By Eben B. “Skip” Scribner IV

Hazardous Materials Regulations:

49 CFR Parts 173, 175 and 178

FR E7-19207

Transportation of Compressed Oxygen, Other Oxidizing Gases and Chemical Oxygen Generators on Aircraft

Enforced as of October 1, 2009

Persons who use Therapeutic oxygen and wish to travel on the airlines have options ranging from the use of customer owned/acquired Portable Oxygen Concentrator’s (POC’s) and/or purchasing airline provided therapeutic oxygen in compressed gas cylinders.

Carriers now fall under E7-19207 regulations that began enforcement on October 1, 2009. As a result, we have seen a few carriers discontinue their Therapeutic oxygen programs, partly due to the cost of the required Super Box containers to move the oxygen cylinders throughout their served airport locations.

The HM 224B Super Box containers must withstand penetration of a 1700ºF flame for 5 minutes, in accordance with Part III of Appendix F, Paragraphs (a) (3) and (f) (5) of 14 CFR part 25.

In the past, a carrier would send ATA300 rated packaged oxygen cylinders, in the cargo hold of the aircraft to the needed airport of departure for the requesting passenger ahead of time. When the passenger showed up for their flight, the needed Therapeutic oxygen was standing by on the jet way for their flight.

As of this writing, Alaska, Continental and Delta/Northwest have either discontinued or temporarily suspended their onboard Therapeutic oxygen programs. Both American and United airlines continue their programs.

Impacts and choices:

Persons who use either a “Pulse delivery” type of flow on POC’s with manufacturer settings up to 6, or a “Continuous” flow up to, but not exceeding 3 liters per minute (LPM), can use a POC. Those who need a continuous flow over 3 LPM would need to explore alternate methods of obtaining oxygen, as there are currently no POC models capable of a continuous flow higher than 3 LPM.

Since there are very few airlines now providing Therapeutic oxygen, it is imperative that passengers check with their individual airlines as to their oxygen customer policy prior to booking their trip. If the passenger has a need for greater than 3 LPM, alternate routing options using a carrier that can provide the needed higher flow oxygen, may be necessary.

In speaking to some of the carriers representatives who have responsibility in this area, it is very clear to me that the airlines who have stopped providing the service certainly wish there could have been another choice. Due to fiscal constraints with regards to the cost of the “Super Boxes” and the small overall percentage of passengers requesting flows higher than can be accommodated by POC’s, they were not left with many options.

POC’s have certainly made air travel more seamless for the bulk of the oxygen dependent community. With new innovations like the POC’s, one must always remember to be educated in the proper use of the product. I have already been made aware of horror stories involving passengers who were not educated on how to use the unit. They were not Knowledgeable on how to adjust the flow, or change batteries on the unit. Some have also come to the airport to travel and had not given appropriate advance notification that they would be traveling with and using a POC. They didn’t have the required physician’s statement with them, or just did not realize they needed one.

Some were beginning a long flight and arrived with far below the proper amount of batteries needed for the trip (typically 150% of the flight time in batteries). All of these instanced could have been avoided with pre-planning and communicating with the airline ahead of time.

In summary, if you or someone you know uses Therapeutic oxygen at a flow rate higher than 3 LPM in flight, you need to stop and evaluate your choices in air travel before booking future travel. The field of choices has narrowed and you may have to rethink how you will get to your final destination.

Feel free to contact the author at +1-757-481-1590 with questions or comments.

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·         What are my oxygen requirements?

·         What are the available sources of oxygen for your travel?

·         POC –vs- airline provided Therapeutic oxygen.

·         If Therapeutic oxygen, then possible layover needs.

·         What are the arrangements at my destination?

What are my Oxygen requirements?

Are you a 24 hour user, only sleep with oxygen, only use as needed on exertion? These are questions that need to be addressed when traveling. Sure, at home it’s not a problem because you have the needed equipment at your fingertips and if you begin to get low on supplies, you simply call your local provider for more supplies.  Not, so easy when you are on the road…..

So, let’s start with just what you use.

1.      Medical Oxygen concentrator: This is a wall powered unit weighing @ 50-60 pounds that plugs into your electrical outlet at home, it takes in ambient air, extracts the nitrogen and provides you with 90% +/-3% pure medical grade oxygen. Most people have this type of device provided by their homecare dealer. It is the most cost effective solution to a stationary oxygen need. Most units will flow up to 5 or 6 liters per minute and select units will produce up to 10 LPM (Liters per minute). These are perpetual units and as long as you have an AC electric source, the machine will produce the needed oxygen.

2.      Liquid Oxygen (LOX): This is a cryogenic product that is delivered by your homecare dealer in the form of a “dewar” or Liquid Oxygen Reservoir. This device is typically about 14” across and 3 to 4 feet tall, typically weighing about 100-150 pounds. A large reservoir holds the equivalent of 51 “E” gas oxygen cylinders (they hold @ 680 gas liters each). As you can imagine this type of equipment is not something you just toss into your car. There is a LOX portable that you refill off of the reservoir or mother as some like to call it. Portables come in different sizes holding from ½ to 1 liquid liter, providing 8+ hours of use as a portable when filled. There are small LOX reservoirs manufactured, but few homecare dealers carry this size due mostly to the acquisition cost. If you are a liquid user, then this might be a very cost effective option if you decide to take a cruise. However please know that LOX is a specialty item and there are many ports and vessels where you can NOT get the LOX for your cruise, so please start planning well in advance.

3.      Cylinder gas: Many people use cylinder gas as their portable solution. Some have their homecare dealer deliver cylinders much in the fashion of the “milk man” bringing multiple cylinders to the home already filled and then collecting the empty cylinders for filling. Another solution with gas cylinders is known as the “home fill” system. This is a concentrator that not only gives you gas to use on a long hose/cannula at home, but also refills the small gas cylinders over a several hour period of time. This solution in the DME business is known as a “no delivery” model, hence the idea that the home care dealer does not have to deliver filled portable cylinders. *** It is important to know that this is a proprietary system and the cylinders cannot be refilled with anything other than with the home fill system that the client has currently in their residence or that exact model when they arrive at their destination.

4.      POC (Portable Oxygen Concentrator): Some homecare dealers will offer POC’s to their clients and the POC may also be rented from a company such as ourselves, Advanced Aeromedical (800-346-3556). The POC allows the person to use the device not only on US wall voltage, but any voltage in the world. The POC also uses batteries and there are 7 approved POC’s for in flight use. Currently only one of the approved POC’s, the  Sequal Eclipse, will provide a constant flow of oxygen in ½ liter increments up to 3.0LPM. The remainder of the approved POC’s are pulse delivery, meaning  that every time you take a breath, the machine senses you taking a breath and gives you a bolus of oxygen commensurate with your selected liter flow.

POC-vs- Airline provided Therapeutic  oxygen:

Depending on your liter flow and the ability to use a pulse delivery system, may dictate exactly how you can travel on an airline. If you need 3.0LPM continuous or can use a pulse delivery up to 6LPM (I personally question the 6LPM), then you should be able to use one of the approved POC’s. If your need is for constant flow above 3LPM, then you MUST fly on a carrier that provides bottle/compressed gas oxygen for a fee such as United. If in fact you do need the aircraft provided oxygen, then there comes the “layover” or connection airport. We at Advanced Aeromedical do provide connecting airport oxygen services, but regardless, you must arrange for someone to meet the arriving aircraft, provide you the needed oxygen and take that equipment away on your departure. Again, we do provide that service and you can contact our coordinators at 800-346-3556 or +1-757-481-1590on a 24 hour basis.

Destination oxygen:  Upon arrival at your destination, you can be provided with perhaps the same type of equipment you use at home, or perhaps a variation of the same or maybe you plan to use your POC for the entire trip. These are decisions that need to be made prior to arriving at your destination. At Advanced Aeromedical we can assist you with these needs if your homecare company has questions. Always take into consideration what you will be doing when you arrive at your destination so that you have plenty of portability if needed.