EMT RESUSCITATOR

K983705 · O-Two Systems Intl., Inc. · BTL · Oct 29, 1998 · Anesthesiology

Device Facts

• Record ID: K983705
• Device Name: EMT RESUSCITATOR
• Applicant: O-Two Systems Intl., Inc.
• Product Code: BTL · Anesthesiology
• Decision Date: Oct 29, 1998
• Decision: SESE
• Submission Type: Special
• Regulation: 21 CFR 868.5925
• Device Class: Class 2
• Attributes: Therapeutic

Intended Use

Pulmonary resuscitation during respiratory and/or cardiac arrest. Short term ventilatory support for both inter and intra-hospital transport of non-breathing patients.

Device Story

EMT Resuscitator provides respiratory support for patients in respiratory arrest or distress. Device features automatic and manual ventilation modes in a single handpiece. Totally pneumatic operation; requires no batteries or electrical power; powered by compressed air or oxygen source (50-90 psi). Used by emergency responders for resuscitation and transport. Healthcare providers operate the device to deliver ventilation; output is gas delivery to patient. Benefits include portable, reliable respiratory support in emergency settings without external electrical power.

Clinical Evidence

Bench testing only. Performance verified against current domestic and international standards, specifically ISO 8382-1988. No clinical data presented.

Technological Characteristics

Totally pneumatic; no batteries or electrical power required. Operates on compressed air or oxygen (50-90 psi). Handpiece design. Features automatic and manual ventilation modes. Complies with ISO 8382-1988.

Indications for Use

Indicated for patients experiencing respiratory or cardiac arrest requiring pulmonary resuscitation, and for non-breathing patients requiring short-term ventilatory support during inter- or intra-hospital transport.

Regulatory Classification

Identification

A powered emergency ventilator is a demand valve or inhalator intended to provide emergency respiratory support by means of a face mask or a tube inserted into a patient's airway.

Predicate Devices

• Genesis® II A/C (K932170)

Submission Summary (Full Text)

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K983705

OCT 2 9 1998

# SAFETY AND EFFECTIVNESS STATEMENT.

#### EMT Resuscitator TRADE NAME:

COMMON NAME: AUTOMATIC RESUSCITATOR

REGULATORY CLASS: II

510K # : TO BE SUPPLIED

LEGALLY MARKETED DEVICE TO WHICH EQUIVALENCE IS CLAIMED:

510K #: K932170 GENESIS® II A/C - - - - -

#### DESCRIPTION OF THE DEVICE:

The EMT automatic/manually triggered resuscitators are designed to provide respiratory support to patients in either respiratory arrest or respiratory distress.

The device incorporates the features of Automatic Ventilation and Manual Ventilation into a single handpiece design that is a derivative of the Genesis® II Adult/Child device. The device is totally pneumatic in its function therefore requiring no batteries or other power sources apart from a compressed gas supply of either air or oxygen (as specified by the customer) and a regulated output from the gas source between 50 and 90 psi.

#### SUMMARY OF TECHNOLOGICAL CHARACTERISTICS

This device is designed to meet the ever-changing needs of the emergency respiratory care market. This device is similar in terms of features to the Genesis® II product -510K # K932170 except in the removal of the demand breathing and auto shut off functions. In addition the calibration for each setting has been amended to incorporate an extra automatic setting.

### ASSESSMENT OF PERFORMANCE DATA

The submission incorporated a significant amount of non-clinical test data to support the claim of substantial equivalence. This test data reviewed the performance of the device against both the current domestic and international standards for these devices.

In particular, references were made to ISO 8382-1988.

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## CONCLUSIONS BASED ON PERFORMANCE DATA

The testing undertaken verified that the EMT Resuscitator device, when compared with the performance of the device to which substantial equivalence is claimed, performed within specification.

CONTACT PERSON: KEVIN BOWDEN, DIRECTOR OF PRODUCT TECHNOLOGY

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Doc. #: SER/EMT/Oct 98

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DEPARTMENT OF HEALTH & HUMAN SERVICES-USA

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

OCT 29 1998

Mr. Kevin Bowden O-Two Systems International Inc. 7575 Kimbel Street Mississauga, Ontario Canada L5S 1C8

Re: K983705 EMT Resuscitator Regulatory Class: II (two) Product Code: BTL October 19, 1998 Dated: Received: October 21, 1998

Dear Mr. Bowden:

We have reviewed your Section 510(k) notification of intent to market the device referenced above and we 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). 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 reqistration, listing of devices, qood manufacturing practice, labeling, and prohibitions against misbranding and adulteration.

If your device is classified (see above) into either class II (Special Controls) or class III (Premarket Approval), it may be subject to such additional controls. Existing major regulations affecting your device can be found in the Code of Federal Regulations, Title 21, Parts 800 A substantially equivalent determination assumes compliance to 895. with the Current Good Manufacturing Practice requirements, as set forth in the Quality System Regulation (QS) for Medical Devices: General requlation (21 CFR Part 820) and that, through periodic QS inspections, the Food and Drug Administration (FDA) will verify such assumptions. Failure to comply with the GMP regulation may result in In addition, FDA may publish further announcements requlatory action. concerning your device in the Federal Register. Please note: this response to your premarket notification submission does not affect any obligation you might have under sections 531 through 542 of the Act for devices under the Electronic Product Radiation Control provisions, or other Federal laws or requlations.

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Page 2 - Mr. Kevin Bowden

This letter will allow you to begin marketing your device as described in your 510(k) premarket notification. The FDA finding of substantial equivalence of your device to a legally marketed predicate device results in a classification for your device and thus, permits your device to proceed to the market.

If you desire specific advice for your device on our labeling requlation (21 CFR Part 801 and additionally 809.10 for in vitro diagnostic devices), please contact the Office of Compliance at [phone]. Additionally, for questions on the promotion and advertising of your device, please contact the Office of Compliance at [phone]. Also, please note the regulation entitled, "Misbranding by reference to premarket notification"(21 CFR 807.97). Other general information on your responsibilities under the Act may be obtained from the Division of Small Manufacturers Assistance at its toll-free number [phone] or [phone], or at its internet address "http://www.fda.gov/cdrh/dsma/dsmamain.html".

Sincerely yours,

Thomas J. Callahan

Thomas J. Callahan, Ph.D. Director Division of Cardiovascular, Respiratory, and Neurological Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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Page__________________________________________________________________________________________________________________________________________________________________________

510K Number (if known):

Device Name: EMT Resuscitator

Indications for Use:

- Pulmonary resuscitation during respiratory and/or cardiac arrest. []
- Short term ventilatory support for both inter and intra-hospital transport of [] non-breathing patients.

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

Concurrence of CDRH, Office of Device Evaluation (ODE)

| Name (Division Sign-Off) | Mark Kreme |
|-------------------------------------------------------------------|------------|
| Division of Cardiovascular, Respiratory, and Neurological Devices | |
| 510(k) Number | K983705 |

| Prescription Use (Per 21 CFR 801.109) | <div style="text-align:center;">OR</div> | Over-The-Counter Use |
|---------------------------------------|------------------------------------------|----------------------|
|---------------------------------------|------------------------------------------|----------------------|

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