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November 2021 Issue 199-Food and Beverage
Gasworld US Edition, Volume 59, Issue 11 (November)-LNG
Author: Rob Cockerill, Global Editor-in-Chief2021-10-27T06:00:00 01:00
As of the end of June 2020, the World Health Organization (WHO) has issued a warning that hospitals are facing a shortage of oxygen generators as the Covid-19 pandemic continues to spread in different parts of the world.
When Europe and North America were mainly at the center of the pandemic in March and April, it is understandable that the challenge of supplying large amounts of liquid medical oxygen to hospitals and temporary field hospitals is understandable. The gas industry has met the frontline challenges with extraordinary agility and speed, and these stories are often online and printed by gasworld82.
The unsung heroes of this effort must not be forgotten, those who continued to fill and maintain the supply of gas cylinders and gas cylinders during the lockdown, those who continued to operate the oxygen plant, deliver liquids and cylinders to the hospital, maintain the hospital system and provide supplies to the patients themselves Home, whether through liquids, gas cylinders or concentrators.
However, there are still clear gaps in the supply chain-this is the degree of crisis facing the medical system. So how is the medical oxygen supply chain constructed and what went wrong? After discussing the discovery and role of oxygen in our previous article, let's now look at the medical oxygen supply chain and prepare for the next further discussion-our oxygen supply chain preparations.
Oxygen in the medical field is traditionally produced centrally at ASU, and then distributed to customers in liquid form or in gas form through gas cylinders.
However, there is another increasingly popular way of producing oxygen in the medical market, namely pressure swing adsorption (PSA). European hospitals usually rely on these two options to supply medical oxygen to their medical gas network—depending on their consumption, they can purchase liquid oxygen stored on-site in bulk cryogenic tanks and piped into the facility, or they can purchase steel cylinder supplies and medical supplies. Regular replenishment as needed.
Bulk supply to wards through storage tanks and pipelines is usually the most popular or most needed supply method, such as the amount of medical oxygen required. However, it’s not uncommon to find a combination of bulk and cylinder supply—especially in the context of this pandemic, the amount of oxygen required may exceed the pipeline’s capacity. Cylinder supply can not only supplement the pipeline capacity, but also provide a relatively mobile supply method.
Oxygen cylinders come in a variety of sizes to provide a continuous or required flow of oxygen while reducing the discomfort associated with these conditions. Hospitals often use these cylinders to ensure easy deployment throughout the hospital, whether it's at the patient's bedside, surgery or surgery area, MRI room, or even integrated into mobile devices. Gasworld understands that this flexibility that can be used in a variety of medical applications not only makes oxygen cylinders commonplace in hospital environments, but it is also essential to respond to the large number of patients infected with the coronavirus at any time.
There are usually reports that hospitals have to set up temporary wards in corridors and non-essential rooms, or that the government has to build temporary facilities in conference buildings to cope with the large number of patients during the pandemic. Both situations require portability of gas cylinder supplies.
First responders also use medical oxygen cylinders. These first responders and emergency services are on the front line of this crisis. For example, ambulances usually use fixed light oxygen cylinders to provide services for various medical equipment in the vehicle; small medical oxygen cylinders used by first responders are the normal state of responding to emergencies and treating patients. Emergency personnel working outside hospitals or in temporary housing wards in urban areas will also rely on these cylinders. For many years, medical oxygen cylinders have been the subject of major advancements, and the healthcare industry naturally needs high-efficiency oxygen cylinders with higher pressure, lighter weight, and improved delivery systems. Significant progress has also been made in valve systems and related accessories, such as hoses and masks83.
Generated on site by PSA system
Back to the third one, an alternative method of medical oxygen supply-on-site generation. Although commercialized in the 1970s, especially in the past 20 years, PSA oxygen concentrators for the supply of medical gas distribution systems have been developed in the global market. Because oxygen is produced on site without transportation and storage, medical oxygen generators have convinced many hospitals and medical institutions in North America, Africa, the Middle East, Asia, and Europe in recent years that they can supply medical oxygen at a competitive price. The price compared to liquid oxygen or steel cylinders 84.
For example, compared with low-temperature production of oxygen, the use of common components in a PSA system can greatly reduce the initial capital required, although it must be noted that the PSA device is installed in a hospital or customer site, and higher capital investment in cryogenic equipment will make The equipment serves multiple customers/sites. The PSA system also provides mobility to meet the different requirements of hospitals and healthcare departments; "monographs" have promoted their rise in this field, and these monographs believe that the use of oxygen with a purity in the range of 90-96% is acceptable.
Part of this independent oxygen generator series is an oxygen generator. In recent years, better, safer, and more efficient portable oxygen concentrators have appeared in the global medical oxygen market-allowing patients with respiratory diseases to regain their lives and stay free in their own homes. The portable oxygen generator in the patient’s home helps reduce the pressure on the hospital, manages to free up beds and see more people in the outpatient clinic. Even the integration of gas sensor technology into portable oxygen concentrators helps patient care, and individuals can better monitor their own oxygen levels.
As mentioned in the previous part of this series, in the first half of the 20th century, compressed oxygen therapy was used to treat many medical problems, transported and delivered in heavy-duty cylinders.
Important developments occurred in the United Kingdom in the late 1960s and early 1970s, however, when Luxfer Gas Cylinders introduced seamless, cold-extruded, high-pressure, portable aluminum medical gas cylinders. Aluminum gas cylinders are 30% lighter than similar steel cylinders. They are not only rapidly popularized among doctors and patients, but also increasingly popular among emergency medical service personnel, who benefit greatly from lightweight equipment that reduces work stress.
Today, there are a series of changes in cylinders or packaged oxygen to meet the developmental branch of healthcare infrastructure. With home care services, health authorities around the world are increasingly inclined to allow patients to stay at home for as long as possible, and oxygen is delivered to patients’ homes in the form of gas cylinders to support their conditions. For example, Luxfer produces 300 bar carbon composite gas cylinders, which can provide more oxygen in the lightest package (a cylinder with a water capacity of one liter is as light as 0.8 kg), which means that patients can keep walking for a longer time and improve Their quality of life. The smaller size of the cylinder means easier transport to the home, and it also means smaller transport vehicles86.
In the traditional hospital environment that we are very familiar with, what we see is usually a 5 liter gas cylinder, each weighing about 5 kg. The weight of the 5 kg product allows hospital staff to easily transport the product around the hospital, and many products will be equipped with so-called "bed frames" so that the gas cylinders can be fixed on the patient's bed. Aluminum alloy gas cylinders have been developed for use in hospital environments to enable them to be used in MRI (magnetic resonance imaging) environments; steel cylinders cannot be used in MRI rooms because strong magnetic fields can cause the cylinder to move and may harm nearby people. Luxfer has also developed these composite cylinders to achieve higher pressures (300 bar compared to traditional 200 bar cylinders) to increase the amount of gas stored. The heavier weight of the cylinder is offset by 50% more gas and reduced refillability87.
The aforementioned portable oxygen cylinder can also be used as a part of hospital mobile equipment, usually integrated in a pediatric incubator. It is understood that these are being integrated into new portable hospital products.
Of course, in order to reach the hospital environment, individuals are likely to need to be transported by emergency personnel by ambulance. There are also requirements for cylinder oxygen. Ambulances usually have a fixed oxygen cylinder used to service the equipment in the vehicle. They usually have a portable weight and size that can be easily replaced. Doctors and paramedics working on ambulances, helicopters, fire trucks and motorcycles will put small medical oxygen cylinders in their first aid kits. The same requirements for light weight and portability also apply to the military field, where many military doctors will carry lightweight oxygen supply devices in their medical field kits. Air cylinders are also provided in the life-saving kits of military jets so that the ejected pilots can heal themselves in harsh environments88.
Obviously, since oxygen was first recorded about 245 years ago, ships that transport oxygen have been in constant demand and continuous development. The same is true today. By 2021, the company is still looking for lighter weight and higher pressure cylinders. Not only has the demand increased, but the shortage of oxygen capacity at the point of use has greatly highlighted the higher and higher demand. The same goes for low-income countries.
After understanding the production and transportation methods, what is the global oxygen capacity and infrastructure?
It is difficult to determine the exact installation basis of oxygen production capacity, because there are many small and large oxygen production plants in the world, many of which may be unknown or undisclosed, and a large amount of production capacity will be its own capacity (privately owned and owned by a steel company). Operating) company, for example) rather than merchant (customer) supply. With the gradual increase in the amount of oxygen produced by PSA, it is also challenging to estimate outside the range of this changing supply capacity. There may be a very wide sliding range of oxygen supply capacity at any time.
However, what we know is the generally accepted ASU (production plant) utilization rate and the internal and external understanding of the industry, that is, most of the bottleneck problems exist in the distribution chain rather than in the production.
It is understood that the utilization rate of an air separation plant is usually about 70-80% of its oxygen capacity, so adding capacity in the installed infrastructure should not be a problem in itself, provided that the self-provided plant is of course willing and able to do so. The challenge lies in packaging and shipping the increased product and ensuring that it reaches its destination and can be accessed/used appropriately after it reaches the destination.
Karina Kocha, gasworld's business intelligence manager, explained at the peak of the pandemic in Western Europe and North America that this is indeed the case; it seems that the challenge lies not in the oxygen supply in the market, but in the ability of the hospital supply system to cope with the sharp increase in demand because they are already overwhelmed.
"The problem here may be the capacity of the hospital's supply system, which may not be enough to increase consumption. The fastest way to increase it is to bring oxygen into the cylinder... The amount of oxygen is hardly a problem. Any shortage may be caused by transportation. The system causes it to become a bottleneck between the producer and the patient.” 89
According to gasworld Business Intelligence quoted on March 25, 2020, the liquid oxygen production capacity in the United States is estimated to produce about 23-26,000 tons per day (tpd) of liquid oxygen, with a utilization rate of 75-80%. The healthcare sector consumes as much as every day 2,600 tons of oxygen, including hospital and home care (under normal conditions). Meeting the increased oxygen consumption may require an additional 300-350 tpd of oxygen, which will account for 12-14% of current medical consumption or 1-2% of the liquid oxygen produced.
"We believe that by increasing the utilization rate and the fact that industrial consumption is expected to be reduced to a certain extent-releasing excess oxygen for medical purposes, additional quantities can be obtained," Kocha affirmed.
When I saw a story of severe hypoxia in India 12 months later, the information was roughly the same-in terms of the known oxygen capacity installation basis and the generally understood utilization rate, there should be enough liquid oxygen to meet the spiral demand .
New Delhi, India, April 30, 2021: People line up outside the gas center to refuel empty oxygen cylinders.
Source: Exposure Vision/Shutterstock.com
When asked for comment and clarification, Kocha was quoted again saying, “According to our data, the total annual production capacity of oxygen in India in 2020/2021 is approximately 65,000 tons per day (tpd). This is the oxygen that all oxygen facilities in India can produce. Total amount."
“The steel industry needs more than 70% of this amount, and the other 15% is consumed by the petrochemical industry, while the non-ferrous industry consumes about 5%. According to our estimates, between 2016 and 2019 and before the outbreak of the Covid pandemic, “normal "Medical oxygen demand is about 1,600-1,700 tons/day. However, due to the Covid-related oxygen demand in 2020, the oxygen consumption of hospitals will soar to about 10-12,000 tons/day in 2020, and it is expected to be 2021. It will reach about 8-10,000 tons/day."
"What does this mean? Although in theory," she added, "it shows that the main problem is not a lack of production. When we talk about the availability of oxygen, we also talk about the ability to transport and distribute - organizing logistics, There are enough low-temperature (tank) trucks, cylinders, and refueling facilities. The situation here does not appear to be production, but the distribution system has become a bottleneck in the oxygen path from the factory to the hospital in India.” 91
Although this is the case, it is clear that the sliding scale of production capacity is not sufficient to cope with the rapidly increasing oxygen demand, and it is usually in remote hotspots where the recently installed oxygen production plant is too far away. Previously unheard of scenes followed one after another, and then the international community began to work hard to transport liquid oxygen tanks, air freight and trucks to India. Given its significant liquid-to-gas expansion ratio, part of the difficulty in these efforts involves the science and effectiveness of moving oxygen molecules. Transporting oxygen in liquid form by bulk transport is considered the most effective, but requires specialized transport equipment, depending on the journey at hand, which is a challenge; on the contrary, if the oxygen is transferred to more in the (compressed) gaseous state In a removable gas cylinder, then you will face the problem of inefficiency in transporting or moving containers that weigh more than their contents. In the latter case, the necessary equipment is needed to facilitate the transition from liquid oxygen to gaseous oxygen and complete the cylinder filling process.
How will it look tomorrow?
Whether it is possible to accurately estimate the oxygen capacity installed globally may be a broader question for industry and world health leaders. As we all know, since oxygen was first discovered about 250 years ago, we have begun to rely on this most precious gas for life and well-being. However, it is clear that during the Covid-19 pandemic, if not before, the supply chain we have traditionally accepted cannot meet our greatest demand when we need it most.
Medical oxygen shortages around the world have been a tragic feature of the pandemic, disproportionately affecting the poorest countries. In countries that do not have the oxygen or infrastructure needed to bridge the gap between supply and demand, the reality is that it is much easier to transport or spread a virus like Covid-19 than to distribute the necessary supplies. oxygen. Before Covid-19, these access difficulties were deeply ingrained in many parts of the world and were exacerbated by the pandemic, putting pressure on fragile health systems and leading to preventable deaths.
At the time of writing (June 29, 2021), estimates from PATH, a global non-profit organization that improves public health, indicate that approximately 1 million severe Covid-19 patients in low- and middle-income countries require 2 million oxygen cylinders (1420 Million cubic meters)/day 92. So the question is, today’s medical oxygen supply chain is not necessarily structured, but how do we need to look at it tomorrow?
How can we learn from the lessons learned in 2020/21 and improve the availability of medical oxygen? How do we try to keep up with its distribution? How strong can our oxygen supply chain be, and how will we prepare for the pandemic in the future?
82 https://www.gasworld.com/a-third-way-onsite-oxygen-generators/2019596.article 83, 84 https://www.gasworld.com/hot-topic-understanding-medical-oxygen/2018708. Article 85-88 https://www.gasworld.com/portable-oxygen-cylinders-for-medical-use/2017373.article 89, 90 https://www.gasworld.com/hot-topic-oxygen-supply -Shortage/2018697.article 91 https://www.gasworld.com/india-restrictions-on-oxygen-supply-as-fight-against-covid-continues/2020774.article 92 https://www.gasworld.com /Exclusive Oxygen is now part of the public health system/2021156.article
https://www.gasworld.com/hot-topic-understanding-medical-oxygen/2018708.article
https://www.gasworld.com/portable-oxygen- cylinders-for-medical-use/2017373.article
https://www.gasworld.com/hot-topic-oxygen-supply-shortage/2018697.article
https://www.gasworld.com/india-restrictions-on-oxygen-supply-as-fight-against-covid-continues/2020774.article
https://www.gasworld.com/exclusive-oxygen-now-part-of-public-health-architecture/2021156.article
In recent weeks, gasworld has published chapters of a 10-point manual on political, social, scientific, and economic structures that constitute one of the most destructive public health emergencies in a century.
Can we say that our oxygen needs have been met? How are we prepared to deal with Covid-19, and how will we prepare in the future? Is it time to make a global estimate of the number of deaths caused by a lack of medical oxygen? all these are...
In the final analysis part of this exclusive series, we will ask how we are preparing for the next pandemic. If needed, is our oxygen supply chain ready? Have we learned the lessons of the Covid-19 pandemic? Can we even expect to improve our response?
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