traveling with oxygen

December 13, 2007 8:44 PM

I'm working to transfer a person on oxygen from San Diego to Oregon. It's a long trip and this person is mostly wheelchair bound. Overexertion causes breathlessness and anxiety. We are trying to effect this ourselves and the oxygen is proving the most problematic. At 12 liter flow, getting enough oxygen is a major technical issue if moving by vehicle. We're talking a 3 day trip with a stop halfway in Watsonville for a day.

The problem I'm having is getting correct information on my alternatives in a reasonable amount of time. I'm thinking that perhaps some Mefites are familiar with this problem, or know of resources I could consult.
We could transfer using air ambulance, or ground ambulance but that's extremely expensive.
Train is a possibility, especially the sleeper bedrooms, but there is a limit on what types of oxygen equipment can be brought on board.
By vehicle, I have considered using an oxygen concentrator running off an inverter, or using liquid oxygen tanks. The concentrator would be noisy and hot inside the car and if it stopped running, that would be a big problem.
The liquid O tanks apparently are so bulky that they wouldn't fit in the car. I'm still researching that last one.
I'm hopeful that this post may generate some avenues that I haven't considered yet. I'm talking to oxygen providers daily getting things worked out but at the moment can't see a really bullet-proof way of doing this without using some kind of medical transport service.

posted by D-ten to health & fitness (15 comments total)

Would it be possible to use the inverter at night, tanks during the day, and arrange for a refill in Watsonville? My grandma's tanks, although her flow rate is 4 or 6 liters, are quite manageable in size. She regularly takes several tanks to her daughters' houses if she's going to be away from home for a couple of days. They're about 3 ft high, 6-8 inches in diameter, if I'm recalling correctly, and they fit in the trunk quite handily. She can move them around on her own when they're on a little wheely cart.
If you could refill in Watsonville, you'd only have to have enough tanks for half the trip. I don't know exactly how many that would be at such a high flow rate, but it shouldn't be too difficult to find that out.
posted by katemonster at 8:59 PM on December 13, 2007

Hmm. On further research, it appears that tanks like this, which are the kind I'm familiar with, would only last about 45 minutes for your person. That would mean a lot of tanks and a lot of transferring. An M size tank would hold 3450 liters, or enough for about 4 hours. I can't tell what the size is of those tanks, though, so those may be the ones that are too large to fit in a car.
I assume you've googled travel oxygen -- I've found some really helpful websites that spell out the various ways of traveling with oxygen.
Good luck -- I know this is complicated and it's difficult to get a straight answer out of anyone. It really shouldn't be this hard.
posted by katemonster at 9:14 PM on December 13, 2007

Is there some reason I'm missing why you aren't flying?
posted by whoaali at 9:20 PM on December 13, 2007

12 L is also a lot of oxygen flow to be introducing into an ordinary passenger car cabin, so be careful! Minor electrical discharges in an enriched oxygen atmosphere can flare very quickly, and passenger car interior materials aren't usually tested for suitability in enriched oxygen atmosphere¹. I'd be concerned about the mobility of a person with such oxygen demand, and their ability to exit the vehicle in case of accidental ignition/fire.

Keeping a standard auto fire extinguisher handy might seem a good idea, if you do this, but in the face of an enriched oxygen atmosphere, it might not mean much, if the time came to use it.

¹ "8. What is FMVSS 302 testing and why am I being asked to do it?

Officially known as 49 CFR 571.302, The Federal Motor Vehicle Safety Standard (FMVSS) 302 for Flammability of Interior Materials - Passenger Cars, Multipurpose Passenger Vehicles, Trucks, and Buses is one of the most common automotive materials tests. Founded as a Federal Standard in 1972, it is identical to the Canadian Motor Vehicle Safety Standard (CMVSS) 302 and will occasionally be called out on a specification or part print simply as MVSS 302. FMVSS 302 is a general safety measure which seeks to reduce the likelihood of injury or death that may result from a vehicle fire. This test, as written, involves burning two or more samples of a 356mm x 102mm x thickness (13mm maximum) plaque or section of material and measuring the burn rate in millimeters per minute (mm/min). Ignition is at one end of the sample by exposing it to a Bunsen burner flame for 15 seconds. The burn rate dictates conforming or non-conforming material and a maximum burn rate of 102mm/min is allowed by FMVSS 302, although this criteria may be overridden by an OEM specification or part print detail. The Society of Automotive Engineers (SAE) J369 and the International Standards Organization (ISO) 3795 are technically equivalent methods of test to FMVSS 302, however they both require burning five specimens per material. Click here to find the text of FMVSS 302."

posted by paulsc at 9:27 PM on December 13, 2007

whoaali, flying with oxygen is increasingly difficult, especially at such a high flow rate. You have to arrange for oxygen to have with you at your airport of departure, oxygen to meet you at any stopovers and your final destination, and you have to pay the airline for oxygen they provide in-flight. Several of them won't even provide oxygen tanks anymore, requiring you to use a portable oxygen concentrator (which won't usually get up to 12 LPM); those that do usually have limits on the amount of oxygen (Continental's limit is 6 LPM). D-ten has apparently looked into air ambulances, which I would guess are one of the only ways one could fly with an oxygen need that high.
posted by katemonster at 9:32 PM on December 13, 2007

12 liters is a heck of a lot of oxygen. Are you delivering it via nasal cannula, rebreather, or nonrebreather mask?
posted by ikkyu2 at 10:04 PM on December 13, 2007

When my father was on oxygen and had to travel overnight, we were able to arrange for tanks to be delivered (ahead of time, and we called to confirm their arrival before we left) to our destination each evening.
I found oxygen delivery services to be amazingly helpful and responsive. They would pick up any unused tanks after we left.
Air ambulance is another option we used for longer trips, its main benefit is that it is so much quicker and less stressful for the patient, but if they prefer to do the car trip, it's not that hard to prearrange for the tanks to be waiting for you.
Good luck with the trip.
posted by mmf at 11:08 PM on December 13, 2007

We're talking a 3 day trip with a stop halfway in Watsonville for a day

Is there any reason this needs to be a 3-day trip?

San Diego to, say, Portland is about 1000 miles, or about 17 hours of driving. You should be able to do it in one day, with appropriate amounts of caffeine (or another driver).

Even if you stop halfway for 8 hours of sleep, that's still just over a day. Doing that reduces your need for oxygen dramatically.
posted by chrisamiller at 11:55 PM on December 13, 2007

12LPM is definitely a lot of O2. Is there any way you can talk to the patient's doc and see if there's a way to change the delivery mechanism so you can lower the flow rate? (Maybe using a partial rebreather or variable flow mask?) Obviously if you could get the rate down, things would be a lot easier.

Given the options you've outlined, I wonder if maybe taking the train and using the O2 concentrator would be a fairly decent option. Most trains have 120VAC power available, so you wouldn't need to worry about using the inverter like you would in a car. (However, you might want to bring a big UPS, since train power isn't very stable and can cut in and out occasionally.) I would talk to Amtrak and see what they have to say about the idea; they must deal with special medical requirements all the time. Just make it clear that you'll always have enough tanked O2 to last until the next stop in case the train power gives out, so that they won't say 'no' as a knee-jerk response to the idea of anyone using their power outlets for a medical purpose (which they might do for liability reasons). Maybe they can even work out a plan to stage tanks at each station for you -- they offer station-to-station package shipping services,* at least on some routes, so they have the infrastructure for handling stuff like that on occasion.

In my experience, Amtrak tends to be a lot more flexible than the airlines, assuming that you're polite and can find the right person to ask. (Tipping the train staff doesn't hurt either.)

Also, have you checked the power requirements for the O2 concentrator and made sure you can run it from your vehicle's electrical system? You may need a big inverter and a vehicle with an upgraded alternator in order to run it. If you pull too hard on a car's power system you can actually run the battery down even when you're driving -- I've had it happen.

* See here. They say 50 lb per item limit, but maybe they can stretch that. I wonder if there's a way that you could keep most of the tanks in the baggage car (or wherever they keep the items to be shipped) and then at each station "receive" a few full ones and "ship" a few empties, basically letting you swap empties for fulls at each station. Not sure what they'd think of liquid O2, but it's worth asking.
posted by Kadin2048 at 12:25 AM on December 14, 2007

At least some types of oxygen tanks are really hazardous if they break/get hit in some fashion. Is this something you need to worry about if you're piling them in a car trunk?

(I'm not sure how useful an answer this is, since I don't *know* this'll be a problem. Hopefully someone who is familiar with these tanks can tell you for sure.)
posted by lorimt at 4:18 AM on December 14, 2007

12 - 15 LPM is a standard flow rate for a nonrebreather. Also, as lorimt says, any tanks will need to be secured to avoid a fantastic catastrophe.

Finally, my advice would be to call the patient's oxygen supplier and ask for some advice. Undoubtedly, they will have had to deal with this before.
posted by Jenafeef at 4:59 AM on December 14, 2007

At the risk of derailing, I'm also wondering if it's been definitively established that there's no way to bring the flow rate down. I apologize if that's irrelevant, it's just that most of the conditions I can think of that would require O2 seem like they could, with some aggressive, possibly short term, medical management, utilize lower flow rates. Your doctor could titrate this in the office and monitor oxygen saturations as a starter. Since you used the COPD tag, I would ensure your patient is on a drug like Spiriva for starters. Since it's pretty costly, a lot of people defer using it, but in the short term it would be well worth it. It binds much better to lung receptors than Combivent or atrovent. Second, would your doctor consider possible a short term steroid bolster to see if that lessens the O2 need?

I guess if my back was to the wall I'd rent a van or better yet a 4wd SUV and stock up on a bunch of canisters, get a note from the doc about what's going on in case you get pulled over, and haul ass, and I'd get a list of hospitals along the way. And be damn sure you don't get caught in bad weather on the passes.

I wonder also if speaking with a medical supply store in your home town might be a start, as Jenafeef said.
posted by docpops at 7:08 AM on December 14, 2007

Also consider discussing with your doc a more liberal use of Xanax during the trip to lessen anxiety and concomitant breathlessness.
posted by docpops at 7:09 AM on December 14, 2007

Okay, thanks for all the posts so far. What I've found out today from an oxygen supplier is that they will not supply oxygen at that liter flow for travel. Technically and in liability terms it's too complicated. They just won't do it. So, vehicle travel is out unless a way can be found to reduce the liter flow.
The suggestions made above regarding different kinds of supply devices, meaning cannula and rebreathers are helpful. She's using a non-rebreather mask now at times and usually what we call a moustache which is a white device that pools oxygen near the intake.
She can't use commercial airlines for the reasons mentioned above, plus she can't walk for any distance.
It's looking like air ambulance is the only realistic method for moving her given all the logistics involved. The only reason I haven't pursued that so far is the cost but it may be that some or all of that will be covered. One can certainly hope.
My perfect picture was something like that if we could get her to sleep in a vehicle so her usage was low, and had a way to deliver 10 liter flow for the length of the trip, then that would do it. Logistically though without the support of the oxygen supply company it doesn't seem doable.
Thanks for all the posts. I'll follow up if I get any more information.
posted by diode at 10:25 AM on December 14, 2007

Mercy flights offers a discount on air and ground transport for members.

I wonder if renting an RV for transport would help with some of the issues. There would be a larger area for the oxygen to disperse in, a place for her to lie down, and plenty of room for the tanks.
posted by yohko at 11:50 AM on December 14, 2007