Introductory Course

in Hyperbaric Medicine
and Wound Care
Introductory Course
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Presentations are numbered to match the

schedule
Accreditation Statement:
“This activity has been planned and implemented in accordance with the accreditation requirements and policies of
the American Council for Continuing Medical Education (ACCME) through the joint providership of the Undersea
and Hyperbaric Medical Society (UHMS) and Physicians Unity, PA. The UHMS is accredited by the ACCME to provide
continuing medical education to physicians”

Designation Statement:
“The Undersea and Hyperbaric Medical Society designates this live activity for a maximum of 40.00 AMA PRA
Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation
in this activity.”

Full Disclosure Statement:

“All faculty members and planers participating in this continuing medical education activities sponsored by
Physicians Unity, PA are expected to disclose to the participants any relevant financial relationships with ineligible
companies. Full disclosure of faculty and planner relevant financial relationships will be made at the activity”.

UHMS Disclaimer Statement:

“The information provided at this CME activity is for Continuing Medical Education purposes only. The lecture
content, statements or opinions expressed, however, do not necessarily represent those of the Undersea and
Hyperbaric Medical Society (UHMS), its affiliates or its employees.”
 Overall Course Goal
Goals, The primary goal of Physicians Unity’s
Introductory Course in Hyperbaric Medicine and

Disclosures,
Wound Care is to provide a forum for
professional scientific growth and development
of the participants. The course provides a basis

and Support for exchange of ideas, both scientific and

practical, among physicians, researchers, and
other allied health professionals.
Disclosures
All indiv iduals in control of content for this educational activ ity with their relev ant financial relationship disclosed are
listed below (if applicable). An indiv idual who refuses to disclose relev ant financial relationships will be disqualified
from being in control of educational content at any time, and cannot have control of, or responsibility for, the
dev elopment, management, presentation, or ev aluation of the CME activ ity.

Financial relationships are relev ant if the following three conditions are met for the indiv idual who will control
content of the education:

• A financial relationship, in any amount, exists between the person in control of content and an ineligible
company.
• The content of the education is related to the products of an ineligible company with whom the person
has a financial relationship.
• The financial relationship existed during the past 24 months

None of the indiv iduals in control of content (planners/faculty/reviewers/authors) for this educational activ ity have
relev ant financial relationship(s) to disclose with ineligible companies whose primary business is producing,
marketing, selling, re-selling, or distributing healthcare products used by or on patients.

There are no relev ant financial relationships with ineligible companies to mitigate for this educational activ ity.

No commercial support was receiv ed for this activ ity.

 For HBOT to be reimbursed, a facility
must ensure the provider supervising
the treatment meets CMS

Provider requirements.

Training Providers who supervise HBOT should be

certified in Undersea and Hyperbaric
Requirements Medicine or must have completed a
40-hour, in-person training program by
an approved entity.
 The training schedule for this
course is 40.00 hours over 4 or 5
consecutive days

This course of instruction will

INTRODUCTION consist primarily of lecture /

discussion with practical exercises
as needed.

There will be an examination at the

end of this course.
 Attendance and successful
You are completion of this course does NOT
imply that the student is considered
beginning an an “expert” in the field of hyperbaric
medicine.
educational Students successfully completing this
journey course will meet the minimum
training requirement as required by
the ACHM, UHMS and the NBDHMT.
 The following organizations provide guidelines and/or regulatory
oversight within the hyperbaric medicine community.
1. Undersea Hyperbaric Medical Society (UHMS)

2. American College of Hyperbaric Medicine (ACHM)

Hyperbaric 3. National Board of Diving and Hyperbaric Medical

Organizations
Technologists (NBDHMT)

4. Baromedical Nurses Association (BNA)

5. National Fire Protection Association (NFPA)

6. Compressed Gas Association (CGA)

7. American Society Mechanical Engineers (ASME)

Undersea &
Hyperbaric Medical
Society (UHMS)
WEBSITE:
http://membership.uhms.org
American College
of Hyperbaric
Medicine (ACHM)
WEBSITE:
http://www.hyperbaricmedicine.org/
National Board of
Diving and
Hyperbaric Medical
Technologists
(NBDHMT)
WEBSITE:
http://www.nbdhmt.org/
Baromedical Nurses
Association (BNA)
WEBSITE:
http://www.hyperbaricnurses.org/
National Fire
Protection
Association (NFPA)
WEBSITE: http://www.nfpa.org/
Compressed Gas
Association (CGA)
WEBSITE:
http://www.cganet.com/
American Society
Mechanical
Engineers (ASME)
WEBSITE: http://www.asme.org/
The History of Mistakes are
Hyperbaric meant for learning,
not repeating!
Medicine
History of Diving

The origins of diving are firmly rooted in

the needs and desires of men to
engage in underwater commerce, to
conduct salvage and military
operations, and to expand the frontiers
of knowledge through exploration,
research, and development
History of Diving

No one knows when man first

discovered he could swim down and
retrieve objects from under the water
but diving as a profession can be
traced back more than 5,000 years.
 AIR SUPPLY
Air Bags and Hollow Tubes
History of Diving

1511 Design
History of Diving

Throughout history imaginative devices were designed to

increase the amount of time one could stay underwater.

But first, the problem of pressure underwater was not fully

understood and the designs were impractical.
History of Diving

As as far back as 9th

century B.C. we see designs
for an air supply contained
in a flexible bladder
History of Diving

Haley's diving bell developed in

1690 by English astronomer
Edmund Haley. It used
weighted barrels of air to
replenish the bells atmosphere
AIR SUPPLY Diving Bell
AIR SUPPLY
Lethbridge’s
One-Man
Diving
Machine
One Man
Diving
Machine
“AQUA LUNG”
The French Caission and The Mysterious Malady

The Caisson allowed humans to work at

a given depth or pressure for long
periods of time.

A major step forward for engineering,

but industrial safety issues loomed large
 With the expanded use of the
caission, an apparently new and

The
unexplained malady began to
affect the caission workers.

Mysterious After returning to the surface the

Malady workers were struck by dizzy spells,
difficulty breathing, and sharp
pains in the joints or abdomen.
 As caisson work was extended to
even larger projects and to greater
pressure, the physiological problems
The increased in number and severity.
Fatalities occurred with alarming
Mysterious frequency.

Malady The malady was called “Caisson

Disease”
Caisson
Disease
The actual cause of the Caission
Disease was first clinically described in
1878 by a French physiologist, Paul Bert.
 If the pressure remained, the gas was
held in solution. When the pressure was

Caisson
quickly released, as when a worker left
the caisson, the nitrogen returned to a
Disease gaseous state too rapidly to pass out of
the body in a natural manner causing
caisson disease.
 Today the bends is the most well-
known danger of diving.
Caisson
Disease Susceptibility is variable, and the
reasons for this variability are still
being elucidated.

“The Bends” Treating this disease has given

birth to clinical hyperbaric
medicine as we know it today.
Divers
return to
the surface
from a
commercia
l dive and
enter an
onboard
hyperbaric
chamber
Early Recognition of DCS

Tunnel and Caisson workers would

spend many hours breathing
compressed air within the tunnel,
often suffering pains and other
disorders after returning to normal
environmental pressure
Origin of the term “The Bends”

A workman walking with a difficult step

and a slight stoop was similar to an
affected gait by the young ladies of
that time know as “Grecian Bends”
CAISSON WORKERS: Today

Tunnel 300 feet under the city

of Los Angeles

Tunnel was 38 miles long

operations were 24/7
CAISSON
WORKERS
Miners entering the
hyperbaric chamber start
their work shift at 36psi
(80fsw) for 6 to 8 hours
 U-LINK LIGHT RAIL TUNNELS
TBM MAN LOCKS -Hyperbaric Chambers

HBO
Chambers x 2

Men 6 ft.
U-LINK LIGHT RAIL TUNNELS
TBM MAN LOCKS
Hyperbaric
Chamber
Console
 Boyle saw bubble in viper’s eye -
1670

Slow ascent of workers better -

1854
PHYSIOLOGY
OF CAISSON’S N2 etiology by Paul Bert - 1878

DISEASE Recompression chambers relieved pain

and reduced fatalities - 1889 (Hudson
River Project - Mortality Rate- 25%/Yr. to
1.6%)
HYPERBARIC TREATMENT became
the definitive solution to the
problem
 The Haldanian Theory

• J. S. Haldane, British physiologist in the early 0’

1900’s, theorized that tissues could withstand a 50%
50% pressure reduction without bubble
formation
• Haldane used 5 tissue compartment models: 5, 33’
10, 20, 40, and 75 minutes
• Eventually the 2:1 Haldane ratio was too liberal
and had to be modified
50%
• His tissue compartment model is still the basis
for tables used today!

99’
Hyperbaric Medicine

One of the first successful uses of a

recompression chamber was in 1879
reducing the incidence of serious injury
and mortality
Discovery of
Oxygen - 1775
• Joseph Priestly was
credited with the discovery
of oxygen in 1775.

• Carl Wilhelm Scheele also

discovered oxygen,
independently but Priestly
is usually given credit for
the discovery
Hyperbaric • Paul Bert father of hyperbaric
research.
Medicine • John Scott Haldane developed the

Pioneers diving tables.( foundation to all

Clinical Hyperbaric Protocols)

(overview) • Dr. Orville J. Cunningham applied

hyperbaric techniques to medicine.
(Hyperbaric Clinic)
 Early
Hyperbaric
Chambers
In 1879 Jaques Fontaine, a French surgeon,
developed a mobile pressurized operating room.
Early Medical Uses of Hyperbaric Therapy

In the early 1900s,

Cunningham observed that
patients with cardiovascular
disease who dwelled at high
altitudes fared less well than
comparable patients living
closer to sea level.
Hyperbaric Medicine History

The steel ball

hospital. Built for Dr.
Orval Cunningham in
1928. It is six stories
high, has 72 rooms
with 12 bedrooms
per floor. Length of
hyperbaric exposure
was four days at 2
ATA.
Early Chambers The Steel Ball

Hyperbaric chamber, 64 feet in

diameter and 5 stories tall, where
patients stayed for up to two
weeks under increased
atmospheric pressure
Early Chambers: The Compressor Room
Early Chambers: The Bed Room
Early Chambers: The Patient Area
Early
Chambers:
The Dining
Room
 • Heinrich Drager is credited with advancing
Drager, the theory and technology for treatment of
DCS during the early decades of the 20 th
Behnke, century.

and Shaw • Navy physicians Behnke and Shaw worked

to make those protocols mainstream
and treatments for DCS in the 1930s.

Modern • In 1939, the US Navy began treating divers

HBOT suffering decompression sickness with
hyperbaric oxygen therapy using 100% O2
 • Early animal experiments
The 1950s – showed that surgeries
conducted inside a hyperbaric
Dutch Navy chamber were associated with
better survival
Surgeon Ite • A full-size Hyperbaric OR was
built at the University of
Boerema Amsterdam where many
successful heart and lung
Expands Use surgeries were performed.

of HBOT
• Successfully treated Clostridial
Myonecrosis with HBOT
 • Founders were largely Navy or ex-Navy

Undersea
physicians
• Dedicated to furthering research and

Medical enhancing safety

• Eventually renamed Undersea and

Society Hyperbaric Medical Society

• Instrumental in developing the
Founded evidentiary basis for modern
Hyperbaric oxygen therapy (HBOT)

in 1967 • Began publishing a list of conditions for

which there was significant evidence
for benefit from HBOT
Hyperbaric •Class A - Multiplace
Chambers •Class B - Monoplace
Today •Class C - Animal
Twelve Man
Multi-Place
Chamber
• PROs
• Can treat a large amount
of patients at once.
• Healthcare provider to
patient contact
Twelve Man
Multi-Place
Chamber
• CONs
• Costly installation
• Costly Fire Code
compliance
• Healthcare providers at
risk for pressure related
injuries.
• Increased staff
requirements
Deck Chamber

NOAA CHAMBER DECK DECOMPRESSION CHAMBER

Portable Monoplace
“Hyperlite”
ONLY
ASME/PVHO
Certified
Chamber
Veterinary
Hyperbaric
Medicine Society
The mission of the Veterinary
Hyperbaric Medicine Society
(VHMS) is to promote the
theory and application of
hyperbaric medicine in the
therapy of animal diseases
through education and
research.
Veterinary
Hyperbaric
Medicine Society
• There are aproximately seventeen
centers that practice equine
hyperbaric medicine.
• Approximately sixty- eight treating
small animals
HBO treatment & Equipment

Mono-place chamber

Can be compressed with either

room air or 100% oxygen

Normal maximum working

pressure 3 ATA (66fsw)

Most popular hyperbaric

chamber currently in use
HBO
treatment &
Equipment
• Multi-place hyperbaric
chamber
• Compressed with air
• Patient to care giver
contact
• Can treat up to 12
patients simultaneously
• Critical Care Capabilities
Hyperbaric
Ventilator
• Currently 16 different
hyperbaric ventilators
• ( only two for class B
chambers)
• Can be with any
combination of gasses
Normal working pressure
• Requires special training
Hyperbaric IV
pumps
• Two of the three pumps are NOT in
production anymore
• Requires special tubing
• NOT interchangeable with hospital IV
pumps
• One of the many reasons why critical
care is not a common practice in class
B chambers
NOT a
Hyperbaric
chamber
by Medical
definition
Questions