Even If It’s Wearable, It May Not Be the Right Fit!
Patrick Dunne is president/CEO of HealthCare Productions, Inc., a California-based professional services corporation assisting Home Respiratory Care providers nationwide in justifying the adoption/implementation of new technology through cost-benefit analysis. Dunne was previously a regional VP and compliance officer at HomeTech Medical, Inc. He was elected and served as president of the California Society for Respiratory Care (CSRC) and later, the American Association for Respiratory Care (AARC).
A little noticed recommendation regarding ambulatory oxygen has slipped below the radar screen.
I refer specifically to recommendation seven of the Recommendations of the Sixth Oxygen Consensus Conference, held in Denver in August 2005. It reads, in part, as follows: “Evidence-based criteria are needed to define ambulatory/portable/wearable (emphasis added) oxygen technologies, as they apply to each specific patient’s clinical and lifestyle needs on an individualized basis.” The word wearable got my attention, since this is the first (and so far only) instance where I have seen it used to describe a particular type of oxygen equipment.
By way of contrast, recommendation number five of the Fifth Oxygen Consensus Conference, held in 1999, essentially defined portable oxygen “as equipment that can be carried by most patients on their person during activities of daily living (ADL), weighing 10 pounds or less with a minimum oxygen duration of at least four to six hours at 2 lpm continuous flow or equivalent.”
One need only take a look at all of the new, lightweight portable oxygen delivery systems that have come to the marketplace since 2000 to see that our colleagues in the industry have done a wonderful job of helping LTOT providers meet this design challenge. In fact, LTOT users have never had such a wide array of options to enable them to move beyond the confines of their stationary oxygen systems as they have today. Why then should I have a problem with the term wearable?
My main concern is that the term wearable denotes that the portable device be carried on the person of the user, most commonly over the shoulder, around the waist or in some cases, a backpack. While this certainly bodes well for the highly ambulatory user, the concept is clearly grounded in older technology, specifically using a small, lightweight canister (either aluminum or carbon composite) that the user must periodically refill or have empty cylinders replaced by the home care provider.
There is now another alternative for providing ambulatory oxygen, however: the portable oxygen concentrator (POC). All POCs currently on the market weigh less than 20 pounds (some are even in the 10-pound range) and can operate on standard household current as well as on DC current (think automobiles, recreational vehicles, cruise ships, trains and planes). Perhaps most appealing, all POCs also can be powered, for a limited amount of time, with a rechargeable battery. More importantly, since POCs continually concentrate oxygen from room air, there is never a need for refilling. LTOT users have clearly embraced POCs, and for one very obvious reason — they never have to worry about running out of oxygen.
Now, is a POC wearable? Unfortunately, not at this point in its development, but this is probably a moot point. Since POCs are intended to go anywhere the user would want to go, all are easy to pull with a telescoping handle on the respective wheeled bases. With a low center of gravity, POCs are easy to maneuver, certainly much more so than the ubiquitous and unwieldy E cylinder and cart. Further, when needed, a convenient handle assists in lifting the POC in or out of an automobile or up or down several steps.
Even though all POCs are not wearable at this point in time, they still may indeed offer many LTOT users the best possible alternative for unlimited ambulation. And, it’s not entirely out of the realm of possibility that, at some future point, POCs may in fact be completely wearable. In the meantime, I believe it would be a mistake to discount this new and exciting technology simply because the first generation failed to meet a somewhat arbitrary weight standard that is clearly linked to the aforementioned devices requiring periodic refilling and resupply of liquid or gaseous oxygen.
This article originally appeared in the Respiratory Management Jan/Feb 2007 issue of HME Business.
Patrick J. Dunne, MEd, RRT, FAARC, is a career respiratory therapist with more than 40 years of clinical practice, the past 20 in respiratory home care. Prior to entering home care, Dunne was an educator and program director at the community college level. He is a past president of both the California Society for Respiratory Care and the American Association for Respiratory Care. He currently serves AARC as a member of the Executive Committee of the International Council for Respiratory Care and as a member of the 2010 Program Committee. Dunne is a nationally recognized authority on the impact of health care reform on the practice of respiratory care.