Equipping training units requires care

The extent and complexity of the clinical training facilities now being provided within, or adjoining, our hospitals, are perhaps best demonstrated by the new West Midlands Surgical Training Centre, as featured within Health Estate Journal in August 2009. This was “the UK’s first medical and surgical training facility to be built from scratch to provide comprehensive simulation of a real operating environment”. The medical gas pipeline systems (MGPS) provided for such a facility may not only add to the realistic nature of a simulated operating theatre, but may well be also be required to operate particular medical equipment used within the theatre environment, and possibly also for pendant operation. While there would be no significant hazards associated with supplying air (medical or surgical) and vacuum to such a facility, the same could not perhaps be said for providing oxygen and nitrous oxide. It could be argued that, as these gases are not being supplied to a patient within the training environment, then there is no reason to actually supply them in view of the associated hazards introduced, such as oxygen enrichment of the local area. It could also be argued that oxygen and nitrous oxide terminal units are in fact required to preserve the realistic nature of the training environment, and to facilitate connection of oxygen flowmeters etc as part of the training programme. Can we then supply the “wrong” gas to the “wrong” terminal unit, which appears to be totally at odds with everything we design, engineer, and test for? This raises issues not only for the MGPS design engineer at the time of specification and design, but also for the Authorised Person (MGPS) and Quality Controller (MGPS) who will subsequently validate the system thereafter.

Hazards within the training environment

While the “trainees” within the facility could also include experienced medical and surgical staff who are perhaps undergoing further training in new surgical techniques/practices, there could also be an element of relatively inexperienced students using it. Although sufficient senior training and teaching staff would undoubtedly be present while the facilities are in use, the risks associated with supplying oxygen and nitrous oxide to the facility when students are effectively only at the learning stage should be considered. Potential hazards could include localised oxygen enrichment from equipment/ flowmeters being left on, with the associated fire hazards and possible exposure to nitrous oxide pollution if used incorrectly, and without the use of an anaesthetic gas scavenging system. There is also an economic argument: why supply oxygen and nitrous oxide which would be more expensive to procure when compared with medical/surgical air supplied from a medical compressed air plant?