(See Appendix F)

- 1) Take inventory of the equipment and supplies available at your treatment facility. Important items include small oxygen concentrators (SAROSTM), oxygen cylinders (D-cylinders and H-cylinders), and oxygen generating systems (POGS and EDOCS).
- 2) Identify the closest resource capable of filling oxygen cylinders. This may be a military biomedical maintenance team or host nation industrial gas supply company.
- 3) If you locate empty oxygen cylinders, begin the process of filling them right away. You will likely consume them quickly if you get a very seriously ill COVID-19 patient.
- 4) Develop a resupply plan for your oxygen cylinders. A very seriously ill COVID-19 patient will rapidly deplete oxygen supplies.
  - If your facility has the capability to fill oxygen cylinders, then develop a plan to refill tanks. Identify someone not directly involved in patient care since tank refill and patient care may need to occur simultaneously.
  - If your facility does not have the capability to refill oxygen cylinders, then develop a re-supply plan. One option is to coordinate medical cylinder exchange in conjunction with MEDEVAC missions.
- 5) The SAROSTM oxygen concentrator can provide up to 3 Lpm of 100% O2. However, when unplugged, battery will only last 30 minutes on continuous flow.
- 6) SAROSTM can be daisy-chained together to provide higher flow, approximating 5-6 Lpm. A suction Y-connector can be used to connect several together.
- 7) Ventilators waste less oxygen when using a high pressure hose. A full D-cylinder providing 15 Lpm of O2 via disposable oxygen tubing will last 20-30 minutes. The same D-cylinder providing 100% FiO2 through a ventilator connected via green high pressure hosing will last 30-45 minutes (depending on minute ventilation).
- 8) Reducing minute ventilation (e.g., sedation with or without paralysis) and oxygen consumption (reduce FiO2 to absolute minimum to attain SpO2 88-92%) will extend oxygen supplies.
- 9) If transporting patient(s) to an evacuation pick-up site, anticipate delay and bring double the estimated oxygen supply.