Oxygen Expresses deliver more than

         Oxygen Expresses deliver more than 7115 MT of Medical Oxygen to the Nation

First Oxygen Express to Tamil Nadu on the way with 80 MT of LMO. More than 3900 MT LMO offloaded in the NCR region by Oxygen Expresses so far

Punjab gets 40 MT of LMO from Oxygen Express that delivered in Dehradun. Oxygen Expresses delivering nearly 800 MT of LMO to the Nation each day now

Oxygen relief by Oxygen Expresses reaches Uttarakhand, Karnataka, Maharashtra, MP, Haryana, Telangana, Rajasthan, Delhi & U.  So far 407 MT has been offloaded in Maharashtra, nearly 1960 MT in UP, 361 MT in MP, 1135 MT in Haryana, 188 MT in Telangana, 72 MT in Rajasthan, 120 MT in Karnataka and more than 2748 MT in Delhi

Overcoming all hurdles and finding new solutions, Indian Railways is continuing its journey of bringing relief by delivering Liquid Medical Oxygen (LMO) to various states across the country. So far, Indian Railways has delivered nearly 7115 MT of LMO in more than 444 tankers to various states across the country. 

Yesterday Oxygen Expresses delivered nearly 800 MT of LMO to the Nation. 

115 Oxygen Expresses have completed their journey so far and brought relief to various states. 

It is Indian Railways endeavour to deliver as much LMO as possible in the shortest time possible to the requesting states. 

Till the time of this release, 407 MT of LMO has been offloaded in Maharashtra, nearly 1960 MT in UP, 361 MT in MP, 1135 MT in Haryana, 188 MT in Telangana, 72 MT in Rajasthan, 120 MT in Karnataka and more than 2748 MT in Delhi. 

Tamil Nadu is set to receive it's First Oxygen Express later tonight with 80 MT of LMO arriving from Durgapur. 

Oxygen Expresses have delivered more than 3900 MT of LMO in the NCR region so far  for further distribution. 

Running of new Oxygen is a very dynamic exercise and figures keep getting updated all the time. More loaded Oxygen Expresses are expected to start their journeys later in the night.

Ministry of Commerce & Industry Centre undertakes multiple initiatives to

                                        Centre undertakes multiple initiatives to enhance
                            Oxygen availability, distributionand storage infrastructure;

Oxygen availability increased through higher production and imports, setting up of PSA Plants, and Procurement of Oxygen Concentrators;

Oxygen Tanker availability strengthened by Conversion of Nitrogen and Argon Tankers, Import, Domestic Manufacturing, and Rail and Air Transportation;

Oxygen Digital Tracking System setup for real time monitoring;

Last mile infrastructure strengthened by increasing number & capacity of Cryogenic Tankers at Hospitals and procurement of MedicalOxygen;

General Financial Rules relaxed to fast-track procurement of critical supplies.

In order to address the surge in demand for oxygen, the Central Government has undertakenkey measures to increase the availability, streamline the distribution and strengthen the oxygen storage infrastructure in the country. The steps undertaken focused on the entire oxygen supply chain. These include efforts for improving oxygen production, enhancing tanker availability to optimizelogistics, improving oxygen storage at thelast mile, and easing norms of procurement.

Oxygen availability has been enhanced by increase in Production Capacity and production, setting up of Pressure Swing Adsorption (PSA) Plants, import of Liquid Medical Oxygen (LMO)from Overseas, and Procurement of Oxygen Concentrators. For enhancing tanker availability to streamline transportation, Nitrogen and Argon tankers have been converted, tankers and containers have been imported, domestic manufacturing of tankersincreased, andrail and air transportation of tankers is being undertaken to reduce turn-around time.Oxygen Digital Tracking System (ODTS) has been setup of for real time monitoring, and driver availability is being enhanced with training of MHV drivers. For improving oxygen storage, number & capacity of cryogenic tankers at hospitals is being enhanced andMedicalOxygen cylinders are being procured.Relaxation of General Financial Rules (GFR) has been undertaken to enable faster procurement of critical supplies. The details regarding the measures undertaken by the Central Government on all fronts of the oxygen production, transportation, storage and infrastructure are as given hereunder.

Increase in Oxygen Production and Capacity Enhancement

Oxygen production has increased from 5700 MT/day in Aug’20 to 9,446 MT/day in May’21. The production capacity has increased from 6817 MT/ day to 7314 MT/day, and capacity utilization has gone up from 84% to 129% during this period

 Steel companies from both the public and private sectors, have stepped up efforts to meet the nation’s requirement of medical oxygen. On 4^th May, 2021, the Total Liquid Medical Oxygen Production by the Steel plants was 3680.30 MT. The total LMO Supply per day was up from an average 1500-1700 MT in mid-April to 3131.84 MT on 25^thApril, and further to4076.65 MT on 4^th May.

Commensurate with the increase in production and demand, LMO sale in the country has also increased from about 1,300 MT/day in March’ 21 to 8,920 MT/day on 6^th May.During the first wave of COVID-19, the maximum sale of 3095 MT/day of LMO was seen on 29^th September, 2020. The sale of LMO grew more than five-fold from 1559 MT/day on March 31, 2021 to over 8000 MT mark by 3^rd May, 2021.

Oxygen Production Capacity Enhancement Plans

Additional capacity expansion is planned in the near future to enhance oxygen production capacity. The measures in this regard include additional 70 MT/day production expected in Karnataka; Supplies from Air Separation Unitof SME sector; Jumbo Hospitals with gaseous oxygen from refineries(11,950 beds), power plants (3,850 beds), and steel plants (8,100 beds) are being set up. Supply of oxygen for non-essential industrial purposes has been prohibited w.e.f. 22^nd April, 2021, resulting in ~1,000 MT of additional oxygen availability. Additional capacity expansion of 630 MT/day is also planned by Steel sector.

1,594 PSA Plants are being established to improve Oxygen Supply near demand clusters.  It includes 162 plants under PM-Cares through MoHFW sanctioned in 2020, 551 under PM-Cares through MoHFW sanctioned in March 2021, 500 under PM-Cares through DRDO sanctioned on 27 Apr 2021, about 100 by Oil and Gas companies under the Ministry of Petroleum and Natural Gas, and rest by States themselves. 74 of the 162 PSA plants have been installed and the rest will be installed by June’21. 1,051 additional PSA Plants sanctioned under PM Cares Fund in March & April’21 will be commissioned in the next three months in phases.

Import of Liquid Medical Oxygen

50,000 MT of Liquid Oxygen is being imported from overseas, with orders and delivery schedule for 5,800 MT finalized. Ministry of External Affairs is actively assisting in securing sources of oxygen from abroad. To expedite the process, quotations were obtained on 21.04.21. 3 quotations have been received for 3,500 MT and approved on 21.04.21 with delivery over 3 months. In addition, 2285 MT of LMO being imported from UAE, Bahrain, Kuwait and France, a part of which has already arrived.

Procurement of Oxygen Concentrators

Procurement of 1 lakh Oxygen Concentrators has been sanctioned under PM Cares Fund on 27.04.2021. Expression of Interest was issued on 29.04.21 and Offer has been receivedfor 2,500 units. There has been good response to the tender floated by ONGC. Offers for 50,000 concentrators have been received from domestic manufacturers. Award for 9,800 units have been finalized with delivery schedule of 4,800 units on 15.05.21 and 5,000 units on 27.05.21. In addition, 55 bidders have expressed interest to supply 70,000 – 75,000 units of concentrators. Orders are being finalized and will be placed based on promised delivery schedule.

Oxygen Allocation Process

Oxygen Allocation process has been established to equitably supply oxygen to all states in line with the demand.First oxygen allocation order issued on 15.04.21 was restricted to a few states like Maharashtra, Gujarat, Delhi, Madhya Pradesh, Karnataka, etc.As the second wave of pandemic spread to other states, demand for Oxygen increased from other states. The formula of Ministry of Health and Family Welfare was used to estimate Oxygen requirement for each state in line with the active cases in the state, and maximum efforts were made to align Oxygen Allocation to the estimated demand for each state. Other factors such as availability of hospital infrastructure including ICU beds were also taken into account while finalizing allocation.

Oxygen Allocation process has continuously evolved to streamline the distribution of Oxygen in the country. Oxygen allocation to States/UTs is dynamic in nature,based on requirement as per Health Ministry norms, and consultation with States/UTs, manufacturers & other stakeholders. There is a mismatch between producing and consuming states, and equity among states to be maintained. Moreover, one-third of the production is concentrated in East India, while the ~60% of demand for oxygen is in North and South India, resulting in transportation challenges. Mapping of source and destination of oxygen has been completed to optimize transportation plan in consultation with States/UTs, manufacturers & other stakeholders.

Zone	Production		Allocation
	MT	%	MT	%
North	1,174	13%	2,897	33%
East	2,867	32%	1,035	12%
West	2,838	32%	2,688	30%
South	1,980	22%	2,239	25%
Total	8,859	100%	8,859	100%

 

Enhancing Oxygen Tanker Availability – Conversion & Import of Tankers

Multiple interventions have been undertaken to improve tanker availability. Availability of Oxygen Tankers has been improved with conversion of Nitrogen & Argon Tankers &their Imports. In March 2020, the capacity of tankers was 12,480 MT and their number was 1040. Now, the capacity of tankers has gone up to 23,056 MT and their number has increased to 1681, which includes 408 converted tankers and 101 imported tankers. 408 out of the 1,105 Nitrogen and Argon Tankers have been converted into oxygen carrying tankers so far; and another 200 tankers will be converted shortly. 248 oxygen tankers are being imported, with 101 tankers imported so far and another 58 tankers to be imported in next 10 days; In addition, 100 tankers are being manufactured domestically.

Oxygen Tankers being transported by Rail and Air to reduce turnaround time

Railways are being used for long distance transport of tankers through Roll on – Roll Off service. So far, Indian Railways has delivered nearly 4200 MT of LMO in more than 268 tankers to various states across the country.68 Oxygen Expresses have already completed their journey so far.Till the evening of 9^th May,293MT has been offloaded in Maharashtra; 1,230 MT in UP; 271 MT in MP; 555 MT in Haryana; 123 MT in Telangana; 40 MT in Rajasthan; and 1,679 MT in Delhi.

Air-lifting of empty tankersis being done to plants to reduce the turnaround time. 282 tankers with 5505 MT capacity have been airlifted, transporting LMO in domestic routes. 75 containers with capacity 1293 MT have been imported from overseas through IAF. In addition, 1252 oxygen cylinders, 3 oxygen generation plantshave been imported through IAF.

Oxygen Digital Tracking System

A Web and App based Oxygen Digital Tracking System (ODTS) has been launched to enable real time tracking of Oxygen movement in the country. Its objectives are effective and instantaneous communication of allocation orders to plants and dispatches from plants, and toenable real-time tracking of Oxygen movement in the country from Plants to States. It integrates with GSTN database for E-waybill based data entry, Tracking of tankers through GPS, SIM (Driver Mobile No.), FASTag, and Automated alerts from system for route deviation, unintended stoppages, delays

Besides, aVirtual Central Control Roomhas been establishedwith officers from Additional / Joint secretary officers of Health, Road, Rail, Industry, Steel and from State Govt. The Control Room is monitoring Oxygen movement 24 X 7 and to resolve any issues in oxygen transportation.

Training Drivers for Driving Oxygen Tankers

2,500 additional drivers are being trained to drive oxygen tankers by National Skill Development Corporation (NSDC) and Logistics Sector Skill Council (LSSC). Availability of skilled drivers is essential to ensure uninterrupted transportation of Oxygen. Since LMO Transportation is covered under Hazardous Chemicals regulations, drivers with adequate training and having HAZ Cargo license only are allowed to operate the trucks. Immediate focus is to make Training module has been developed by NSDC and LSSC in English and Hindi &20 master trainers identified. Online Refresher coursesareplanned for non-active drivers with training in handling HAZ chemicals. 73 locations have beenidentified for organizing physical training programs for drivers along with oxygen plants.

Enhancing Storage of Oxygen – Cryogenic Tanks

Number of cryogenic tanks for storing oxygen at hospital has increased to 901 from 609 since March 2020. Availability of medical oxygen cylinders has increased from 4.35 Lakhs in March 2020 to 11.19 Lakh in May 21. Additional, 3.35 Lakh cylinders are being procured in line with estimated increase in demand. Orders have been placed for additional 1,27,000 cylinders on 21.04.21. DRDO is procuring 10,00,000 NRM valves under PM Cares Fund - this device will reduce wastage of oxygen by shutting out the supply during exhalation. 

Measures to expedite procurement of critical supplies

To expedite procurement of critical supplies, General Financial Rules(GFR)have been relaxed to enable expedited procurement of critical supplies for COVID Management. All restrictive provisions have been removed to enable larger participation and faster procurement. Bank Guarantees have been waived off for all procurement. 100% payment of advance has been approved for critical COVID procurement. Procurement on nomination basishas been permitted in case of constrained supply market.

YB/SS

 

20 மெட்ரிக் டன்கள் ஆக்சிஜனை முன்னுரிமை அடிப்படையில் ஜவகர்லால் நேரு

120 மெட்ரிக் டன்கள் ஆக்சிஜனை முன்னுரிமை அடிப்படையில் ஜவகர்லால் நேரு துறைமுகப் பொறுப்புக் கழகம் மற்றும் புதிய மங்களூர் துறைமுகம் இன்று கையாண்டன.

இந்தியாவின் மிகப்பெரிய கொள்கலன் துறைமுகமான ஜவகர்லால் நேரு துறைமுக பொறுப்புக் கழகம், நான்கு மருத்துவ தரத்திலான ஆக்சிஜன் நிரப்பப்பட்ட 80 மெட்ரிக் டன் மொத்த கொள்ளளவுடன் கூடிய கிரையோஜெனிக் களன்களை கையாண்டது. ஒவ்வொரு கொள்களனிலும் தலா 20 மெட்ரிக் டன் திரவ மருத்துவ ஆக்சிஜன் இருந்தது. ஐக்கிய அரபு எமிரேட்டில் நிரப்பப்பட்ட இந்த ஆக்சிஜன் கொள்கலன்கள் இன்று இந்தியாவை வந்தடைந்தன.

இந்தியக் கடற்படையின் ஐஎன்எஸ் கொல்கத்தா கப்பல் 40 மெட்ரிக் டன் ஆக்சிஜனுடன் குவைத்திலிருந்து இன்று புதிய மங்களூர் துறைமுகத்தை வந்தடைந்தது. 5 டன்கள் ஆக்சிஜன் உருளைகள் மற்றும் 4 உயரழுத்த ஆக்சிசன் செறிவூட்டிகளும் வந்தடைந்தன.

மேற்கண்ட சாதனங்களுக்காக, துறைமுகங்கள், கப்பல் மற்றும் நீர் வழி (தனிப் பொறுப்பு) & ரசாயனம் மற்றும் உரத் துறை இணை அமைச்சர் திரு மன்சுக் மண்டாவியா பாராட்டு தெரிவித்துள்ளார்.

மேலும் விவரங்களுக்கு இந்த ஆங்கில செய்திக் குறிப்பைக் காணவும்:

JNPT and New Mangalore Port handles

JNPT and New Mangalore Port handle 120
Metric Tonnes of Oxygen on priority basis

JNPT and New Mangalore Port today handled 120 Metric Tonnes of Medical Oxygen on priority basis

India’s largest Container Port, Jawahrlal Nehru Port Trust handled  four medical-grade oxygen filled  cryogenic containers with total quantity of 80 MT. Each cryogenic container carried 20 MT of Liquid Medical grade Oxygen. These medical grade oxygen containers were loaded in Jebel Ali, United Arab Emirates and reached India today.

80 MT of Medical Oxygen reaches JNPT today from Jebel Ali , UAE @JNPort handled the Oxygen Cargo on utmost priority basis. #Unite2FightCorona

It may be noted that Ministry of Ports, Shipping and Waterways has directed all Major Ports of India, including the Kamarajar Port Limited, to waive-off all charges levied by Major Port Trusts (including vessel related charges, storage charges etc.) and accord highest priority in the berthing sequence to the vessels carrying oxygen related consignments

 

Awake Proning and High-flow nasal cannula (HFNC) are the

Awake Proning and High-flow nasal cannula (HFNC) are the Game Changers in Covid Treatment that Help Cure Patients      

Apollo Speciality Hospitals, Vanagaram was one of the first hospitals in Chennai to step up and treat COVID patients in the private sector. An exclusive fever clinic at the hospital has treated over more than thousand patients. Apollo Speciality Hospitals Vangaram has saved many lives with HFNC and Awake Proning eliminating the need for ventilation.

Many COVID patients are profoundly Hypoxemic with low oxygen saturation- a condition called “Silent / Happy Hypoxia”. They will be completely normal and comfortable with no breathing difficulty, however, their oxygen level will be deteriorating at a faster pace. This can be picked up only by pulse oximeter. These patients really do well with oxygen supplementation alone.

With progression of the disease some of these patients with “Silent Hypoxia” become more hypoxic in spite of oxygen supplementation. This is where we have seen the results of “Awake Proning”. In any patient requiring more than 4 litres oxygen an awake proning protocol is employed. This simple non-invasive technique can eliminate the need for ventilation in some Covid-19 patients. “Awake Proning” is basically having patients turn over onto their stomach or onto their side while lying down. This method has been remarkably effective in boosting the “Blood Oxygen Saturation” levels in the covid patients who have silent Hypoxia.

Based on observation at Apollo Hospitals Vanagaram, the results are so encouraging in people with both silent Hypoxia and severe Hypoxia said Dr. Ebenezer, Senior Consultant and ICU Incharge “When the patients lie on the back, the fluid in the lung in Acute Respiratory Distress Syndrome accumulates in the bottom of the lung, the heart and other abdominal contents further compress the lung region leading to non-uniform ventilation. When proning is done the patient’s body is parallel to the ground, this flipping over will give more room to the lungs without any compression. Awake Proning eliminates the need for intubation and ventilatory support in some patients”

He also added, “Some patients with a severe disease become progressively hypoxic at the same time breathless requiring some form of support and assistance for which we use a High Flow Nasal Cannula or a non-invasive ventilator. In these patients also we employ awake proning to help us tide over the crisis and offset the hypoxemia.”

Below are details of few patients on who both Awake Proning and HFNC were used:

·         65yr old gentleman with coronary artery disease and H/O spine surgery had severe covid pneumonia. His CT severity index on admission was 26 and he became progressively hypoxic. We tried NIV but he was not tolerating, on employing HFNC with awake proning he beautifully settled down, A team of ICU technicians and nurses diligently worked on the protocol. Finally after two weeks of stay in ICU he was weaned off HFNC and walked home safely.

                               

·         40 yr old diabetic patient was admitted with severe hypoxemia, admission CT scoring was 33, was treated effectively with HFNC/NIV and awake proning we were able to avoid intubation. Once we explained in detail the protocol and sought the cooperation of the patient we were surprised by his willingness to strictly adhere to the protocol. Constant motivation and encouragement from his family was a force multiplier.

        

 ·         72yr old DM with underlying COPD admitted with very bad lungs, severely hypoxic was initially managed with NIV and routine supportive treatment. Subsequently he became breathless and was intubated and placed on ventilatory support.after a prolonged stay on the ventilator he was successfully weaned and extubated, discharged after forty days in hospital proving that age is after all a number.

·         65yr old with no comorbids shifted from another hospital with severe respiratory distress COVID positive was subsequently intubated and ventilated. Patient required prolonged periods of paralysis and sedation. He was on LMWH. On stopping sedation paucity of movement noticed on left side. Shifted for CT brain, Right MCA territory infarct noted. Neurologist opinion obtained and treated appropriately. He started spiking fevers became hypotensive requiring vasopressors ,blood cultures grew MDR Acinetobacter, treated with colistin, survived septic shock. Slowly patient was weaned and extubated. Neuro-rehabilitation was provided and patient is ready for discharge.

·         39 yr old patient with admitted with C/O fever,cough and breathing difficulty with a CT severity of 33,got intubated for worsening hypoxia and was successfully weaned and extubated.He was treated with steroids, LMWH and Tocilizumab. He was a young individual who responded very well to invasive ventilatory support based on tried and tested ARDS ventilatory protocol.

Happy hypoxemia is a true phenomenon, HFNC and awake proning is a game changer and where there is a need there should be no hesitation no dilemma in instituting invasive ventilator support. Across the globe sick COVID pneumonia patients did not die because they were ventilated rather they died on the ventilator due to the disease per se and in many instances many lives were lost because of absolute lack of ventilators. As the war against COVID intensifies Apollo Speciality Hospitals Vanagaram will continue to be a beacon of hope for the sick and suffering in and around Chennai.