DISMOUNTED MEDICAL & SUPPLEMENTAL OXYGEN SYSTEM (DMOS)

K130068 · Essex Industries, Inc. D/B/A Essex Cryogenics of M · BYJ · Jul 19, 2013 · Anesthesiology

Device Facts

• Record ID: K130068
• Device Name: DISMOUNTED MEDICAL & SUPPLEMENTAL OXYGEN SYSTEM (DMOS)
• Applicant: Essex Industries, Inc. D/B/A Essex Cryogenics of M
• Product Code: BYJ · Anesthesiology
• Decision Date: Jul 19, 2013
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 868.5655
• Device Class: Class 2
• Attributes: Therapeutic

Indications for Use

The DMOS is intended to convert liquid oxygen to gaseous oxygen for delivery to a patient and/or for delivery to rescue personnel to supplement environmental oxygen at high altitudes while being carried by a rescue personnel at one-half (0.5) to fifteen (15) liters per minute (LPM) and fifty (50) pounds per square inch gauge (psig).

Device Story

The Dismounted Medical & Supplemental Oxygen System (DMOS) is a portable liquid oxygen (LOX) storage and conversion unit. It consists of a thermally insulated container (1.4L capacity) housed in an aluminum enclosure with an integrated heat exchanger. The device stores LOX and converts it into gaseous oxygen for delivery to patients via masks, cannulas, or bag-valve masks, or to rescue personnel via a dedicated parachutist port for high-altitude operations. It is designed for use by military and commercial emergency response personnel in field, aircraft, or ground vehicle settings. The device is carried by a single operator using a handle. It features battery-powered monitoring for pressure and LOX quantity. By providing a portable, high-pressure oxygen source, it enables medical treatment and high-altitude survival for personnel in remote or crisis situations.

Clinical Evidence

No clinical data. Substantial equivalence is supported by extensive bench testing, including insulation resistance, leakage, quantity indicator performance, fill time, delivery rate, delivery temperature, and environmental testing (altitude, vibration, shock, temperature, humidity, salt fog, rain, snow) conducted in accordance with MIL-STD-810G.

Technological Characteristics

Portable LOX system; 1.4L capacity; aluminum sheet metal enclosure; thermally insulated container (DOT-4L specification). Operates at 50 ± 5 psig. Features heat exchanger for LOX-to-gas conversion. Battery-powered monitoring for pressure and quantity. Two outlet ports (DISS 1240 and Female Dixon Quick-Disconnect). Flow control valve with 12 settings (0.5-15 LPM). Tested per MIL-STD-810G for environmental and mechanical durability.

Indications for Use

Indicated for adult patients and rescue personnel requiring supplemental oxygen, including high-altitude environments. Used for medical oxygen treatment or supplemental oxygen delivery at flow rates of 0.5-15 LPM and 50 psig.

Regulatory Classification

Identification

A portable liquid oxygen unit is a portable, thermally insulated container of liquid oxygen that is intended to supplement gases to be inhaled by a patient, is sometimes accompanied by tubing and an oxygen mask. An empty portable liquid oxygen unit is a device, while the oxygen contained therein is a drug.

Predicate Devices

• Backpack Medical Oxygen System (BMOS) (K071581)

Submission Summary (Full Text)

{0}------------------------------------------------

Image /page/0/Picture/0 description: The image shows the logo for Essex Industries. The logo is in black and white and features a stylized font. The word "ESSEX" is in large letters, and the word "INDUSTRIES" is in smaller letters below.

K130068

# JUL 1 9 2013

# 510(k) Summary

1. Owner Information

| Owner's Name: | Essex Industries, Inc. d/b/a Essex Cryogenics of Missouri |
|-----------------|-----------------------------------------------------------|
| Address: | 8007 Chivvis Drive |
| | St. Louis, Missouri 63123-2395 |
| Phone Number: | 314-338-8533 |
| Fax Number: | 314-832-8208 |
| Contact Person: | Kenneth L. Seise |
| Date: | January 5, 2013 (Revised July 19, 2013) |
| | |

2. Medical Device Information

Dismounted Medical & Supplemental Oxygen System (DMOS) Trade Name: Common Name: Portable Liquid Oxygen System Classification Name: Portable Liquid-Oxygen Unit Classification Code: II Product Code: BYJ CFR Section: 21CFR 868.5655

510(k): K130068

3. Substantial Equivalence to Predicate Medical Device

The DMOS is substantially equivalent to the Backpack Medical Oxygen System (BMOS) (K071581).

Image /page/0/Picture/12 description: The image contains a large, black, right-pointing chevron. The chevron is simple in design and takes up most of the frame. The background is white, providing a stark contrast to the black chevron.

{1}------------------------------------------------

Image /page/1/Picture/0 description: The image shows the logo for ESSEX Industries. The word "ESSEX" is written in a stylized font, with the letters connected and having a three-dimensional appearance. Below the word "ESSEX" is the word "INDUSTRIES" written in a smaller, sans-serif font. The letters are all black and the background is white.

## 4. Medical Device Description

## Physical and performance characteristics

The DMOS, when filled with liquid oxygen, will be used to provide medical oxygen treatment to injured personnel or provide supplemental oxygen to operator during dismounted operations above 10,000 feet MSL. The following general requirements apply.

- The DMOS shall supply 93% oxygen concentration when filled from Oxygen a) Generator System (OGS).
- The DMOS shall be capable of delivering gaseous oxygen to one patient at a b) maximum flow rate of 15 ambient Liters Per Minute (LPM).
- The DMOS shall be capable of connecting to medical mask or cannula to supply c) oxygen during operations above 10,000 feet MSL.
- d) The DMOS shall be capable of delivering oxygen to one patient at a flow rate of 5 LPM for a minimum duration of 4 hours.
- The DMOS operating pressure shall be 50 ± 5 pounds per square inch gauge e) (psig).
- f) The liquid oxygen (LOX) capacity shall be 1.4 liters.
- The DMOS shall operate up to 35,000 feet MSL. g)
- The overall weight of the DMOS, including LOX, shall be less than 16 lbs. h)
- The oxygen delivery pressure shall be monitored and displayed. i)
- The liquid oxygen quantity shall be monitored and displayed. j)
- Any power required by the DMOS shall be self-contained. k)
- 1) The DMOS shall have the capability to be filled with LOX by standard Department of Defense (DoD) and North Atlantic Treaty Organization (NATO) servicing connectors.

Image /page/1/Picture/18 description: The image contains a right-pointing arrow. The arrow is black and has a thick, bold line. The arrow is pointing to the right, indicating direction or progression.

{2}------------------------------------------------

Image /page/2/Picture/0 description: The image shows the logo for ESSEX Industries. The word "ESSEX" is written in a stylized font, with each letter outlined. Below "ESSEX" is the word "INDUSTRIES" written in a smaller, sans-serif font.

- The DMOS shall be refilled in 10 minutes or less from the Oxygen Generator m) System (OGS).
#### How the device functions

The DMOS provides for storing of 1.4 liters of liquid oxygen and converting this liquid into its gaseous state. The gaseous oxygen is capable of being delivered in controlled amounts to provide medical treatment to injured patients and uncontrolled amounts to drive respiratory medical devices or supplemental oxygen in high altitude. The DMOS is capable of being filled with liquid oxygen from the Oxygen Generator System (OGS) and with current liquid oxygen storage/ filling stations.

DMOS contains liquid oxygen (LOX). The DMOS contains a thermally insulated container of liquid oxygen (LOX) that is intended to supplement gases to be inhaled by a patient. The DMOS supports medical devices provided by the user including masks, cannulas, and Bag Valve Mask (BVM) being attached to the flow control patient outlets. An empty portable liquid oxygen unit is a device, while the oxygen contained therein is a drug.

The DMOS is portable. The handle on the front control make the DMOS portable. The DMOS can be carried onboard, tied down, transported and operationally perform on various aircraft and ground vehicles.

The DMOS converts liquid oxygen from its insulated container through its heat exchanger into gaseous oxygen and finally the gaseous oxygen is available for distribution from an outlet port on the user interface. After connecting a tube assembly connector of a mask, cannula, and Bag Valve Mask (BVM) to an outlet port, masks, cannulas, and BVMs or other similar medical device (none of these devices is included in the DMOS) the patient can inhale the gaseous oxygen.

- 5. Indications for Use of Medical Device
The DMOS is intended to convert liquid oxygen to gaseous oxygen for delivery to a patient and/or for delivery to rescue personnel to supplement environmental oxygen at high altitudes while being carried by a rescue personnel at one-half (0.5) to fifteen (15) liters per minute (LPM) and fifty (50) pounds per square inch gauge (psig).

5-3

{3}------------------------------------------------

## 6. Comparison to Predicate Medical Device

The BMOS (K071581) is the predicate medical device to which DMOS (K130068) is compared. Indications for Use for BMOS is that the BMOS is intended to be used by emergency response personnel in military and commercial fields to provide an emergency source of supplemental oxygen for a patient while being transported from a crisis situation to a health care facility. The BMOS is not intended to be a life sustaining or life-supporting device.

- Both the submission device and predicate device convert liquid oxygen to gaseous . oxygen
- Both devices can be used in military and commercial applications .
- Both devices supply supplemental oxygen to a patient .
- Both flow at one-half (0.5) to fifteen (15) liters per minute (LPM) and fifty (50) . pounds per square inch gauge (psig)
- The only difference between the two devices is that DMOS is capable of . supplying oxygen to rescue personnel in situations where they themselves need additional oxygen when they are in high altitude, mountainous region

BMOS & DMOS are both portable. Personnel can move a BMOS device by picking up the unit by the handle on the front face and walking with it while personnel can move a DMOS device by in the same manner. Both the BMOS and DMOS devices are similar in that they include a thermally insulated container. Both containers are designed built, and tested per 49 CFR §178.57, Specification 4L welded insulated cylinders, and are housed in aluminum sheet metal enclosures that contain heat exchangers that convert the liquid oxygen to gaseous oxygen. Both devices have ports that can be connected to tubing intended for connection to an oxygen mask or other similar medical device to ultimately supplement gases to be inhaled by a patient.

Both devices can be monitored for pressure and liquid oxygen quantity. The differences in the BMOS and DMOS are in the container size and LOX capacity. The BMOS container is a cylinder that is approximately 13.1 inches long and 5.0 inches in diameter with a LOX capacity of 2 liters while the DMOS container is a cylinder that is approximately 12.3 inches long and 4.4 inches in diameter with a LOX capacity of 1.4 liters.

The DMOS has an additional parachute port, which the BMOS does not have, that allows the military rescue personnel to plug in his/her parachutist mask for additional oxygen when they are in high altitude, mountainous region.

Image /page/3/Picture/13 description: The image contains a black and white drawing of a stylized letter X. The letter is formed by two diagonal lines that intersect in the center. The lines are thick and bold, creating a strong visual impact. The background is plain white, which helps to emphasize the shape of the letter.

{4}------------------------------------------------

Image /page/4/Picture/0 description: The image shows the logo for Essex Industries. The logo consists of the word "ESSEX" in a stylized font, with the letters connected. Above the right side of the word is the trademark symbol. Below the word "ESSEX" is the word "INDUSTRIES".

DMOS is a slightly smaller version of the BMOS, where both systems function exactly the same, with the exception that DMOS has the capability to provide oxygen at high altitude for rescue personnel.

| Performance | DMOS (K130068) | BMOS (K071581) |
|------------------------|-------------------------------------------------|-------------------------------------------------|
| Characteristics | | (PREDICATE DEVICE) |
| Indications for Use | The DMOS is intended to convert liquid | The BMOS is intended to be used by |
| | oxygen to gaseous oxygen for delivery to a | emergency response personnel in military |
| | patient and/or for delivery to rescue personnel | and commercial fields to provide an |
| | to supplement environmental | emergency source of supplemental oxygen |
| | oxygen at high altitudes while being carried | for a patient while being transported from a |
| | by a rescue personnel at one-half (0.5) to | crisis situation to a health care facility. The |
| | fifteen (15) liters per minute (LPM) and fifty | BMOS is intended to be a life sustaining or |
| | (50) pounds per square inch gauge | life-supporting device. |
| | (psig). | |
| Target Population | Adult | Adult |
| Where Used | Military & commercial emergency response | Military & commercial emergency response |
| | /rescue | /rescue |
| Dimensional Envelope | Height = 5.5" | Height = 6.5" |
| | Width = 7.25" | Width = 7.5" |
| | Depth = 17.0" | Depth = 17.5" |
| System Weight | 15.3 lbs when filled with LOX | 18.5 lbs max when filled with LOX |
| Delivery Rate (outlet | 15 LPM @ 50 PSIG | 15 LPM @ 50 PSIG |
| flow) | | |
| Delivery Temperature | Within +10/-20 °F of low ambient (-40 °F) | Within +10/-20 °F of ambient at outlet ports. |
| | and within +10/-65 °F of high ambient (130 | |
| | °F) at the outlet ports. | |
| Delivery Temperature | No alarm | No alarm |
| Alarm | | |
| # Person Carry | 1-Person-unit has one handle. | 1-Person-unit has one handle. |
| Energy Used | Battery operated | Battery operated |
| LOX Quantity Indicator | Battery powered indicator (One 9V) | Battery powered indicator (Six AA) |
| Low Quantity Alarm | No alarm | No alarm |
| Outlet Pressure | 50 PSIG outlet pressure | 50 PSIG outlet pressure |
| Outlet Pressure Alarm | No alarm | No alarm |
| Outlet Ports | 2 Outlet Ports (DISS 1240 & Female Dixon | 1 Outlet Port (DISS 1240) |
| | Quick-Disconnect) | |
| Flow Control Outlet | 1 Flow Control Valve (0.5-15 LPM, with 12 | 1 Flow Control Valve (0.5-15 LPM, with 12 |
| Ports | settings) | settings) |
| Human Factors | Single-person carry | Single-person carry |
| Standards Met | DOT-4L (Production Units) | DOT-4L |
| Sterility / Shelf Life | N/A | N/A |
| Electrical Safety | Tested IAW MIL-STD-810G | Tested IAW MIL-STD-810F |

Image /page/4/Picture/4 description: The image contains a right-pointing arrow. The arrow is black and has a simple, angular design. The arrow is pointing to the right, indicating direction or progression.

{5}------------------------------------------------

Image /page/5/Picture/0 description: The image shows the logo for Essex Industries. The word "ESSEX" is written in a bold, sans-serif font with a unique design, and the letters are outlined in black. Below the word "ESSEX" is the word "INDUSTRIES" written in a smaller, sans-serif font.

| Performance/<br>Characteristics | DMOS (K130068) | BMOS (K071581)<br>(PREDICATE DEVICE) |
|----------------------------------|----------------------------------------------------------------------------------------------------------------------------------------------|----------------------------------------------------------------------------------------------------------------------------------------------|
| Medical Devices<br>Compatibility | Commercial Mask<br>Commercial Cannula<br>Flow Control Valve (0.5-15 LPM, with 12 settings) | Commercial Mask<br>Commercial Cannula<br>Flow Control Valve (0.5-15 LPM, with 12 settings) |
| Fill Connection | Standard Military CRU-50/A connection<br>which connects with the military standard<br>CRU-59/E connector on all the LOX filling<br>equipment | Standard Military CRU-50/A connection<br>which connects with the military standard<br>CRU-59/E connector on all the LOX filling<br>equipment |
| Storage Capacity | 1.4 Liters of LOX | 2 Liters of LOX |
| Operating Temperature | -40°F to 130°F | 32°F to 120°F |
| Storage Temperature | -40°F to 130°F | -40°F to 160°F |

## 7. Medical Device Tests

Essex Industries, Inc. Engineering personnel completed extensive DMOS capability, performance, and environmental testing with similar acceptable results as that of BMOS and so have determined that DMOS is substantially equivalent to BMOS. The combined testing and analysis of results provides assurance that the device meets it specifications and meets its intended use. See the following table for bench tests and standards.

| Bench Test | Test or Analysis | Test Standard |
|-------------------------------------|------------------|--------------------|
| Insulation Resistance | Test | |
| Visual & Dimensional<br>Examination | Test | |
| Leakage | Test | |
| Quantity Indicator Performance | Test | |
| Weight & Capacity | Test | |
| Fill Time | Test | |
| Buildup Time | Test | |
| Parachutist Mask Delivery Rate | Test | |
| Patient Delivery Rate | Test | |
| Patient Delivery Temperature | Test | |
| Delivery Duration | Test | |
| Normal Evaporative Rate | Test | |
| High Temperature Operation | l est | MIL STD 810 Rev. G |
| Low Temperature Operation | Test | MIL STD 810 Rev. G |
| Altitude | Test | MIL STD 810 Rev. G |

Image /page/5/Picture/6 description: The image shows the text "assexindustries.com" in a sans-serif font. The text is black and is set against a white background. To the left of the text is a black arrow pointing to the right.

{6}------------------------------------------------

Image /page/6/Picture/0 description: The image shows the logo for Essex Industries. The logo consists of the word "ESSEX" in a stylized font, with the word "INDUSTRIES" underneath. The font is bold and sans-serif, and the letters are outlined in black. There is a trademark symbol to the right of the X.

| Bench Test | Test or Analysis | Test Standard |
|--------------------------|------------------|--------------------|
| Helicopter Vibration | Test | MIL STD 810 Rev. G |
| Aircraft Vibration | Test | MIL STD 810 Rev. G |
| Ground Vehicle Vibration | Test | MIL STD 810 Rev. G |
| Functional Shock | Test | MIL STD 810 Rev. G |
| Crash Hazard Shock | Test | MIL STD 810 Rev. G |
| Safety Drop | Test | MIL STD 810 Rev. G |
| Ballistic Test | Analysis | |
| Salt Fog | Analysis | |
| Humidity | Analysis | |
| Rain | Analysis | |
| Freezing Rain | Analysis | |
| Blowing Snow | Analysis | |

#### 8. Conclusions

Based on review of the design and test results, Essex Industries, Inc. believes that no significant differences exist between this medical device, DMOS, and the predicate medical device, BMOS, and therefore DMOS is substantially equivalent to BMOS.

Image /page/6/Picture/5 description: The image contains a black greater-than sign on a white background. The greater-than sign is a mathematical symbol used to indicate that one value is larger than another. The symbol is oriented horizontally, with the open end facing to the right. The image is simple and minimalist, with the focus on the greater-than sign.

{7}------------------------------------------------

Image /page/7/Picture/1 description: The image shows the logo for the U.S. Department of Health and Human Services. The logo consists of a stylized depiction of an eagle or bird-like figure with three curved lines forming its body and wings. The text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" is arranged in a circular fashion around the emblem.

Food and Drug Administration 10903 New Hampshire Avenue Document Control Center - WO66-G609 Silver Spring, MD 20993-0002

#### July 19, 2013

Essex Industries, Inc. d/b/a Essex Cryogenics of Missouri C/O Mr. Kenneth Seise Quality Assurance/Regulatory Compliance Manager 8007 Chivvis Drive St. Louis, MO 63123-2395

Re: K130068

Trade/Device Name: Dismounted Medical & Supplemental Oxygen System Regulation Number: 21 CFR 868.5655 Regulation Name: Portable Liquid-Oxygen Unit Regulatory Class: II Product Code: BYJ Dated: June 17, 2013 Received: June 19, 2013

Dear Mr. Seise:

We have reviewed your Section 510(k) premarket notification of intent to market the device referenced above and have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate commerce prior to May 28, 1976, the enactment date of the Medical Device Amendments, or to devices that have been reclassified in accordance with the provisions of the Federal Food, Drug, and Cosmetic Act (Act) that do not require approval of a premarket approval application (PMA). You may, therefore, market the device, subject to the general controls provisions of the Act. The general controls provisions of the Act include requirements for annual registration, listing of devices, good manufacturing practice, labeling, and prohibitions against misbranding and adulteration. Please note: CDRH does not evaluate information related to contract liability warranties. We remind you, however, that device labeling must be truthful and not misleading.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to additional controls. Existing major regulations affecting your device can be found in the Code of Federal Regulations, Title 21, Parts 800 to 898. In addition, FDA may publish further announcements concerning your device in the Federal Register.

{8}------------------------------------------------

Page 2 - Mr. Seise

Please be advised that FDA's issuance of a substantial equivalence determination does not mean that FDA has made a determination that your device complies with other requirements of the Act or any Federal statutes and regulations administered by other Federal agencies. You must comply with all the Act's requirements, including, but not limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Part 801); medical device reporting (reporting of medical devicerelated adverse events) (21 CFR 803); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please contact the Division of Small Manufacturers, International and Consumer Assistance at its tollfree number [phone] or [phone] or at its Internet address http://www.fda.gov/MedicalDevices/Resourcesfor You/Industry/default.htm. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). For questions regarding the reporting of adverse events under the MDR regulation (21 CFR Part 803), please go to

http://www.fda.gov/MedicalDevices/Safety/ReportaProblem/default.htm for the CDRH's Office of Surveillance and Biometrics/Division of Postmarket Surveillance.

You may obtain other general information on your responsibilities under the Act from the Division of Small Manufacturers, International and Consumer Assistance at its toll-free number [phone] or [phone] or at its Internet address http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm.

Image /page/8/Picture/5 description: The image shows a signature followed by the text "Sincerely yours,", "Tejashri Purohit Sheth, M.D.", "Clinical Deputy Director", and "DAGRID". The text appears to be part of a letter or official document. The word "FOR" is at the bottom right corner of the image.

Kwame Ulmer, M.S. Acting Division Director Division of Anesthesiology, General Hospital, Respiratory, Infection Control and Dental Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

{9}------------------------------------------------

Image /page/9/Picture/0 description: The image shows the logo for ESSEX Industries. The word "ESSEX" is written in a stylized font with a trademark symbol in the upper right corner. Below the word "ESSEX" is the word "INDUSTRIES" in a smaller, sans-serif font.

#### Indications for Use Statement

510(k) Number (if known):

Device Name: Dismounted Medical & Supplemental Oxygen System

Indications for Use: The DMOS is intended to convert liquid oxygen to gaseous oxygen for delivery to a patient and/or for delivery to rescue personnel to supplement environmental oxygen at high altitudes while being carried by a rescue personnel at one-half (0.5) to fifteen (15) liters per minute (LPM) and fifty (50) pounds per square inch gauge (psig).

Anya C. Harry Digitally signed by Anya C. Harry
DN: c=US, o=U.S. Government, ou=HHS,
ou=FDA, ou=People, cn=Anya C. Harry,
0.9.2342.19200300.100.1.1=0011315590

(Division Sign-Off) Division of Anesthesiology, General Hospital Infection Control, Dental Devices

510(k) Number: K130068

Prescription Use. X (CFR Title 21, Part 801, Subpart D)

AND/OR

Over-The-Counter Use (CFR Title 21, Part 801, Subpart C)

(PLEASE DON NOT WRITE BELOW THIS LINE-CONTINUE ON ANOTHER PAGE IF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE)

4-1

Image /page/9/Picture/13 description: The image contains a string of numbers and letters. The string is "16-6101-014-30-6677-1-1". The text is black and is on a white background.

assexindustries.com

Even Industries, Inc. | 9007 Chivats Drive | St. Lovic, MC143123 | 314.832.8077 | 314.832.8208 Fax