Attachment 2 - Medical Equipment Compendium.pdf

Table of Contents

CUI

Aeromedical Evacuation

Medical Equipment Compendium

Release date, 30 APRIL 2026

HQ AMC/A3VM Scott AFB, IL

For Official Use Only

THIS PUBLICATION CONTAINS COPYRIGHTED MATERIAL

Note: Send comments and suggested improvements to this manual on an AF Form 847, Recommendation for Change of Publication, through appropriate channels to HQ AMC/A3VM. This guidance contains copyright material from Essex Corporation. The use of the name or mark of any specific manufacturer, commercial product, commodity, or service in this guidance does not imply endorsement by the Air Force.

Summary of updates include: The addition of the C-12 and C-21 Spectrum and 847 submissions. KC- 10 references were removed. Approved AMC/SGXL chest drains were added. Guidance for the Atrium Mini, EMMA, Kangaroo Joey and Powered Air Purifying Respirator (PAPR) was added. Additional guidance for AE Technicians ability to press shock button for Zoll MD during ACLS/ALS. Incorporated FCIF 24-06-15 preflight steps for IVAC Medsystem III and B. Braun Infusomat. Removed Stanchion Litter System (SLS) configurations for the KC-135 and C-17 due to AFMAN 11-2AEV3 ADDA being the governing document. The inclusion of a chapter with pieces of equipment that have a long-term waiver to ensure their lack of Safe-to-Fly documentation is known to cue those in the AE system to verify waiver currency before being utilized in flight.

Key Words Explained in this Document:

“WARNING” indicates operating procedures, techniques, etc., which could result in personal injury or loss of life if not carefully followed.

“CAUTION” indicates operating procedures, techniques, etc., which could result in damage to equipment if not carefully followed.

“Note” indicates operating procedures, techniques, etc., that are considered essential to emphasize.

TABLE OF CONTENTS

The PREFLIGHT and Function Check (FC) links send you directly to the preflight/FC of the piece of equipment.

1. Air and Oxygen Equipment

Back Pack Medical Oxygen System (BMOS) PREFLIGHT Bag Valve Mask Resuscitator (BVM) (Adult/Child/Infant) PREFLIGHT Adapter Assembly for C-17 High Altitude Liquid Oxygen (HALO) System PREFLIGHT Minilator PREFLIGHT Next Generation Portable Therapeutic Liquid Oxygen System (NPTLOX) PREFLIGHT Portable Therapeutic Liquid Oxygen System (PTLOX) PREFLIGHT Pulse Oximeter NONIN 9550 Onyx II® PREFLIGHT

2. Cardiac Equipment

ZOLL® Propaq® M PREFLIGHT FC

ZOLL® Propaq® MD PREFLIGHT FC

3. Infusion, Power, and Suction Equipment

Electrical Cable Assembly System (ECAS) Model no. 1079 PREFLIGHT

Electrical Cable Assembly System (ECAS) Model no 860969 PREFLIGHT

B. Braun Infusomat Space PREFLIGHT FC

Unitron Portable Power System PREFLIGHT FC

Zoll Aspirator PREFLIGHT FC

4. Miscellaneous Equipment

Airborne Life Support System (ALSS) 185M PREFLIGHT FC Aircraft Wireless Intercom System (AWIS) PREFLIGHT Atrium 4050 Chest Drainage Unit PREFLIGHT Atrium Mini 500 Chest Drainage Unit* PREFLIGHT Sahara Teleflex Chest Drainage Unit PREFLIGHT Heimlich Valve PREFLIGHT Kangaroo Joey Feeding Pump PREFLIGHT Massimo EMMA Capnograph PREFLIGHT NATO & Decontaminable (DECON) Litters* PREFLIGHT

NATO Litter Backrest* PREFLIGHT

North American Rescue Oversized Litter PREFLIGHT

North American Rescue Products, INC Raven 90C PREFLIGHT North American Rescue Products, INC Talon II 90C* PREFLIGHT KC-135 Portable Cargo Light System

Leather Restraints PREFLIGHT

Stanchion Litter System (SLS) KC-135 & C-17 Operations

- Attachment 1 SLS Pin Upgrade Guide

- Attachment 2 Oversized Litter Adaption Kit

- Attachment 3 Oxygen Cylinder Mounts Stryker Wedge Turning Frame 965 Military Option (MO) PREFLIGHT Ultrasound Stethoscope Fetal Pulse Monitor-Medasonics Model FP3A PREFLIGHT C-12J Spectrum PREFLIGHT C-21 Spectrum PREFLIGHT

5. Special Team & Commonly Utilized Medical Equipment

International Biomedical, Inc., Model 20M, Neonatal Transport System (NTS 20M)

Medfusion® 3500 Syringe Pump

IVAC Medsystem III PREFLIGHT FC Freestyle Freedom Lite® Glucometer

VenaFlow® Elite Sequential Compression Device (SCD)*Zoll Uni-Vent 731 Electrical Mini

Ventilator (EMV+) PREFLIGHT FC

K.C.I. VAC Freedom (Wound Therapy System)

Kendall SCD Express (Compression System)

K.C.I. Multi-Channel Wound VAC

Belmont Buddy Lite Fluid Warmer

V-Scan Ultrasound

Glidescope Ranger

Breathe EasyTM Turbo PAPR iSTAT

C-MAC

Lumify*

ATLIS

6. Waived Equipment

BioMed MVP-10 Ventilator*

Bronchotron® Ventilator*

NeoPuff™ Infant Resuscitator*

Medela Breast Pump*

Medisense Precision XTRA (Glucose Monitor System)*

Contour Ascensia (Glucose Monitoring System)*

Vacuum Spine Board*

7. Checklists EHR Preflight Checklist

EFB Preflight/Postflight Checklist

8. Attachments

Attachment 1 AE Equipment Amperage & Information Guide

Attachment 2 NPTLOX and PTLOX Conversion

Attachment 3 Oxygen Compressed Air Cylinder Duration Formula

Attachment 4 LOX Weight Conversion

* Denotes a piece of equipment that has an approved long-term waiver. Some items that have a long-term waiver are not nested in the Waived Equipment chapter to maintain the integrity of equipment organization. Long-term equipment waivers can be found in Aircrew Pubs Library > Master Library Verified > AE > 10 Series Operations > Long Term Equipment Waivers.

Backpack Medical Oxygen System

Figure 1.1. Backpack Medical Oxygen System

1.1 Purpose

2.1 Power

3.1 Parts

4.1 Preflight

5.1 Performance

6.1 Placement/Securing

7.1 Cleaning

8.1. Unique Patient Considerations

Table 1.1. BMOS Quick Reference

QUICK REFERENCE

Power Required (6) AA-batteries

Oxygen Required 2 liters (for msn planning account for 0.5L LOX of bleed off)

Weight 18.5 lbs full / 14 lbs empty

Dimension 17.5” L x 7.5” W x 6.5” H

1.1. Purpose. BMOS is a portable Liquid Oxygen (LOX) system. When filled with LOX the BMOS will provide an uninterrupted supply of therapeutic oxygen. The system has the capacity to store two liters (2L) of liquid oxygen and convert the LOX to a gaseous state at a max flow rate of 15 LPM.

AECMs can utilize the built-in flow control valve to deliver oxygen to a single patient at flow rates from

0.5 to 15 LPM; in addition, the unit is equipped with a secondary auxiliary outlet that can supply oxygen to a second patient when a flow control valve is installed.

CAUTION: When using both supply outlets simultaneously, ensure that the combined total flow rate does not exceed 15 LPM.

Note: Due to the limited capacity of liquid oxygen, a minilator will NOT be used in connection with the

BMOS.

Figure 1.2. BMOS Panel

2.1. Power. The BMOS requires six (6) AA alkaline/lithium batteries to power the LOX quantity indicator panel. A minimum of one (1) green LED light must be lit to indicate sufficient power available for use.

3.1. Parts. The BMOS assembly combines the following items into a single/portable transportable unit:

A liquid oxygen dewar, Primary oxygen outlet, secondary auxiliary outlet, outlet pressure gauge, LED light display, battery housing, (1) flow control valve, toggle vent valve, fill connector, and a carry case pull handle with four (4) securing rings.

Stock number #50C-0089-3

Note: Stock Number #50C-0089-3 depicted in Figure 1.2. The fan is to be utilized when the unit is in an enclosed ballistic case.

4.1. Preflight. Ensure equipment is within calibration requirement date and that this date is recorded on the DD Form 2163, Medical Equipment Verification/Certification, or most current and approved calibration sticker and will not be exceeded during the planned mission. Ensure AF Form 4033, PMI/AE Certification Label, is complete and present.

Note: The BMOS requires both scheduled monthly and annual inspections. A qualified AECM may perform the monthly inspection IAW T.O. 15X2-5-21-2, this inspection will be annotated on the AFTO 244, Industrial/Support Equipment Record. The annual inspection will be completed by the host unit’s designated Biomedical Equipment Maintenance personnel or Maintenance Squadron (MXS) Electrical and Environmental specialists.

4.1.1. Inspect the system for any signs of damage, ensure the carrying handles and securing straps are in place and are securely attached to the unit.

4.1.2. Check the battery condition by depressing the BAT TEST button. The digital display must show a minimum of one (1) green LED light, to indicate sufficient power available for use. If not, replace the batteries with six (6) double AA batteries. If battery replacement does not correct the problem, complete an AF From 4449, En Route Care Equipment Malfunction Report Tag, (or if unavailable complete AFTO 350, Repairable Tag) and affix tag to the unit, do not use. Turn the equipment into medical maintenance for repair.

4.1.3. Inspect the outlets for any indication of damage.

4.1.4. Ensure the unit is full of Liquid Oxygen, depress the LOX QTY button and ensure the green LED lights light all the way up. Momentarily pressing the membrane button labeled LOX QTY on the panel will display the quantity of liquid on the LED display window. The contents of the liquid oxygen can be checked when the unit is either in horizontal or vertical attitudes.

4.1.5. Check the pressure gauge for proper operating pressure which is 45-55 pounds per square inch

(PSI).

Note: The pressure indicated on the outlet pressure gauge should be within the green zone (45 to 55 PSI) during normal use. The pressure can indicate as high as 65 PSI while in standby with no flow.

4.1.6. Turn flow control valve to 15 LPM and allow oxygen to flow for 20 seconds. Check to ensure that the pressure gauge does not fall below 45 PSI. Smell the emitted oxygen for any odors. Return setting to

0 LPM.

WARNING: If any odors other than the hose smell are detected, have other personnel recheck it for odors. Contact MXS Electrical and Environmental specialists as soon as possible and report this incident. Do not use this unit! Replace it.

4.1.7. After completing the preflight inspection and when applicable, document completion of the non-scheduled inspection on the unit’s AFTO Form 244. Ensure AFTO Form 244 remains attached to the

BMOS.

WARNING: Ensure BMOS does not contain Nitrogen; this is indicated with a sticker or written on the AFTO Form 244.

Note: Refer to AE Checklist Insert A for mission oxygen calculation.

Note: Mission planning should account for 0.5L LOX reserve and unit bleed off rates after filling.

5.1. Performance. Owner’s/User’s Manual must be accessible in flight. Refer to Owner’s/User’s Manual located in Electronic Flight Bag for performance information.

6.1. Placement/Securing. Placement of the BMOS in the aircraft is at the discretion of the MCD and or CMT based on the following criteria:

Note: Secure no more than 5 feet from the patient due to length of tubing.

WARNING: Place unit a minimum of 50 feet from all sparking or flammable devices. Never place the system where it will encounter petroleum products or hydraulics. Operate and maintain the BMOS system only in a well-ventilated location. Never allow the unit vent port to be obstructed. Stay clear of the vent port during filling. Do not position unit near hydraulic reservoirs. Ensure cargo floor is free of oil or any other petroleum-based products.

Note: To prevent a potentially hazardous situation from gas pressure buildup, a system relief valve, set at 65 PSI, and a safety relief valve set at 100 PSI are incorporated into the BMOS.

6.1.1. Secure the BMOS system in place when used inflight or transported in a ground vehicle using the securing rings and a cargo strap or on litter with litter strap across the top and through the carry strap.

Note: The BMOS can operate either in the horizontal/vertical or any in-between position.

CAUTION: Overtightening of a cargo strap across the unit may cause damage.

6.1.2. The BMOS can be worn in transport by a single AECM or ground personnel for transport to and from the aircraft.

7.1. Cleaning. If unit becomes soiled, clean with an approved germicidal wipe.

8.1. Unique Patient Care Considerations.

WARNING: Due to its limited capacity of liquid oxygen, the BMOS is NOT an appropriate oxygen supply for most transports of mechanically ventilated patients. However, at the discretion of the En Route Critical Care (ERCC) team leader, BMOS may be the best option for a small subset of transport, e.g., missions of short duration in a tactical environment or on a nonstandard aircraft.

Bag Valve Resuscitator (BVM)

2.1 Parts

3.1 Preflight

4.1 Performance

5.1 Cleaning

6.1 Unique Patient Care Considerations

Figure 1.1 “Reusable” BVM Figure 1.2 “Disposable” BVM (Adult/Child/Infant) (Adult/Child/Infant)

Table 1.1. Quick Reference

Oxygen Required Suggest 15L or Flush Weight < 16 oz

1.1. Purpose. The Bag-Valve-Mask (BVM) Resuscitators are used to administer artificial ventilation when natural inspirations are insufficient or absent.

Note: BVM Resuscitator brands may be disposable or reusable depending on the manufacturer selected for AE In-Flight Kit, Packaging Guide/Allowance Standard. The following guidelines are general in description. Variances based on current brands will be identified prior to use.

2.1. Parts. The BVM kit consists of a bag-valve-mask assembly and an oxygen reservoir bag (or corrugated tubing). There are three (3) sizes: Note: Some sizes may show up differently when ordering.

2.1.1. Adult or (W/LGE & Large) – The Adult unit consists of cuffed masks, a non-re-breathing patient valve, a ventilation bag, an intake/reservoir valve, and an oxygen reservoir bag (or corrugated tubing).

2.1.2. Child or (Med Adult)–The Child unit is like the Adult unit, but has smaller cuffed masks, a non-re-breathing patient valve with a pressure limiting device, a ventilation bag, an intake/reservoir valve and an oxygen reservoir bag (or corrugated tubing).

2.1.3. Infant or (Child)– The Infant unit is like the Child unit, but has a one-piece mask, a non-re-breathing patient valve with pressure limiting device, a ventilation bag, an intake/reservoir valve and an oxygen reservoir bag (or corrugated tubing).

3.1. Preflight. Ensure all components are present and in serviceable condition and the bag is intact and does not contain any rips or holes.

3.1.1. Ensure airway adjuncts are present.

4.1. Performance. Select the resuscitator based on patient size (Adult, Child, or Infant).

4.1.1. Connect oxygen tubing from the BVM to flow meter or oxygen flow regulator outlet and set the rate to 15 LPM or flush to achieve maximum oxygen percentage available based on BVM type.

4.1.2. Connect the appropriately sized mask to the manual resuscitator.

4.1.3. Place an airway adjunct if necessary to maintain a patient airway.

4.1.3.1. An Oropharyngeal Airway (OPA) is measured from the corner of the patient's mouth to the angle of the mandible. Flange should rest on patient's lips. Insert the OPA in accordance with (IAW) the member’s certification.

4.1.3.2. Nasopharyngeal Airway (NPA) is measured from the tip of the patient's nose to the earlobe of the ear. Select a diameter that is smaller than the inner aperture of the patient's nostril. Insert the NPA IAW the member’s certification.

4.1.4. Seal the mask over the patient’s nose and mouth. Maintaining a seal, compress the ventilation bag to ventilate the patient. Observe for chest rise and fall.

WARNING: Ensure corrugated tubing or proper size reservoir bag is used with ventilation bag (adult, child, or infant). Ensure non-re-breathing valve, with pressure limiting device, is in place on child and infant units. If needed, the pressure-limiting device can be overridden.

WARNING: Ensure a BVM with a Positive End Expiratory Pressure (PEEP) valve accompanies intubated patients on ventilators when PEEP is > 5 cm H2O. PEEP valve is available in the Allowance Standard.

WARNING: Refer to the applicable Life Support training/certification recommendation(s) on ventilation bag compression/volume ranges to minimize possible negative outcomes (i.e., barotrauma).

Note: The pressure-limiting device restricts airway pressure to 35 centimeters H20 pressure or manufacturer’s guidelines.

Note: The oxygen reservoir bag must inflate with oxygen to be effective. If it does not, ensure oxygen is being delivered to the unit at an adequate rate.

5.1. Cleaning. For reusable BVMs, refer to manufacturer’s guidelines for cleaning specifics. For disposable BVMs, dispose according to infection control guidelines.

6.1. Unique Patient Care Consideration. For patients who require airborne infection control precautions, place ventilator breathing circuit filter aft of mask and forward of elbow fitting. If expired body fluids block the filter; replace filter and continue cardiopulmonary resuscitation effort.

6.1.1. If endotracheal tube (ET) is used, place filter aft of ET and forward of BVM elbow fitting.

Adapter Assembly for C-17 High Altitude Liquid Oxygen (HALO) System

3.1 Preflight

4.1 Performance

5.1 Placement/Securing

6.1 Cleaning

7.1 Unique Patient Care Considerations

Table 1.1 Quick Reference

Weight 7 ounces

1.1. Purpose. The HALO adapter assembly for the C-17 aircraft is designed to allow humidified oxygen to be distributed throughout the aircraft utilizing the HALO outlets aboard the C-17. Use of humidification allows the integral aviator grade oxygen to be used for medical oxygenation of patients during transport to medical facilities.

WARNING: To prevent the danger of explosion/fire, all equipment will be kept free from oil, grease or any material not approved for use in the presence of oxygen.

WARNING: All HALO outlets are designed to provide 13 LPM without a drop in pounds per square inch (PSI). AECMS will not exceed 13 LPM at any of the HALO outlets to include connection of a minilator.

2.1. Parts. Carrying case, HALO device (oximeter), oxygen fitting, bail assembly and bottle holder assembly. Stock # 1680NCM082876.

3.1. Preflight. Inspect the HALO for any signs of visible damage.

3.1.1. Check to ensure external cap plug is in place.

3.1.2. Ensure there are no visible signs of damage or hydraulic fluid on or within the device.

4.1. Performance. Owner’s/User’s Manual must be accessible in flight. Refer to Owner’s/User’s Manual for performance information.

WARNING: The aircraft’s HALO system regulators are sized to maintain 50 +/- 5 pounds per square inch (PSI) output. Do not exceed a combined 75 LPM from all Flow Control Valves attached to HALO outlets.

4.1.1. Ensure equipment functions properly on the aircraft.

4.1.2. Have the loadmaster turn off HALO system.

4.1.3. Remove external cap plug from oxygen fitting and attach to end cap rest.

4.1.4. Depress push button and remove humidification bottle holder assembly.

4.1.5. Connect oxygen fitting to mating adapter on C-17 HALO system.

4.1.6. Rotate bail support assembly towards the outside of the aircraft to provide adequate support for humidification bottle.

4.1.7. Install humidification bottle to Flow control Valve and bottle holder assembly, and secure with nylon Velcro strap.

4.1.8. Remove protective cap and attach a Flow Control Valve via a medical DISS connector, ensure Flow Control Valve is on zero before installation.

4.1.9. Turn on system to 13 LPM and test for leakage.

Note: If unit is leaking re-accomplish steps and ensure proper placement.

5.1. Placement/Securing. For this application, the user requires an assembly which plugs into any C-17 HALO outlet.

WARNING: DO NOT wear leather/nomex gloves when connecting oxygen components.

5.1.1. The adapter assembly provides support and stability for the Flow Control Valve and humidified bottle (using the bail assembly), in such a way that all the forces are not applied to the C-17 HALO outlet. Figure 1.

WARNING: If the Flow Control Valve and humidified bottle are not secured properly by the bail assembly, leakage/and or failure of the C-17 HALO outlet and/or adapter could occur over time.

6.1. Cleaning. If soiled, use approved germicidal wipes to clean.

7.1. Unique Patient Care Considerations. The HALO adapter may also be connected to a low-pressure oxygen hose, with use of a female-to-female coupling (Figure 2).

Note: This would allow AE crew to string therapeutic oxygen to a patient.

WARNING: If using a minilator, do not exceed 13 LPM.

Figure 2.

WARNING: HALO outlets will NOT be used to support ventilators/respirators because they do not provide sufficient flow rates to support those devices.

Minilator

3.1 Preflight

4.1 Performance

5.1 Disassembly/Storage

Figure 1.1 Minilator and Connectors - Front View Table

Table 1.1 Quick Reference

Weight 13.5 oz.

1.1. Purpose. The Minilator is an oxygen distribution system designed to provide therapeutic oxygen for up to five (5) patients from a single oxygen hose from a given source.

WARNING: The Minilator can be used with ventilators on low flow systems to provide more capability to the ERCC team. Coordination with ERCC team is imperative.

GREEN 50 PSI OXYGEN HOSE

FROM

PTLOX/NPTLOX or O2 hose.

Connect directly to Minilator Inlet

CAUTION: The oxygen flow control valve, from the PTLOX/NPTLOX system accessory kit, can be used with the minilator. When using oxygen flow control valves from the accessory kit, the top hat regulator will limit the number of Veriflow flow meters that can fit on the minilator, reducing overall capabilities.

2.1. Parts. The minilator is an oxygen distribution system with one (1) inlet, which is connected to the oxygen source, and five (5) outlet valves for distributing oxygen, and one (1) connector for use with a standard green 50 PSI oxygen hose. Check valves are installed in the outlets to prevent oxygen flow from any unused outlets. Dust covers are installed to prevent debris from entering the minilator.

3.1. Preflight. Inspect the manifold and connector for damage or obvious contamination.

4.1. Performance. Connect green 50 PSI oxygen hose to the minilator inlet valve. Remove the necessary dust caps from the outlet valves and connect a flow meter or a green 50 PSI oxygen hose to the outlets. Connect the green 50 PSI to flow meter/humidifier or flow meter/nipple and nut (Christmas tree) assemblies and purge the system with low flow oxygen and then set the flow rates to the prescribed values.

4.1.1. When using the PTLOX/NPTLOX as an oxygen source, connect the PTLOX/NPTLOX green 50 PSI oxygen hose directly to the minilator inlet valve. Remove the necessary dust caps from the outlet valves and connect a Veriflow flow meter or a standard green 50 PSI oxygen hose to the outlets. Ensure Veriflow flow meter setting is at zero. Then connect the PTLOX/NPTLOX green 50 PSI hose with Schrader end into the PTLOX/NPTLOX system. Purge system to clear the lines of any contaminants and return setting to zero. Attach humidifier or nipple and nut assemblies as required and set the flow rates to the prescribed values.

WARNING: Prior to connecting to an oxygen source, a flow meter with index set at zero liters per minute (LPM) must be attached to any oxygen hose connected to the minilator.

Note: NPTLOX has a maximum oxygen flow of 66 LPM, (e.g., if the minilator line is using 20LPM, 46LPM total flow is available for the 5 other ports on the NPTLOX). When using a minilator with the PTLOX maximum flow rate is 60LPM. Minilator outlets have a one-way valve allowing the connection or disconnection of a flow meter to the minilator without disconnecting from the oxygen source. If the minilator is being used to supply a ventilator, the low flow system should be attached to a flow meter/nipple and nut assemblage rather than a humidifier assemblage.

5.1. Disassembly/Storage. Ensure that the patients have been disconnected from oxygen and the lines are turned off. Discontinue the oxygen source to the minilator. Remove the hoses from the minilator outlets and replace the dust caps. Disconnect the hose from the minilator inlet or connector and remove the connector (if used) from the inlet. Replace the dust cap. Store the minilator and connector, if applicable.

Next Generation Portable Therapeutic Liquid Oxygen (NPTLOX)

3.1 Parts

4.1 Preflight

5.1 Performance

6.1 Placement/Securing

7.1 Disassembly/Storage

8.1 Shipping/Transport

Figure 1.1 Next Generation Portable Therapeutic Liquid Oxygen System (NPTLOX)

Power Required: 9V lithium batteries (2)

Oxygen Required: Liquid Oxygen 20L (oxygen calculations, add 1 liter to any oxygen requirement under 5 liters).

Weight: Empty: 107 lbs Full: 157 lbs

Dimensions: L 22” x 24.5” W x 32” H

1.1. Purpose. The NPTLOX System, when filled with liquid oxygen (LOX), will provide for an uninterrupted supply of therapeutic oxygen. The system has the capacity to store twenty liters (20L) of LOX and convert the LOX to a gaseous state. The gaseous oxygen is then humidified and delivered at a controlled flow rate to up to six (6) ambulatory or litter patients as long as 66 LPM is not exceeded. The NPTLOX System is configured to be carried on-board and tied down to the floor of the aircraft cargo compartment.

CAUTION: A dedicated NPTLOX can support three (3) ventilated patients and one (1) emergency line.

En Route Critical Care (ERCC) team can increase or decrease ventilator and emergency lines, depending on patient needs. The remaining outlet port may be utilized for LOW flow oxygen if needed.

Maximum oxygen flow rate is 66LPM.

Note: When using a minilator with the NPTLOX, the maximum oxygen flow is 66 LPM.

1.1.2. During all operational missions the AECMs will ensure adequate patient oxygen supply and management throughout the duration of the flight.

2.1. Power. Power consists of two (2) 9V lithium batteries. Batteries are required for LCD panel only and do not affect oxygen delivery.

CAUTION: Use only batteries recommended by NPTLOX Operation and Maintenance Manual.

2.1.1. To change the batteries, remove the battery compartment access panel on the face of the quantity indicator by removing the four panel retaining screws. Remove the wire leads from the batteries.

Remove the batteries from the battery clips. Insert two new 9-volt lithium batteries into the battery clips.

Attach the wire leads to the new batteries. Press the “TEST” button and check the value displayed. The reading should be between “10.0” to “16.0”. Reinstall the battery compartment access panel. Install the four-access panel retaining screws.

3.1. Parts. The Container Assembly combines the following items in a single, portable and transportable unit: a liquid oxygen dewar, heat exchangers, relief valves, pressure regulating valves, outlet pressure gauge, LOX quantity indicator, battery “TEST” indicator, miscellaneous tubing and fittings, (6) quick disconnect outlet ports, and (4) tie down provisions.

CAUTION: High Vacuum Container Handle with Care. Keep the Container Assembly sliding door closed at all times when the Container Assembly is not in use to prevent entry of contamination around the six-oxygen outlet quick disconnect receptacles.

3.1.1. Accessory Kit: The accessory kit attaches to the top of the container assembly unit. It contains the following: three (3) 20-foot oxygen hoses, three (3) flow control valves, (3) humidification bottles and

(3) Schrader/DISS quick disconnect adapters.

Note: Ensure the proper accessory kit is attached (NPTLOX versus PTLOX). PTLOX accessory kit does not have 3 Schrader/DISS quick disconnect adapters.

Figure 3.1 Accessory Kit (from Essex) Figure 3.2 Accessory Kit (with prefilled bottles)

WARNING: Per DAFI 21-101, Maintenance Management of Aircraft, maintenance and filling of LOX systems will be done only by qualified LOX personnel. Per T.O. 15X2-5-21-2, Operation and Maintenance Manual, only personnel fully trained and qualified in the operation of the NPTLOX System are authorized to use this equipment.

WARNING: Keep away from exposure to oil and grease. Do not handle oxygen with greasy hands or clothing. Do not let fittings, hoses, or any oxygen equipment come in contact with oil, grease, hydraulic fluid or dirt.

WARNING: Keep oxygen away from open flame. A small flame in the presence of oxygen can quickly flare up and become uncontrolled.

WARNING: When oxygen equipment is in use, keep in a well-ventilated area away from all gasoline, kerosene, oil, grease, and other hydrocarbons. These substances are not compatible with liquid or gaseous oxygen.

4.1. Preflight. Ensure equipment is within calibration requirement date and that this date is recorded on the DD Form 2163, Medical Equipment Verification/Certification, or most current and approved calibration sticker, and will not be exceeded during the planned mission. Ensure AF Form 4033, PMI/AE Certification Label, or equivalent is complete and present.

Note: The NPTLOX requires both scheduled monthly and annual inspections. A qualified AECM may perform the monthly inspection IAW T.O. 15X2-5-21-2. The annual inspection will be completed by the unit’s designated Biomedical Maintenance Equipment Technician repair personnel.

4.1.1. Check both the Container Assembly housing and the Accessory Kit case for any damage that could possibly affect the system performance, such as missing components, severe dents, missing fasteners, broken or damaged latches, and tie downs, cracked or broken lens on the outlet pressure gauge, or any visible damage to the quantity indicator.

4.1.2. Check the LOX quantity by actuating the “LOX QTY” button. The quantity will be between

0.00 liters and 20.00 liters. One (1) liter of liquid oxygen will equate to 860 liters of gaseous oxygen.

Ensure NPTLOX is filled with liquid oxygen, and the quantity is sufficient for the mission. (Figure 4.1.)

Figure 4.1 Quantity Indicator and Battery Compartment

Note: For minimum oxygen calculations, add 1 liter to any oxygen requirement under 5 liters.

4.1.3. Check the battery power by actuating the “TEST” button. The reading should be between “10.0” to “16.0”. If not, replace the batteries with 9V lithium batteries. If battery replacement does not correct the problem, complete an AF Form 4449, En Route Care Equipment Malfunction Report Tag, (or if unavailable complete AFTO Form 350, Repairable Tag) and affix to the unit. Do not use. Turn the equipment into medical maintenance for service or repair. (Figure 4.1.)

4.1.4. Check the pressure gauge for proper operating pressure and ensure it reads (50 +/- 5 psi). (Figure 4.2.)

Figure 4.2 Outlet Pressure Gauge

Note: The pressure indicated on the outlet pressure gauge should be within the green zone (45 to 55 PSI) during use. The pressure can indicate as high as 62 PSI while in standby with no flow.

4.1.5. Check the Container Assembly sliding door for smooth and positive operation.

4.1.6. Check the Container Assembly outlet ports for general condition, for smooth and positive action and ensure the protective dust covers are installed. Visually inspect the oxygen outlet of the container for any debris PRIOR to inserting the Schrader end of the supply hose into the oxygen outlet.

WARNING: If debris is found in the outlet, contact the biomedical maintenance equipment technician as soon as possible and report. Do not use this unit! Replace it.

4.1.7. Check Accessory Kit contents for (3) each of the flow control valves, 20-foot oxygen hoses on storage reels humidification bottle.

4.1.8. Check the flow control valves for cleanliness and for smooth operation of the control knob through its entire setting range.

4.1.9. Check the oxygen hoses for end fitting condition, excessive wear and flexibility, obvious physical damage and cleanliness.

4.1.10. Ensure 300 mL humidification bottles are present and check for obvious physical damage and/or cleanliness. Ensure sterile water, if present, has not expired.

4.1.11. After completing the preflight inspection and when applicable, document completion of the non-scheduled inspection (if the last date accomplished has exceeded 30 days) on the unit’s AFTO Form 244, Industrial/Support Equipment Record. Ensure AFTO Form 244 remains attached to the NPTLOX.

4.1.12. Based on mission requirements, refer to paragraph 6.1 for placement/securing procedures.

5.1. Performance. Open accessory case and remove a flow control valve (each assembly is comprised of a flow valve, clip assembly, and retaining strap). Remove the dust caps from the inlet and outlet of the flow control valve and secure them in the accessory case. Remove an oxygen hose, attached to a storage reel, from the accessory case and remove the hose from the reel. Connect the threaded end of the hose to the inlet on the side of the flow control valve, and ensure the valve is set to 0 LPM.

CAUTION: Maintain positive control of schrader valve end of hose until insertion into NPTLOX to avoid damaging the schrader valve.

Figure 5.1 Flow Control Valve Inlet Fitting for Oxygen Hose

Outlet to Patient

WARNING: Always connect the flow control valve fitting marked “INLET” to the mating fitting on the oxygen hose. Connect the fitting marked “OUTLET TO PATIENT” to the humidifier bottle, oxygen tubing and/or oxygen wing nut adapter. Reversing these connections or use of a gas source other than specified, may result in inaccurate flow rates and patient injury (Figure 5.1.)

WARNING: Protective gloves (i.e., leather work gloves/nomex flight gloves) are required when lifting/securing the NPTLOX for transport. DO NOT wear leather work/nomex gloves when connecting the oxygen components.

WARNING: Prior to connecting an oxygen hose to an outlet port, a flow control valve, with the control knob set at zero (0), must be attached to the mating hose fitting. This step is imperative to prevent pressurized oxygen from escaping out an open-ended hose.

5.1.1. Slide the oxygen outlet cover back until it is secure. Remove the outlet cap by twisting the knurled knob at the outlet in a clockwise direction. Inspect the oxygen outlets of the container for debris PRIOR to inserting the Schrader end of supply hose into the oxygen outlet. Insert the Schrader end (tapered) of the oxygen hose into the oxygen outlet and press firmly until it attaches securely. Turn flow control valve to highest setting and allow oxygen to flow for 20 seconds to purge the system. Check to ensure that the oxygen delivery pressure indicated on the outlet pressure gauge does not fall below 45 PSI.

Smell the emitted oxygen for any odors. Return setting to 0 LPM.

WARNING: If debris is found in the outlet, contact the biomedical maintenance equipment technician personnel as soon as possible and report. Do Not Use This Unit! Replace it.

WARNING: If any odors other than the hose smell are detected, have other personnel recheck it for odors. If odor detected, contact the biomedical maintenance equipment technician personnel as soon as possible and report this incident. Do Not Use This Unit! Replace it

WARNING: If more than 3 outlets are used simultaneously, ensure that the combined total flow rate does not exceed 66 LPM, this could result in under oxygenated patients.

CAUTION: The oxygen flow produced by this device can be within 10 degrees F of ambient temperature. Caution should be exercised if the room temperature is warmer than 90 degrees F.

5.1.2. Assemble the humidification bottle by filling the 300ml container with sterile water and attaching it to the humidifier adapter. Note: AECMs may have to request sterile water if it is not included in the allowance standard. Attach the flow control valve fitting marked “OUTLET TO PATIENT” (Figure 5.1.) to the mating fitting on humidifier adapter. Ensure that the oxygen flow is in the proper direction.

Connect patient oxygen mask or cannula to the outlet tube fitting of the humidifier adapter. Note: For pre-filled humidification bottles, attach to the humidifier adaptor per the directions on the bottle.

5.1.3 Place the mask or cannula on the patient as required. Oxygen may be administered by adjusting the flow control valve knob to the following settings: 0, 0.5, 1, 2, 3, 4, 5, 6, 8, 10, 12 and 15 liters per minute when supply pressure is at 50 +/- 5 psi (green zone on the outlet pressure gauge).

6.1. Placement/Securing. Placement of the NPTLOX in the aircraft is at the discretion of the MCD and CMT based on the following criteria:

6.1.1. Using four (4) tie-down straps, located on two (2) sides of the unit, secure the unit to the d- rings located on the aircraft floor. Each individual tie-down strap will be secured to a separate d- ring. See example below as one way of securing the unit. (Figure 6.1).

Figure 6.1 NPTLOX Tie-Down

WARNING: Place a minimum of 50 feet from all sparking or flammable devices. Never place the system where it will come in contact with petroleum products or hydraulics, explosion may result.

WARNING: Operate and maintain the NPTLOX System only in a well-ventilated location. Never allow the unit vent port to be obstructed. The vent port must remain open at all times.

WARNING: The NPTLOX is to be positioned facing upright and never on its side to avoid improper operation and excessive venting of oxygen.

WARNING: Do not secure/run lines over moving aircraft parts. Consult with the loadmaster or boom operator if oxygen lines are strung outside the litter stanchion area or above the patient area.

WARNING: Do not position NPTLOX near hydraulic reservoirs. Ensure cargo floor is free of oil or any other petroleum-based products.

6.1.1.1. Securing procedures for NPTLOX on the ramp. See figures 6.2, 6.3 and 6.4. When securing the NPTLOX on the ramp, AECMs will follow these securing procedures.

CAUTION: NPTLOX can only have 15 liters of LOX or less to secure on the ramp.

WARNING: If there is leakage into the drip pan AECMs will remove NPTLOX from ramp and secure on a flat surface.

WARNING: AECMs will only secure as shown below, with the quantity indicator, gauge and battery compartment facing the fight deck, as seen in Figure 6.2. Procedures have been coordinated and approved by ESSEX Industries.

Figure 6.2 Front View Figure 6.3 Back View

Figure 6.4 Side View

7.1. Disassembly/Storage. Disassemble the NPTLOX System in the reverse order of assembly. Remove delivery device from the patient. Turn the flow control valve off. Remove the oxygen hose Schrader end from the base assembly oxygen outlet by turning the knurled knob in a clockwise direction and pulling up on the end of the hose. Replace the outlet cap by pushing it firmly into the outlet and then close the oxygen outlet cover. Remove and dispose of the humidifier bottle. Remove the flow control valve from the oxygen hose, replace the dust caps, and secure the valve in the accessory case. Rewind the oxygen hose on its storage reel and stow the reel in the accessory case.

Note: The oxygen hose must be wound tightly, otherwise it will not fit back into the accessory case.

7.1.2. Close and secure the accessory case lid and attach the case to the top of the container assembly.

Release the tie down straps and secure them to the rings on the sides of the unit.

Note: The NPTLOX system will be stored with nitrogen IAW T.O. 15X2-5-21-2, Type CRU- 50/A.

8.1. Shipping/Transport. The NPTLOX system is transported IAW AFMAN 24-604 Preparing Hazardous Materials for Military Air Shipments.

Note: AFMC 24-204-117-11, must accompany the shipment within the Defense Transportation System and incidents will be reported IAW the waiver.

8.1.1. IAW AFMAN 24-604, shipment/transport of up to twenty-five (25) 20-liter NPTLOX converters per aircraft, may be shipped without overboard venting aboard USAF transport aircraft.

8.1.2. NPTLOX converters shipped as cargo in a non-operational condition, purged per the manufacturers, Operation and Maintenance Manual, and the liquid oxygen replaced with gaseous nitrogen not to exceed 40 PSI may be shipped as empty IAW AFMAN 24-604.

8.1.3. NPTLOX converters identified as part of the aircraft equipment and used on aeromedical evacuation mission are not subject to the requirements of AFMAN 24-604.

8.1.4. The NPTLOX does not require HAZMAT certification, processing through Aerial Port and venting is not required when an AECM is accompanying the equipment.

8.1.5. HAZMAT certification is required when an AECM is unable to accompany the equipment.

8.1.6. All other requirements of AFMAN 24-604 must be met.

8.1.7. AECMs who transport must be in mission essential personnel (MEP) status.

8.1.7.1. Inform the command post (CP) of the amount of equipment and NPTLOX to be carried on the aircraft. CP advises Air Transportation Operations Center (ATOC). Notify the Pilot in Charge (PIC) and Loadmaster (LM)/Boom Operator (BO) that NPTLOX will be transported and determine proper placement on the aircraft with direction from PIC/LM/BO.

8.1.7.2. The NPTLOX will not be hoisted into the aircraft using cargo straps IAW DAFMAN 91-203 Chapter 12, paragraphs 12.7 and 12.10.

Portable Therapeutic Liquid Oxygen (PTLOX)

1.1 Purpose

2.1 Power

3.1 Parts

4.1 Preflight

5.1 Performance

6.1 Disassembly/Storage

7.1 Placement/Securing

8.1 Shipping/Transport

Figure1.1 Portable Therapeutic Liquid Oxygen System (PTLOX)

Power Required 9-volt batteries (2) Oxygen Required Liquid Oxygen 10L (oxygen calculations, add 1 liter to any oxygen requirement under 5 liters).

Weight Empty: 55 lbs Full: 80 lbs Dimensions W 18”x L 20” x H 24”

1.1. Purpose. The PTLOX is designed to provide controlled flow of humidified oxygen from three (3) oxygen outlets when an aircraft oxygen source is unavailable. Oxygen is delivered to the converter outlets at a pre-set pressure of 50 +/- 5 pounds per square inch (psi), and a maximum flow rate of 15 LPM per outlet due to the limiting factor of (3) integral flow control valves, located in the accessory kit, each with the peak rate of 15 LPM per flow control valve, with an overall maximum oxygen flow rate of 45 LPM for the unit. A pressure gauge continuously registers oxygen delivery pressure.

1.1.2. During all operational missions the AECMs will ensure adequate patient management throughout the duration of the flight.

WARNING: A dedicated PTLOX can support one (1) ventilated patient and one (1) emergency line. Do not exceed the maximum flow rate of 45 LPM. If exceeded, ventilator(s) WILL NOT function properly.

The remaining outlet port can be utilized for LOW flow oxygen if needed.

Note: When using a minilator the maximum flow rate of 45 LPM may be achieved. Continuous monitoring of the pressure gauge and patient oxygen saturation must be monitored throughout the mission.

2.1. Power. No requirement affecting oxygen delivery. Two (2) Lithium batteries run the LCD panel only.

3.1. Parts. The container assembly consists of three (3) gaseous oxygen outlets with dust caps, an operate button to check the level of liquid oxygen (LOX), a test button to check the battery condition, a pressure gauge to check the psi of the converter, a liquid oxygen filler port, a vent tube, four (4) securing straps, and an internal drip pan.

Note: The internal drip pan is large enough to hold possible spillage and thus provides an added safety feature should a catastrophic system failure occur. Therefore, no external drip pan is necessary.

3.1.1. Accessory kit: The accessory kit attaches to the top of the container assembly unit. It contains the following: three (3) 20-foot oxygen hoses, three (3) flow control valves, and three

(3) humidification bottles.

WARNING: Per DAFI 21-101, Maintenance Management of Aircraft, maintenance and filling of LOX systems will be done only by qualified LOX personnel. Per T.O. 15X2-5-21-2, Liquid Oxygen Converter only personnel fully trained and qualified in handling and servicing liquid oxygen are authorized to service the container assembly. Never allow the container assembly to be placed where the vent may be obstructed.

4.1. Preflight. Ensure equipment is within calibration requirement date and that this date is recorded on the DD Form 2163, Medical Equipment Verification/Certification, or most current and approved calibration sticker, and will not be exceeded during the planned mission. Ensure AF Form 4033, PMI/AE Certification Label, is complete and present.

Note: The PTLOX requires both scheduled monthly and annual inspections. A qualified AECM may perform the monthly inspection IAW T.O. 15X2-5-21-2. The annual inspection will be completed by the unit’s designated Biomedical Equipment Maintenance personnel or Electrical and Environmental Control Systems.

4.1.1. Inspect the system for any signs of damage.

4.1.2. Ensure the carrying handles and securing straps are in place and are securely attached to the unit.

4.1.3. Open the accessory case, inventory the components, and inspect them for serviceability.

4.1.4. Ensure the sterile water has not expired (If present).

4.1.5. Check the structural soundness and function of the accessory case securing latches.

4.1.6. Remove the accessory case from the liquid oxygen unit.

4.1.7. Check the battery condition by depressing the TEST button. The digital display should show between 10.00 and 19.99. If not, replace the batteries with 9-volt batteries. If battery replacement does not correct the problem, complete AF Form 4449, En Route Care Equipment Malfunction Report Tag, (or only if unavailable complete AFTO 350, Repairable Tag), and affix to the unit, do not use. Turn equipment into medical maintenance for repair.

4.1.8. Open the outlet cover panel and check the outlets for any indication of damage. Visually inspect the oxygen outlet of the container for any debris PRIOR to inserting the Schrader end of the supply hose into the oxygen outlet.

WARNING: If debris is found in the outlet contact the aircraft environmental systems personnel as soon as possible and report. Do not use this unit! Replace it!

4.1.9. Determine the liquid oxygen quantity by depressing the OPERATE button and observing the digital display for the liters of liquid oxygen present. The quantity will be between 0.00 liters and 10.00 liters. One (1) liter of liquid oxygen will equate to 860 liters of gaseous oxygen. Ensure PTLOX is filled with liquid oxygen, and the quantity is sufficient for the mission.

Note: For minimum oxygen calculations, add 1 liter to any oxygen requirement under 5 liters.

4.1.10. Check the pressure gauge for proper operating pressure (50 +/- 5 psi).

4.1.11. After completing the preflight inspection and when applicable document completion of the non-scheduled inspection (last date accomplished has exceeded 30 days) on the unit's AFTO Form 244, Industrial/Support Equipment Record. Ensure AFTO Form 244 remains attached to the PTLOX.

WARNING: Ensure PTLOX does not contain Nitrogen (storage state only). Indicated on the unit with a sticker or written on DD Form 2163, Medical Equipment Verification/Certification.

WARNING: Protective gloves (i.e., leather work gloves/nomex flight gloves) are required when lifting the PTLOX for transport. DO NOT wear leather work/nomex gloves when connecting the oxygen components.

WARNING: Oil, grease, gasoline, kerosene, and other hydrocarbons are not compatible with oxygen.

5.1. Performance. Remove and open accessory case. Remove a flow control valve. Remove the dust caps from the inlet and outlet of the flow control valve and secure in the accessory case. Remove an oxygen hose storage reel from the accessory case and remove the hose from the reel. Connect the threaded end of the hose to the inlet on the side of the flow control valve, and ensure the valve is set to 0 LPM (Figure 2.1.)

WARNING: A flow control valve, with index set at zero (0) must be attached to the supply hose fitting prior to inserting the supply hose Schrader end (tapered) into the oxygen outlet of the container assembly supply receptacle. This procedure is imperative to prevent 50-psi oxygen from escaping out an open hose.

Figure 2.1. Flow Control Valve

Inlet Fitting for Oxygen Hose

Outlet to Patient

WARNING: Always connect the flow control valve fitting marked “INLET” to the mating fitting on the oxygen hose and the fitting marked “OUTLET” TO PATIENT to the humidifier bottle, oxygen tubing and/or oxygen wing nut adaptor. Reversing these connections or use of a gas source other than specified may result in inaccurate flow rates and patient injury.

CAUTION: DO NOT connect Schrader adapter to outlets if PTLOX is empty or prepared with nitrogen (Check AFTO 244, Industrial/Support Equipment Record for “Purged for Storage” documentation). This will bleed off pressure and/or introduce contaminants into the system and potentially ruin the unit.

5.1.1. Slide the oxygen outlet cover back until it is secure. Remove the outlet cap by twisting the knurled knob at the outlet in a clockwise direction. Inspect the oxygen outlet of the container for debris. Insert the Schrader end of the oxygen hose into the oxygen outlet and press firmly till it attaches securely.

WARNING: If debris is found in the outlet, contact the biomedical maintenance equipment technician as soon as possible and report. Do not use this unit! Replace it.

5.1.2 Turn flow control valve to highest setting and allow oxygen to flow for 20 seconds to purge the system.

5.1.3. Smell the emitted oxygen for any odors.

WARNING: If any odors other than the hose smell are detected, have other personnel recheck it for odors. If odor detected, contact the aircraft environmental systems personnel as soon as possible and report this incident. Do not use this unit! Replace it.

5.1.4. Return setting to 0 LPM.

Note: The PTLOX system vents oxygen when the system is not being used and a low hissing sound may be heard.

5.1.5. Remove a humidification bottle from the accessory case, and fill bottle with sterile water, as required. Attach humidification bottle to the bottom outlet of the flow control valve. Secure the bottle to the litter support strap by wrapping the hook and pile strap on the flow control valve around the bottle and litter support strap. Set the flow control valve to the prescribed flow rate and ensure there is flow from the humidifier. Place the delivery device on the patient.

6.1. Disassembly/Storage. Remove delivery device from the patient. Turn the flow control valve off.

Remove the oxygen hose from the base assembly oxygen outlet by turning the knurled knob in a clockwise direction and pulling up on the end of the hose. Replace the outlet cap by pushing in firmly into the outlet and then close the oxygen outlet cover. Remove and dispose of the humidifier bottle.

Remove the flow control valve from the oxygen hose, replace the dust caps, and secure the valve in the accessory case. Rewind the oxygen hose on its storage reel and stow the reel in the accessory case.

Note: The oxygen…