HBOT State of Affairs

  In 1974, marine biologist Sylvia Earle was still five years from the record-breaking, untethered JIM suit dive that earned her the nickname “Her Deepness” and turned her into an international celebrity. That year, Earle was among the aquanauts living in the Hydrolab underwater habitat stationed on the sloping sea floor of the Bahamas. Dick Clarke, CHT, five years removed from the Royal Navy at that point, was in charge of surface support. My father, the physiologist William Fife, a veteran of a prior Hydrolab operation, was performing various physiological experiments on the aquanauts. During that warm Bahamian winter of ’74, I also worked for Mr. Clarke on the Hydrolab II surface support team, dutifully delivering mail and taking out the trash, or generally doing anything asked of me. I was the same age as Sylvia’s teenage daughter, and neither of us thought much about the fact that our parents were intermittently living underwater or that we had to make daily scuba dives to 60 feet of sea water to visit them. It all seemed quite normal to us. Now, 40 years later, as I read books such as Eyes in the Sea by Robert I. Wicklund, co-founder of the Hydrolab Undersea Research Program, I realize how incredibly challenging and even dangerous it was to run that operation. Mr. Clarke made it look so easy, however. In fact, if he needed to make a quick trip down to the lab, he would simply don a mask and make a breath-hold dive to 60 feet, popping up inside the habitat.

  By the 1980s, the great era of shallow underwater habitats for scientific diving had largely ended, although deep commercial saturation diving continued to expand. Young physicians like me, who were training in undersea and hyperbaric medicine for what we thought were “diving medicine” jobs, were only beginning to understand the value of hyperbaric oxygen therapy (HBOT) for wound healing. Mr. Clarke became a household name in hyperbaric medicine as the president of National Baromedical Services. In addition to directing one of the most respected annual, national hyperbaric medicine training courses, he began the Baromedical Research Foundation, which conducted the Hyperbaric Oxygen Radiation Tissue Injury Study (HORTIS), a prospective, multicenter, randomized clinical trial focused on HBOT for radionecrosis prevention and delayed radiation-injury treatment. Mr. Clarke also conceived of the certification program for hyperbaric technicians and continues to be active on the National Board of Diving & Hyperbaric Technology, which provides that certification. He also coordinates a national team of diving medicine consultants for the Diver’s Alert Network (DAN) that is activated when severely injured divers insured by DAN fail to respond to an initial series of recompression treatments. The team emergently reviews cases and makes recommendations to physician treating the diver regardless of where treatment is occurring.

  As the national coordinator for this DAN initiative, Mr. Clarke has had a front-row seat to observe the demise of 24/7 emergency hyperbaric services, which may be one of the greatest ironies in medical history — that emergency HBOT services have disappeared because of the growth of clinical hyperbaric medicine. I’ve experienced this phenomenon first hand. For 19 of the 23 years that I ran the HBOT program at one particular hospital, we offered 24/7 emergency HBOT. As hospitals within the system added HBOT departments that operated only during typical business hours of Monday through Friday, they also removed insured patients from the pool of potential hyperbaric patients while we continued to handle all emergencies.

  Eventually, emergency services began to collapse without a viable balance sheet to sustain it and the “call schedule” could not be fully covered. Ironically, on the first weekend in 19 years that HBOT emergency call coverage was unavailable at the medical center, two firefighters experienced carbon monoxide poisoning.

  This issue of Today’s Wound Clinic addresses the current state of affairs for HBOT, including an article by Mr. Clarke on the topic of emergency services. It is hard to believe that 40 years have passed since I was a young surface support diver on Hydrolab II. About 20 years later, on a visit to the Smithsonian museum, I stumbled upon the Hydrolab, which was cut in half like a doll’s house as part of an exhibit paying homage to the bygone days of underwater habitats. Unless we work together, we could soon be looking back nostalgically to the bygone era of hyperbaric medicine.

For author info and disclosures, see page 4.