I was thinking back to the days when I worked as a hyperbaric technologist. Hyperbaric medicine has significantly evolved over the past decade. Many things stick out in my mind, such as criteria for insurance payor reimbursement, hyperbaric dosing, and regulatory standards, to name a few. Those were the days when we had to fax hyperbaric research articles and case studies to the utilization review departments of insurance companies. Ninety-nine percent of the time, panel review board members didn't know what hyperbaric oxygen therapy (HBOT) was. I would also get asked, "Do you mean 'bariatric'?" (instead of hyperbaric). The legwork seeking prior authorization for HBOT was dreadful during that time.

Key Positions and Roles in Hyperbaric Medicine Safety

I then started thinking about the changes regarding patient safety. The National Board of Diving & Hyperbaric Medical Technology issued a statement in 2009, that every recompression treatment facility and clinical hyperbaric medicine service center appoint a Hyperbaric Safety Director. The HBOT technologist must undergo formal and comprehensive safety training. The course should be designed to meet the National Fire Protection Association 99, Healthcare Facilities, Chapter 14, Hyperbaric Facilities recommendations for the appointment of the Safety Director. Safety programs should demonstrate effective elements of hazard mitigation and recognized risk management concepts.

Hypebaric oxygen therapy safety course program topics include:

• Fire Chemistry
• Hyperbaric Equipment Risks
• Hyperbaric Maintenance
• Safety of Medical Gases
• Operational Decompression Procedures
• Safety Elements of Performance Improvement
• Understanding the Regulatory Environment
• Monoplace Department Survey
• Multiplace Department Survey
• Risk Management Process

Duties and Responsibilities of Safety Directors in Hyperbaric Facilities

Hospitals and wound care management companies with more than one hyperbaric facility may appoint corporate safety directors, in addition to on-site safety directors. The safety director performs duties under supervision of the Medical Director, Program Director, and or Clinical Coordinator as appropriate for the program. This individual will also be responsible for the daily safe and effective operation and maintenance of the hyperbaric chamber(s).

• Responsible for all hyperbaric equipment
• Mock fire drills with all department staff
• Department safety policies and incorporate new safety procedures as appropriate
• Participate on the hospital's safety committee
• Remove any potentially hazardous supply or equipment items from the chamber
• Provide leadership and safety training to other hyperbaric personnel
• Maintain all facility safety-related standards as required by various licensing and regulatory agencies
• Support clinical hyperbaric facility accreditation
• Ensures department compliance with NFPA 99, chapter 20, Hyperbaric Facilities
• Reviews all department safety incidents
• Collects information regarding equipment/patient safety
• Reports relevant incidents to the staff
• Periodically provides in-service training

Hyperbaric Medicine Education

There are number of organizations and associations in the health care community dedicated to the education and professional development of individuals working in hyperbaric medicine. Following are a few resources that offer certification, courses and resources to those looking to advance their skills and knowledge in this discipline.

The National Board of Diving and Hyperbaric Medical Technology (NBDHMT) is a non-profit organization whose mission is to the meet the clinical, technical, and safety discipline of undersea and hyperbaric medicine. The NBDHMT offers professional certification in several clinical areas of hyperbaric medicine.

You can view the NBDHMT position statement on safety director appointment (Hyperbaric Safety Director: (2009-03) July 2009) by clicking here.

The National Fire Protection Association (NFPA) 99 determines criteria to minimize the hazards associated with fires, explosion and electricity for levels of health care services or systems based on risk to patients, staff, or visitors in health care facilities.

NFPA 99 2012 Edition 14.3.1.3.2 states: Each hyperbaric facility shall designate an on-site hyperbaric safety director to be in charge of all hyperbaric equipment and the operational safety requirements of this chapter.

The Undersea Hyperbaric Medical Society (UHMS) is an international non-profit organization with a focus on providing research and scientific information supporting diving and hyperbaric medicine,

The American College of Hyperbaric Medicine (ACHM), was established in 1983 by a group of hyperbaric specialist physicians who identified a need for a national organization to represent this specialty discipline. The ACHM provides hyperbaric oxygen therapy introductory training to national wound care companies. This specialized training is offered to all hyperbaric staff physicians, nurses and technicians. There is also a course available to prepare hyperbaric professionals for certification in hyperbaric medicine and wound care.

About the Author
Cheryl Carver is an independent wound educator and consultant. Carver's experience includes over a decade of hospital wound care and hyperbaric medicine. Carver single-handedly developed a comprehensive educational training manual for onboarding physicians and is the star of disease-specific educational video sessions accessible to employee providers and colleagues. Carver educates onboarding providers, in addition to bedside nurses in the numerous nursing homes across the country. Carver serves as a wound care certification committee member for the National Alliance of Wound Care and Ostomy, and is a board member of the Undersea Hyperbaric Medical Society Mid-West Chapter.