Entonox safety in the workplace, administration equipment, scavenging and ventilation systems, occupational exposure levels.

Entonox is a medical gas 50% Oxygen 50% Nitrous Oxide – used as a form of inhalation pain relief in many medical settings, in Obstetrics it is used in Labour.

Nitrous Oxide is classed as a hazardous substance, which if exposure to such substances is not properly controlled may cause ill health in a number of ways (HSE EH405/2005 workplace exposure limits 2020 edition).

Download HSE guidance

Download BOC essential guide to entonox 

As elected RCM health and safety representatives you can legally undertake an inspection of your workplace. You will need to give reasonable notice to your employer (if it has not been inspected within last three months), however if an issue has arisen urgently, please discuss with the employer, that you intend to do this.

You can perform an inspection individually or take another RCM activist with you, your manager can accompany you if they wish to do so.

As part of the inspection of areas where Entonox is administered you should contact the estates officer and HB/Trust safety lead ask for written response and evidence to answer the following questions:

  • What scavenging /ventilation system the unit has
  • What are the rate of air changes per hour and how it works.
  • Are these compliant with manufactures recommendations and the DOH recommendations?
  • How often are the seals checked on all tubing and appliances are these seals changed regularly – is this compliant with manufacturer and DOH recommendations?
  • When was the last inspection what was the outcome
  • Evidence of maintenance and regular inspections for damage to equipment required to administer and work with Entonox safely.
  • Do you have a clear policy for administration of Entonox
  • What training do staff receive regarding the administration of Entonox including storage, transportation and personal safety.

There should be evidence that is happening. Once you have completed your inspection you must report any issues arising.

The first thing you should do is submit an incident report and you should escalate this immediately, verbally and in writing to the employer, area manager and the employer’s safety officer and ensure this is raised at the employer safety meetings, to make sure it is followed up.

It is always worth keeping an eye on it yourself and checking what progress is being made. As an elected H&S rep for a recognised TU you should be part of the safety meetings and any consultations.

RCM H&S reps can work with the safety officer and, if necessary, a representative from the Estates department to perform a COSHH risk assessment.

Inform the staff side chair and work collectively with other Trade Unions with members in the affected areas.

RCM health and safety rep guide to Entonox safety

Download here

Entonox legal advice - frequently asked questions 

Call the RCM legal helpline on 0300 30 30 444 and they will be put straight through to the RCM’s lawyers Thompsons Solicitors.

Remember, there is a 3 year time limit to issue court proceedings which runs from the date you developed symptoms which you thought were work related, so members should not delay.

The member will be referred to a specialist disease lawyer in the nearest office geographically to where they live who will be in touch. The specialist lawyer will arrange to take a statement from the member over the telephone and explain the next steps. 

If the member makes the call to Thompsons does that mean a claim will be made against their employer? No. Thompsons will advise your member of their options and will not take any steps unless your member wants them to do so.

At this stage Thompsons are gathering information and obtaining input from experts to enable them to advise your members on the next steps. This information will be treated confidentially.

Thompsons are specialists who act only for the injured never for employers or insurers. They have been acting exclusively for the injured and the trade unions since 1921 and have won many of the key cases that have made new law.

At this stage it is difficult to say, as investigations are at an early stage and expert opinion is awaited. Members should be assured that they will be provided with full advice as soon as possible. 

Members should obtain medical advice from their GP. The member should also tell RCM, if they have not already, and report their symptoms to their employer and Occupational Health.

Members should speak to their RCM health and safety representative/steward.