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Safe storage and management of medical gases. Remember, they are medical gases, they are classed as drugs. So when they are stored, most important thing is that they are stored in an appropriate place. It needs to be lockable, it needs to be well ventilated, it needs to be large enough and we need to have a process, if we are storing more than a couple of bottles, to make sure that the date stamps on the bottles are changed on a regular basis. So we should have a log-in and a log-out of all medical gases and a date stamp on all medical gases which tracks them through the process, so we are not using the same bottles time and time again and we are refreshing cylinders on a regular basis.

Remember, oxygen, in particular, is very, very flammable; it burns at an extremely high temperature, and it ignites.  Medical gases ignite very easily and burn very hot, so we have to make sure that no oxygen gets in contact with greases and oils which will combust very easily. And naked flames and lights and the temperature of the room we are storing it have to be at a normal room temperature, preferably outside, but it has to be locked at all times.

Remember, when we are exchanging bottles either in or out of the stores or from our car to an address or vice versa, dropping the bottles we have to be careful. These bottles are made of aluminium, carbon fibre or sometimes steel, in the olden days, but they're very easily damaged. The actual regulators are plastic, the actual headsets are plastic, and they are there to protect the contents, gauges to protect the regulators. If we drop it on the head and it is very, very easy to actually smash off the regulator or smash off the valves that supply the oxygen. And if that happens, we will then either have assumed we can't use any more on the patient we need to use it on, or we will have a projectile because the pressure of the oxygen in the cylinder will come out at a very high speed and send the bottle flying across the floor or around the room at high speed becoming a danger, and also increasing the danger of damage from the oxygen coming out under pressure. Entonox is the same, we have to be careful how we handle it and make sure that we don't drop it.

Remember, the organization or the response group that you work with or the ambulance service that you are connected to, will have their own policies and procedures for you and what you can and can not and how you do and how you don't store and look after your oxygen cylinders. Most first response groups will come underneath their ambulance services policies and procedures for the storage and often an exchange of oxygen. Really important that when this is in your kit or in your car or your vehicle, that it is always fixed down. It should never be allowed to just roll around in the boot and be free-flowing in the back, because in the incident of a bump or a crash or you turn sharply or skid, the bottle becomes a projectile, which can be lethal inside a confined space, I.e, your car. So if it is in your kit bag, your kit bag needs to be in a storage place in the boot of the car. If it's not in your kit bag and you are carrying more than one cylinder, there should be a storage container inside the boot of your car where the bottles can be stored and fixed in place so they don't become loose and become a weapon or a free-flowing object in the car under situations where the car may be involved in a crash or a skid. Safety comes first. This is a lethal gas if not looked after properly.

And one final bit to remember is that empty and full cylinders should be always stored separately. The regulator gauge on the bottle should be changed when the bottle is roughly a quarter full. We like to leave a little bit of pressure inside the bottle so stop infection and contaminants getting into the bottle, and if we drain the bottle completely dry, infection and contaminants actually come into the bottle itself. It is a sterile environment inside the bottle and needs to remain that way. So when the bottle becomes just below a quarter full, it's time to exchange for a new one, but make sure when we're going to the storage that empty bottles and full bottles are stored separately and we have a log of both. Always check your cylinder is full. It is very easy to pick the wrong bottle out of the stores if we don't have an organized approach, and we then reload our bag with a bottle that's got less in it than the one we put back in storage. So always check before you start any shift before you start going out on a job, and every time you change your cylinders make sure they are full.