole audience what they should now be looking for; however, this is my well-rehearsed presentation. And I start off this way. Can I please ask you all under COVID rules, put on your mask and just stand up. Not just to flex your legs, but this is part of, can I ask you to stand up please? Thank you very much everybody, excellent. This refers back to the first ever scientific paper I read in 1986, as John introduced me there, when I worked in Cardiff Royal Infirmary.

The first three rows, you can sit down, you can sit down, because according to the research paper that I read you are academics, and in your professional career you will contribute towards academic scientific research papers. That’s what the research said. The middle rows, all bar the back two, the middle rows, you can sit down as well, because you’re kinaesthetic learners. You learn with your hands, you’re good with your hands, you’re practically skilled, and you’ll also contribute towards policies and procedures that will end up saving patients’ lives. That’s what the research says, and it’s proper scientific research. The people in the back two rows you think about sex and chocolate apparently. That’s all it says. You can sit down as well by the way, you can sit down.

A little bit about me then. So I’ve worked for wow, 34, just over 35 years in the NHS. I started with long blonde hair. I started when Bros were in the charts first time round. Some people will know what I’m talking about, and the young people in the audience won’t have a clue. But what I did do the day that I started, Justin McCarthy just in there, interviewed me for my first very job. And I started in October 1986. So what I did was I went onto the internet and I searched which pop group or star was number one in the charts the day I started my professional career. And mine’s a one hit wonder, Nick Berry, who was on Eastenders, then he went on to other programmes as well. So that’s mine, and your takeaway message today when you leave the auditorium is to have a search on the internet, and see which pop group or band was number one when you started your professional career. Yeah, we’ll have a look at that later perhaps.

So, as John as said, one of my big subject matter areas is infusion therapy, or IV devices, I do a lot of work on that. My second best subject, if you like, or equivalent subject is medical gases and oxygen safety, what I’m here to talk to you about today. So if I was going to be on Mastermind, rather sadly I might choose one of those two subjects, or maybe music by the Jam. That’s my third choice if I was going to be on Mastermind. I’m going to try and cover in less than 30 minutes those subjects. This is just a snapshot of the training that we’ve designed and developed and delivered, and are going to be sharing across the UK. So we’re looking at medical gases and oxygen safety, and we’re going to cover everything was from what we breathe, why, where, risks, safety and your role, and hopefully you can take some messages back to where you work in your professional career.

The first thing I’d like to say is that we have to consider medical gases, oxygen in particular, they have the same status as a drug, and therefore they should be managed as a drug would be managed. They should be prescribed, monitored and measured, except for an emergency then anybody can give oxygen, anybody. It comes from the Medicines Act but the drugs don’t come in packets or little foil bags, they come in cylinders like I have here. Some of the most common drugs you’ll see, and I’ve made a list there for you, oxygen right at the top, it’s absolutely everywhere. Then we get medical air. And our engineers would know we have two different pressures for medical air. We have medical air four bar or 60psi, and we have seven bar, which is a higher pressure equivalent that’s used in theatres for air tools and driving other air operated devices. We have Entonox, trade name Entonox, belongs to BOC. That’s a 50/50 mixture of oxygen and nitrous oxide. It’s a 50/50 mixture.

The interesting thing about Entonox is when it gets cold those two gases can separate out, and one of those gases becomes a liquid that can sit inside the cylinder. And the temperature isn’t that low, it’s about minus six. So if you keep your Entonox cylinders outside, and it gets lower than minus six, which it can in winter, then those two gases can separate out, and then you have to physically pick up the cylinders and mix it. If you ever watch Call the Midwife where they call for a bowl of warm water, it’s not for the mother of the baby, it’s to warm up the cylinder. No, it’s not, I just made that bit up!

Then you have nitrous oxide as well. Literally before I left my department I was teaching this course to my portering staff three days ago, and we had our second break-in where 20 cylinders of nitrous oxide were stolen. They smashed the door open with a van, disconnected them off the manifold and just stole them. So they’re gone again. Last time we found them in Liverpool, I don’t know why, they must have been going up North somewhere, so we’ve lost 20 cylinders of nitrous oxide. There’s other gases as well: carbon dioxide. Carbon dioxide when compressed can go into a liquid, and there’s only a couple of gases that can do that. Then we have Heliox, special mixtures for ECG, nitric oxide, which is only about 25 years old in terms of a treatment. I think I worked in special care baby unit, where they’d administer nitric oxide for the time ever, and that’s been in my professional lifetime, and then special gases. I’ve mentioned [vacuum? 0:40:49]. It’s a suction unit; it’s not actually a gas per se.

So I’ve mentioned about the liquid status of gases. When you compress some gases into a cylinder, they are still a gas. The bottom one’s there, air and oxygen you’ll see, and the top ones like nitrous oxide, Entonox and carbon dioxide. It’s important to know that your gas is a liquid or it’s a gas, because of the gauge and the contents. The contents gauge for a gas will remain full when it’s full, half full when it’s half full, quarter full when it’s quarter full. But a liquid gas pretty much remains full all the time until all the gas has gone. The last bit of liquid turns into a gas and only then does the gauge start to fall. And that’s when the anaesthetist will scream that certain gases are running out, because as soon as that liquid gauge starts to fall you need to change those cylinders almost immediately.

Your cylinders could be large J sized cylinders connected in a manifold, as you’ll see on the top right there, or we have the most common themed portable cylinders. This is a CD side cylinder. You can have an HX sized cylinder. It’s an alphabetical code, and you’ll get to learn that as well. And it’s about transporting patients. And I will concentrate on this particular cylinder today as well. You can also get your oxygen, most hospitals get their oxygen from DVIE, the vacuuming so it evaporates, or the flask. Inside the large tank there you’ve got liquid frozen oxygen that’s about minus 183 degrees, and there’s hundreds and hundreds of thousands of litres in there. The little tank to the right-hand side of it is the backup tank in case the oxygen runs out. Then you have the warming pipes. That’s where the ice collects, and then those pipes go round the wards.

And that’s where you’ll see the oxygen flows on the wards. And I’m sure my contemporaries in the room during COVID have dealt with the issues that we’ve dealt with, which is millions of litres in the tanks, but you can’t get it out through the pipes, because you can’t get the flow out that you need. You mentioned high flow devices that take tens and tens of litres out of the wall. In our hospital we had a list of all the products and all the flows, and some of the devices near the bottom end, the high flow nasal oxygen devices, we had a mandate in our hospital that if a patient came in with a HFNO that the patient wouldn’t be treated, because we couldn’t afford the gas, and that patient would have to go to end of life and palliative care for COVID. So we learned an awful lot about that, and a lot of information was shared about these VIEs as well.

So, first question, I’d like you to ask the person sitting next and/or near to you please, there’s a picture there of one of these cylinders. This is a CD cylinder. There’s a one litre bottle next to it. How many litres do you think the nurse has in one of these during transport? Ask the person sitting next to you, how much do you think? How many litres of oxygen in one of these cylinders? Anybody? OK, there’s 460 litres in there. That’s a lot of litres. That’s a HX cylinder, which is the larger one on a transport trolley that sits in the corridor in the hospital that I work. That’s the bigger version, that’s got 2,300 litres in there. That’s a lot of oxygen in there. Now nursing staff have to know how much oxygen is in there, how long it will last, will it last for transfer and how long will it last on an emergency rebreathe mask? And there’s a chart that’s available, it should be available everywhere in the wards and departments.

Just to give you an example, if the patient was on one of these on a nasal cannula, I’ll show you in a moment, that will last about for hours. If however this is used for an emergency and it’s full, and you put an emergency mask on there that you’ll need to set to 50 litres, if it’s full you’ll get 30 minutes if you’re lucky. If the gauge is in the middle, half full, you get about 15, and if the gauge is towards the red, and you’ve picked that up for an emergency resus, you’ll get seven minutes of oxygen. That’s all you’ll get. So it’s really important that you know how much is in those cylinders and the flows. And in fairness to BOC, last year they issued a free app for phones called the BOC estimator app you can download, and all nursing staff can use it. You can point the camera at the barcode, it’ll detect the size of cylinder, point it at the gauge, it’ll read the gauge, turn it to the dial flow, it’ll tell you how long that cylinder will last, and you can set an alarm. So there’s some good stuff coming out there.

I’m going to ask you another question for you to ask the person sitting next to you, but before I do can I tell you that I just taught a thousand staff last year on this training course during COVID. That’s new staff coming back to the hospital, doctors, GPs, all sorts of people coming back to help - 80% of the nursing staff and staff that I asked didn’t know the answer to this question. They didn’t know it. They got nowhere near it. What percentage oxygen is in the atmosphere that we breathe? How much? 21%? Did you say 21? Correct, you were a little bit worried there, it’s 20.96%. Nitrogen of course, but look at the percentage of trace element of carbon dioxide in the atmosphere, 0.04%, a tiny amount. Clinically insignificant for humans, however, we breathe out, and we breathe out a hundred times more.

So we are breathing out 4% carbon dioxide every time we breathe, every time you breathe. Every time you breathe into your mask, you’re breathing out 4% carbon dioxide. Every time a patient breathes into a plastic mask that’s enclosed on their face they’re breathing out 4% carbon dioxide. Hopefully all our patients have got two lungs, and they breathe in 21% oxygen from the atmosphere. That’s immediately combined with the haemoglobin. 97% of the oxygen ends up in the haemoglobin, 3% in the tissue, but we can’t measure that. So when you’re measuring oxygen saturation the most you can get is 97%, but the computer cheats it to 100%, because the rest is in the tissue. It takes half a second for the oxygen to be taken up in your bloodstream, and every single person in this room today has only got four minutes of oxygen in your bloodstream. So if you stopped breathing, or you had a closed face mask on your face and the oxygen ran out, you have four minutes to live. That’s the reality of oxygen therapy.

We measure with pulse oximeters of course. I’ve got one, I’m going to put myself on oxygen in a moment. But we’ve had an issue with these recently, small portable digital displays. I measured my oxygen saturation earlier on, and it was 86%. But I was reading the numbers upside down, so it was in fact 98%. And we’ve had phone calls from people in community, I’ve been well all day, my sats are down to 80%. So turn it around, that’s better. So they just turn the dial the wrong way around, there we are. This is an interesting one. So Mo Farah and athletes who run at altitude, they’ll go to the top of mountains where the oxygen level is lower than 21%, and their body will get used to lower percentages, say 18%. It didn’t help Mo Farah this time round mind, he didn’t qualify did he, but then again he wasn’t rehearsing for it. And as the figures fall of course humans will just die. Those numbers are quite large, and the jumps are quite large as well. Use carbon dioxide. You’re sitting there with a mask on, and you’re breathing out 4%, and if a patient rebreathes 2 to 4% it makes them feel asphyxiated, like an increased breathing rate. 5% can cause dizziness, 9% can affect your breathing, and 9 to 12% of rebreathing carbon dioxide will actually be fatal. So carbon dioxide, small percentages is a killer.

There’s only one thing to read on that slide, which is the top line that’s in bold, oxygen is life saving. You can have it absolutely everywhere. Not just for adults, not just for humans, but for animals as well. Adults, paeds, neonates, everybody needs oxygen including animals. There’s some really good guidelines out there, the ones on the left-hand side from the HSIB have only just come out. There’s some links there if you can read those, and a report I think just came out last week, in fact just this week. But on the right-hand side is the medical gas HTM, the Health Technical Memorandums that we use, and there’s a couple of parts of those and we use those. There’s two parts: one about implementing gas pipelines etc. and part B is all about the training and the colour coding, and what cylinders what should look like and how to store them, and there’s a new supplement on dental devices as well.

So there is an international colour code. Sorry yeah, a UK wide colour code. European I think it still is, and it’s the old black with the white collar for oxygen, blue etc. And the new colour code, which is now being implemented, where the cylinders are all painted white with words printed them on. But really importantly is the label that sticks around the collar, because that has to be intact and in place, and that’s the drug information. That tells the user what drug is in there, the concentration of the drug, the safety warnings and the safety signs. And the [unclear 0:50:35] label, the one on the bottom there tells the user when it was filled and its expiry date. Most medical gases have an expiry date of about three years, which isn’t long, and some gases are stored and never used, and they’re wasted, and that’s really important that staff need to know about that. And of course they’ll be on those cylinders, and everybody must be aware of where [unclear 0:50:56] label is.

Sitting on top of some of those cylinders we have a range of valves, and these valves vary from sign spindle pin index hand wheel or integrated, where engineers, technicians or staff have to fit regulators, and change seals as well, very important. And we have the pin indexing system, where there’s individual pins on the head of the regulator that you can’t really mix the gases up, with what we know as the Bodok washer or the Bodok seal on the right-hand side. And we’re expected to check and change that at regular intervals.

Next question for the audience then: ask your colleague sitting next to you, what do you think the average pressure in a car tyre? What is the average pressure in a car tyre? Ask the person sitting next to you. OK, have we got some answers? John, can I ask you, do you know what pressure is in your tyre? 2.2 bar in new money. Cheers mate, what’s it in PSI? 34psi, that’s about right actually. 32psi actually, spot on. Do you know what PSI stands for? Pounds per square inch. 32 pounds, that’s weight, 32 pounds per spare inch pushing out against the side wall of your tyre to maintain its shape. If the side wall of that tyre should split or rip and explode out, and your hand is nearby, you’d probably lose your fingers. That’s the pressure in a car tyre. Can I reassure you they’re very heavily built, they have reinforced steel radials and that doesn’t happen. That’s my vintage Lambretta there, which has very small wheels, and that’s 19psi. Nevertheless still a high pressure. What do you think the pressure is in one of these? 2,000psi. That is a bomb. That is, I’m carrying here a bomb in my hand. That’s 2,000psi. I see nursing staff throwing these around, hanging them on wheelchairs, swinging off the bed, sitting on the patient’s lap - 2,000psi. That is an enormous pressure, an enormous pressure!

Summary slide Dave, thanks for that, summary slide. They’re heavy bulky objects. There’s an enormous amount of pressure in these cylinders. Some of the gauges you need to know how to read because it’s liquid or it’s a gas-gas. It must be prescribed, the drugs, unless it’s an emergency. You can get cold burns because of the high pressure and the gas that’s released, and of course oxygen added to a fire will vigorously increase the fire. The fire risk with oxygen, interestingly I think you’re all sitting on fire retardant chairs, and this is a fire retardant carpet, provided there’s only 21% oxygen in the room. If you increased the oxygen to 24%, you’ll double the chance of that chair catching fire. If I increased the oxygen in this room to 100%, even the metal will burn. That’s what oxygen can do. And I’ve got some rather worrying pictures to show you of our fire that happened in our hospital as well.

This is Jean Booth. This is the first person I’ve managed to find on the internet. Manchester she’s from. I don’t know if you know the story, Manchester crowd, any Manchester crowd in? So Jean Booth was the first person we know that smoked an e-cigarette underneath the bed clothes, made herself a little oxygen tent while the oxygen was flowing. It took off all the layers of skin off her hands, arms, eyes, eyebrows and face, and put her in intensive care. That’s what it did. She was fighting for her life.

So there’s an experiment done many years ago, I managed to find the video actually. I’m hoping it’s going to play if I do this. This is a cigarette burning in room atmosphere, and we simply add oxygen from a cylinder to see if we can increase the burning rate of a cigarette. So we put it on, and it takes one, two, three and a half seconds before the cigarette completely disintegrates, and that’s just by enriching the oxygen around an already lit cigarette.

Nos, have you heard of it? I’m looking at the youngsters in the room. Hippy crack, the number two drug for 16 to 24-year-olds. My daughter went to the Reading Rock Festival, a couple of years ago. It was 34 degrees boiling hot. She suffered badly from dehydration, because the people who are coming round the Reading Rock Festival pulling the trolleys weren’t selling water, they were selling Nos, hippy crack, nitrous oxide, and the reason nitrous oxide is in there is purely because when you compress it, it goes into a liquid and you can get a lot in there. Of course if you were to crack this with a cracker, I’ve already done that for this experiment, crack it and breathe it, you get all sorts of short-term highs, but you get those effects as well: burns, heart rate, swelling of the brain, nerve damage, anaemia and serious psychological problems. There has been 17 recorded deaths in the last three years from youngsters snorting this.

You can buy this for 75p off the internet. It’s bought legally because it’s used in the cream industry for a cream dispenser for making cakes. The only other drug they could put in one of these that compresses into a liquid would be carbon dioxide. You don’t want to go sniffing that, because that will kill you. But we used to, I’m showing my age again here, we used to have little cassettes of these, of carbon dioxide for a drinks machine in the house called a Soda Stream. Anybody remember the Soda Stream? Don’t go sniffing that though will you whatever you do, because that will actually kill you.

So this is a typical prescription of what a nurse is presented with in the NHS. And the doctor will prescribe a target saturation level. That’s all a doctor will say. They won’t say put the patient on two litres, one litre, pick a mask. They’ll say target sats please 94%, 98%, or for CODP patients 80%. That’s all the doctor does. And then we need these devices, pulse oximeter, oxygen saturation devices on the end of the figure. When I was in Cardiff in 1986 a company came to us and said - Nelco they were called - we’ve had a pulse oximeter machine that’s going to transform healthcare. It was about half the size of that box there, a giant thing with a big crocodile clip on the end of it. It’ll never take off we said, and there it is. There it is in my professional career, an oxygen saturation device, and that’s all that’s needed.

The nurse then has to decide what am I going to put on my patient to get the oxygen saturation level up to 94 to 98%. The first thing she might do, or he might do, is pick one of these devices, which is the first starting point for oxygen therapy. Have you all seen one of these before, has anybody been on one? They’re supposed to be comfortable, let me tell you they’re not. So the setting would be the nurse first has to know how to switch the cylinder on. That’s usually the first point of failure. There’s a grey cover on there, and they have to turn the valve on. And it’s a multiple turn valve, it goes round a few times and then back a little bit and then expose the fir tree connector, which is the universal connector for said nasal specs. The settings for nasal specs are low, two to six, two to four actually, two to four litres per minute.

Now, if I turn this on to two litres, I can feel this, that will be around my head, but I’m breathing in oxygen from a cylinder at a 100%. That’s 100% oxygen in there. That’s not 22 or 24 or 28%, that’s 100%. That’s going up my nose, and I’m mouth breathing, and I’m nose breathing, and between the two you get a bit of a mixture, and you can increase the FIO to - the fraction inspired oxygen - between 24 up to say 30%, but it’s very hit and miss. And the nurse will set that. If two doesn’t do the job, the nurse might turn it up to four to see that affects the saturation level. If that’s not working it’s rare that you’d go up to five or six, because if that’s not working they need a different product. And for that they’d use the simple face mask, which is the next product that the nurse should be using.

So the simple face mask is exactly what it says. It’s a simple face mask; however, don’t start these off at one, two, three or four, because of the retained carbon dioxide that the patient’s breathing out. The patient’s now breathing out into a closed plastic mask, and then the bottom will sit the rebreathed carbon dioxide. You need to start these off at least five, because that will raise the oxygen level and exhaust the carbon dioxide. It’s very important that nursing staff know this. If that’s not effective you can go six, seven, eight, nine, 10. I’m now flowing at 10 litres per minute. And my father-in-law’s been in hospital recently and that was not effective for him either. But you’re breathing in 100% oxygen. And through the holes in the side, you’re also breathing in atmospheric oxygen as well, so it mixes in the mask. So it’s not accurate either, but it gives you an increased level of oxygen.

There’s products that we sometimes use, especially for COPD patients, called Venturis. Has anybody seen those? Show of hands if you have. Yeah, colour coded, accurate prescription, accurate oxygen concentration levels. You can increase the flow rate as well as a driving gas to drive the patient to breathe more, to deep breathe, doesn’t affect the saturation levels, really good. There was an issue in the beginning of COVID whether they were AGP - aerosol particle generating - but all masks will cause breathing to come out. Then we have the big daddy now. This is the one if you watch television programmes you’ll see are the worst used on Holby City and any medical drama, nightmare, they are rubbish. They’re terrible users.

It is the emergency rebreathe mask. The first thing you do is put it on and turn it up to the maximum 15 litres per minute. You then have to block the valve on the inside to inflate the bag. That’s never done. You watch TV dramas, it’s never done. They get £185 a day for advising medical dramas, these people, and then you apply the mask. The patient now breathes only from the bag and then out through the valves. And on six different occasions that we know of, the nurse forgot to switch the cylinder on properly, and the patient simply ran out of oxygen and suffocated during transfer, all because the staff didn’t know how to use a one pound plastic mask.

So we have codes that we use in the NHS, and I’m going to flick through these pictures because you’ll get the slides and presentation as well, and this is a true emergency resuscitation from a news chart of a real live patient that was saved by the members of the nursing staff. And they’ve basically gone through the demonstration I just showed you. They started with a nasal cannula. They increased the flow rate settings, right through to reservoir mask at the end, and that’s exactly what I just demonstrated there, and how the nurse actually saved the patient by using the right products with the right settings.

There’s some safety alerts out that you need to be aware of as well. These are the ones around pulse oximetry. I can’t believe I still see pulse oximeter probes stuck on people’s noses and on ears. You’ll get a reading. It’ll be 30% out. You’ll still see it. Patient safety alert came out in 2018 about people not being able to turn on these cylinders. We took a poster campaign and training, and we developed something called the 20 second rule. It’s an easy acronym to remember, because the chemical symbol for oxygen is 02, and we just wrote it backwards, 20, and it’s called the 20 second rule. So 20 seconds after the oxygen has been switched on, check it’s still flowing. And if it’s still flowing, they must have turned the valve on on the side. A little bit of bench top tests our engineers did for us.

A bit of health and safety around fire now before I finish. This is the famous Great Ormond Street Hospital in 2008. That’s what’s left of the children’s ward in seven minutes. Behind the metal door in the centre that’s where the oxygen cylinder was kept, but they got everybody out. Preservation of life, that’s the important thing. Get the patients out, let the building burn. That’s a CD cylinder, recognise it? It’s one of them. Royal United Hospital in Bath dropped the night before. Instead of being reported as faulty, put back in the storeroom, nobody told anybody. Porters got up in the morning, went to transfer the patient, put the cylinder on the bed, turned the regulator on, the 2,000psi pressure ignited the particles of metal and a four foot flame came out of that and set fire to the patient and the intensive care unit. So it’s not just a bomb, it’s a flame thrower as well. Quite a dangerous thing really isn’t it?

This is our hospital fire from 2019. I’ve got some pictures to show you very quickly. They’re in the public domain, I think. It’s too late now. You’re going to see them, aren’t you? Six-bedded unit, 24-bedded ward, top floor, sixth floor, Singleton Hospital, end of life, mental health patient decided she was going to set fire to the oxygen: turned on all the flow metres, got out a match and a lighter and set fire to the flow meters. This is what the fire brigade saw when they came into this small six-bedded room. On the right-hand side is the bed that’s furthest away from the patient, notice the flash over has actually blown the curtains off the wall, never mind the soot.

This is the picture on the right-hand side. You can actually see the ceiling tiles are beginning to burn. How can you set fire to ceiling tiles, because it’s 100% oxygen in there. The aluminium curtain rails are all charred as well. This is the bed on the left-hand side as the fire brigade came in. The heat was so intense when she set fire to the oxygen it melted the curtains around the bed, and they just disintegrated in front of the patient. This is the bed next to the patient, and that’s the patient’s bed in the bottom left-hand corner. Notice the explosion in the ceiling above the patient’s bed space. Notice it’s blown the windows out, and just as well it was the top floor, because it set fire to the cladding as well on the building on the outside.

This alert has come out this week, brand new information, I don’t know if you’ve seen it, air flow meters. We’ve had problems with them in the past, people have mixed them up. The mandate this week has come out remove from clinical use all air flow meters, remove them.

Shall we finish with a quiz? I’m on time. I’ll finish with a quiz. Please tell me what’s wrong with those pictures, anybody? Just tell the person sitting next to you. Do you agree you shouldn’t be using an oxygen cylinder keeping the door open? That’s not what that’s for is it? You should be using a fire extinguisher for that. On the right-hand side, it’s a bit more difficult the right-hand side, because not only should you not have a trolley parked behind the door, it’s the wrong sized cylinder in the trolley. That’s quite difficult that one. That’s an HX cylinder in a G-sized trolley, you try to move that it’ll slip out under the chain and roll out and probably break your toes.

On the right-hand side, our clinical department, the burns the plastic unit, wanted a storeroom and started to build their own medical gas storeroom. So instead of using the appropriate signs from the BSI catalogue, they printed out their own sign on Word, you can’t do that, and just stacked up cylinders top left, right, out of reach, empties mixed all over the place. Bottom left if the best picture I’ve seen so far in my hospital. Everything stacked up, everything in its bracket, everything new.

It says in the guidelines to keep cylinders away from sources of heat and vibration, that’s what it says, heat and vibration. I’ve got to say this is not my hospital, my pictures are too embarrassing, I’ve shared them with my colleague from down south down in Torbay, Mike, and he said have these Paul. He did tell them. He said I’m coming round to take picture for medical gas training. So they tidied up and cleaned the floor. That’s exactly what they did. They missed the point. The fact is they’ve got cylinders in a sharps bucket right next to a sink where there’s oils and grease, right next to egress, that’s a recipe waiting to happen isn’t it?

An important message for all staff, you need to know where to set the ball on a flow meter. It’s in the middle. Go back where you work and read the instruction that’s printed on the flow meter. It’s been there for 28 years. Read the gas at the centre of the ball, it’s absolutely there. There’s something wrong with this picture though, and I’ll tell you what it is. It’s oxygen, it’s an oxygen flow meter, correct. The flow rate is six litres. I can see the ball is dissected in the six line there. It’s an SM simple face mask, I know the flow rate is correct for that, because it’s above five because of the rebreathing. Where’s the patient? That oxygen is pouring out of the wall, pouring down the bed because oxygen’s heading there, filling up the ward space with oxygen.

£185 a day they get paid for these television dramas, these advisers, and I was watching. Anybody recognise the programme? Silent Witness. It’s great isn’t it? No, it’s rubbish. I saw a brand new type of device I’d never seen before, and I thought wow, an infinite oxygen flow device. It’s in the top right-hand corner there. Can anybody see what it is? It’s an upside down oxygen flow tube. How on earth are you going to set the flow rate on that I have no idea! So whoever’s installed that has put it in upside down. The medical experts have told them that’s OK and the flow rate is infinite. That’s infinite flow rate of oxygen, unlimited oxygen supply.

Animals as well, there was a fire in a zoo in Austria back in 2010. They had some very old African spurred tortoises there, I think they had six of them there, and when the fire brigade arrived, of course being tortoises they can’t run. They looked over the wall and they saw in the distance a wooden hut, and the wooden hut was aflame, and in there were the African spurred tortoises. So the resuscitation team and the emergency evacuation team put on their backpacks, put on their oxygen flow meter devices, rushed over and saved every single one of them with a bit of oxygen. So for animals as well isn’t it?

So, what are we going to do next in terms of education and training? So we’ve been working on this training project now for a number of years, and we have a whole raft of PowerPoint training sessions. We have interactive e-learning courses on medical gases. We have workbooks that all our staff get. We’ve got a pictorial guide for porters, a step-by-step instruction of how to change cylinders. We have assessments, quizzes and handouts, and all of this is being developed into an interaction e-learning suite for all NHS staff for free. So watch this space, we’re hoping by the end of 2021 all of these resources will be available for everybody to have for nothing, because that’s what we do. Can I say thank you very much for having me, and I don’t know if there’s time for questions.

Paul Lee's presentation at the EBME Expo: Safe Use of Medical Gases and Oxygen Therapy