Press Release: IOM offers a practical and robust solution to Entonox withdrawal

As multiple NHS trusts across England suspend the use of Entonox due to health fears around overexposure to midwifery teams, Institute of Occupational Medicine (IOM) has a robust solution to the crisis with a trusted health and safety approach designed to control risk.  

Made up of 50% Nitrous Oxide (N2O) and 50% Oxygen, Entonox or gas and air, was withdrawn to protect delivery suite staff due to concentrations in some hospitals exceeding the safe working exposure limit of 183mg/cubic metre by up to fifty times. If left unchecked repeated overexposure can lead to anaemia and is linked to fertility issues. 

A highly emotive issue its removal has left many expectant mothers who rely on it for pain relief during labour feeling anxious and fearful. IOM’s independent experts believe the withdrawal is an overreaction, easily avoided by implementing health and safety measures which control the concentration of Nitrous Oxide in the air to a reasonable level.  

When carried out correctly, these HSE advised control measures will ensure hospitals stay on top of the problem, allowing mother’s access to this welcome pain relief at a vulnerable time whilst keeping staff safe and healthy.  

The measures include: 

• On-site COSHH risk assessments to measure personal exposures – IOM occupational hygienists will analyse real-time staff exposures based on frequency, magnitude, and duration.  
• Implementation of ongoing air monitoring – utilising an air quality sensor to measure the concentration of Nitrous Oxide in the air and alerting staff to potential high and dangerous levels. 
• Expert advice and support around robust control measures – IOM can assist with design and implement the appropriate Local Exhaust Ventilation, Gas Scavenging or Mechanical Ventilation Systems. 
• Establishing a regular programme to assess, clean, maintain and verify ventilation systems – in so doing IOM ensure the equipment is fit for purpose. 

 It is their firm belief that this professional risk mitigation solution will protect individuals, ensure long-term air quality and safely maintain workplaces to ensure exposure limits are not exceeded. In so doing, worried mothers will have access to Entonox and midwifery teams can work with peace of mind. 

 “We would urge those in hospitals not to panic in the face of the news stories coming out. N2O can be safe to use in environments with the right controls that are properly maintained. Keeping this vital pain relief available for expectant mothers across the country.” Ross Clark, Head of Workplace Protection, IOM 

It is vital that all workplaces ensure adequate ventilation to protect everyone from harmful exposure.  

With many hospitals facing ageing infrastructure, and wards and birthing suites often windowless, a practical approach to ventilation with tried and tested control measures and technology at its heart would appear to be the way forward.  

One which gives peace of mind, allows people to work safely and does not necessitate the removal of basic pain relief at the most stressful of times.