24 Tips for Safety in HBOT

  The rapid growth in hyperbaric medicine facilities in the United States and throughout the world has created a demand for large numbers of new employees, some of whom have no experience and little training. This has heightened the concern for patient safety. The following are tips and takeaways for your clinic’s Hyperbaric Oxygen Therapy practices.

  1. Each individual who works at a hyperbaric facility must know the potential for mishaps and use that information to safely operate the chamber and its support equipment.

  2. Although the hyperbaric medicine community enjoys an enviable safety record, it is important to periodically review hyperbaric mishaps and consider the lessons learned from prior experience in order to avoid repeating them.

  3. There are five basic safety issues including integrity of the pressure vessel, safe gas handling practices, decompression safety, fire safety, and training.

  4. Clinical hyperbaric chambers and systems used for patient care in the US must be constructed in accordance with the American Society of Mechanical Engineers (ASME) Standards for Pressure Vessels the [Boiler and Pressure Vessel Code (BPVC) and Pressure Vessels for Human Occupancy (PVHO)] or an international equivalent.

  5. Chambers constructed to ASME standards are safe provided the operators are trained and are safety conscious.

  6. Hyperbaric chambers must be constructed in accordance with ASME or equivalent standards.

  7. Qualified individuals in accordance with ASME or equivalent standards will perform any modifications to the chamber.

  8. Two areas of concern are a gas mix-up that results in the patient receiving the wrong gas and mishandling, which causes damage to the gas cylinder.

  9. Damage to the gas cylinder can occur if it is overheated, dropped, or rusts. Heat causes an increase in pressure inside the cylinder that can cause the cylinder to explode.

  10. The fire department will want to know where all of the oxygen cylinders are in service or stored within your facility.

  11. When a cylinder is dropped and the regulator or fill port is broken, the cylinder will suddenly release its contents and become a projectile, destroying anything in its path.

  12. Gas cylinders are periodically inspected and hydrostatically tested by the gas delivery service and a date stamp of the original hydrostatic test is etched in the top of the cylinder.

  13. Labels will show subsequent tests, which are conducted at five-year intervals.

  14. Many clinical hyperbaric chamber fires have been started by the chamber occupants (staff or patients who smoked, patients who were cold, patients with cell phones, and children with toys).

  15. The only survivors were in chambers pressurized with air in which the oxygen percentage was known to be below 24%.

  16. Special vigilance is required to ensure that no igniters enter the chamber.

  17. Oxygen percentage in multiplace chambers should be kept below 23.5%. There have been no survivors to chamber fires that had oxygen above 24%.

  18. The amount of burnable material must be limited. Paper products should be stored in metal containers when not in use.

  19. Water deluge FES and hand aimed hoses are effective in putting out a fire.

  20. Signs should be posted in the vicinity of the chamber and clothing change stations to remind patients of the forbidden items.

  21. Checklists should be used for daily operations. Patients should be briefed about items that are excluded from the chamber and reminded prior to each treatment.

  22. The staff must be trained, present, and vigilant in order to avoid mishaps. Each member of the staff should attend formal training.

  23. Physicians should attend a UHMS Designated Introductory Course in Hyperbaric Medicine consisting of at least 40 academic hours.

  24. The hyperbaric facility is safe—provided a qualified team adheres to establish safety practices is operating the facility.