A variety of products used or produced daily by hospitals need to be handled and transported with special care because they are infectious, hazardous or radioactive substances. The United Nations have developed Recommendations for the Transport of Dangerous Goods to ensure their safe and efficient transport. These recommendations are applied worldwide for all modes of transport by direct integration into national and international regulations and ensure safety and harmonization of provisions across modes.
Among these substances are gases used to provide respiratory assistance to patients developing acute respiratory symptoms. The European Industrial Gases Association (EIGA) has reported that due to the COVID-19 pandemic, its members, which are the primary suppliers of medical gases in the European Region, are facing an unprecedented demand, in particular for medical oxygen. Demand has been between five and ten times higher than usual.
As well as medical gases, other products used by or generated in hospitals must also be transported with special care, such as:
- healthcare hazardous substances
- Infectious substances / biological specimens / hospital samples
- Radiopharmaceuticals for nuclear medicine
- Clinical Waste, including used surgical instruments transported to central decontamination units.
Countries negotiate multilateral agreements to ensure delivery
The transport of these products in Europe is governed by harmonized provisions under three international agreements, covering road (ADR), rail (RID) and inland waterways (ADN). In order to ensure continued safety of operations, these cater, among other aspects, for periodic inspection of vehicles and materials, and regular refresher training sessions for drivers and safety advisers every 5 years.
In light of the COVID-19 pandemic, these training sessions have been suspended in most countries due to confinement and social distancing measures. In view of ensuring the smooth flow of critical medical supplies, several ADR contracting parties agreed to extend the validity of the training certificates of drivers and safety advisers ending between 1 March and 1 November 2020 to 30 November 2020.
This has taken the form of a multilateral agreement in accordance with ADR procedures. Another such multilateral agreement has also been prepared to allow delays for the periodic or intermediate inspections of tanks and extend the validity of vehicle certificates of approval ending between 1 March and 1 August 2020 to 30 August 2020. Luxembourg initiated corresponding multilateral agreements M324 on 18 March 2020 and M325 on 19 March 2020.
Likewise, some ADN contracting parties prepared a multilateral agreement to compensate for the cancellation of refresher training sessions for Dangerous Goods Safety Advisers and ADN experts in their countries. As a result, specialized knowledge certificates ending between 1 March and 1 December 2020 remain valid until 31 December 2020. The Netherlands initiated corresponding multilateral agreement M025 on 19 March 2020.
UNECE Executive Secretary Olga Algayerova commented: “This is an example of multilateralism at its best: adopting coordinated solutions to common problems. Only by working together will we overcome the COVID-19 pandemic leaving no-one behind. UNECE is fully mobilized to help member States address the challenges caused by the COVID-19 pandemic and prepare for the recovery in all its areas of work.”
The exceptional provisions introduced by these measures come as a necessary response to the current emergency. The stringent requirements set out in the UN agreements and recommendations will ensure continued high levels of safety for the transport of vital products during this period.
Note to editors
About the UN work on dangerous goods
Dangerous goods are classified based on their hazards and they are assigned UN numbers and proper shipping names according to their classification. These UN numbers are internationally recognized.
The transport of these dangerous goods is governed by national and international regulations based on the United Nations Recommendations for the Transport of Dangerous Goods, Model Regulations. These Model Regulations are prepared by the Subcommittee of Experts on the Transport of Dangerous Goods of the United Nations Economic and Social Council (ECOSOC), which is serviced by UNECE. These Recommendations are updated every two years and implemented worldwide in modal regulations such as the ADR for road transport and the ADN for inland waterways.
The Agreement concerning the International Carriage of Dangerous Goods by Road (ADR) applies to transport operations carried out in the territories of at least two of its Contracting Parties (see list at https://www.unece.org/trans/maps/un-transport-agreements-and-conventions-53.html). It is open to all UN Member States.
For the sake of uniformity and to ensure free trade in the European Union (EU), Annexes A and B to ADR have now been adopted by all the Member States of the European Union and constitute the basis for the regulation of the transport of dangerous goods by road within the EU (Directive 2008/68/EC of the European Parliament and of the Council of 24 September 2008 on the internal transport of dangerous goods, as amended). ADR also applies to national traffic in Switzerland (« ordonnance relative au transport des marchandises dangereuses par route - 741.621 Ordonnance du 29 novembre 2002 »).
The European Agreement concerning the International Carriage of Dangerous Goods by Inland Waterways (ADN) was done in Geneva on the occasion of a Diplomatic Conference held under the joint auspices of the UNECE and the Central Commission for the Navigation of the Rhine entered into force in 2008.
About the three multilateral agreements negotiated last week
List of signatories to M324: Austria, Belgium, Czechia, France, Germany, Ireland, Luxembourg, Netherlands, Norway, San Marino, Spain, Switzerland, United Kingdom.
List of signatories to M 325: Austria, Belgium, France, Germany, Italy, Luxembourg, Norway, San Marino, Switzerland, Spain.
List of signatories to M 025: Austria, France, Germany, Luxembourg, Netherlands, Slovakia, Switzerland.
These lists are updated as soon as member States notify the UNECE secretariat.
About medical gases
Medical oxygen is distributed in two forms:
- Refrigerated Liquid Oxygen (LOX) - UN1073 – which is usually transported to hospitals, as well as to filling centres where cylinders are filled, in tank vehicles.
- Compressed gaseous Oxygen (GOX) - UN1072 – which is used in applications such as hospitals, emergency transport and, at the moment, for field hospitals.
In addition to oxygen, other medical gases include liquid helium in cryogenic vessels for magnetic resonance imaging (MRI) and mixtures in cylinders that are used in applications such as lung function testing and a mixture containing nitric oxide for specialist breathing application.