Best Publishing Company Announces Publication of 2nd Edition of Hyperbaric Facility Safety: A Practical Approach in 2019

  • Best Publishing Company
  • Volume 09 - Issue 4

The first edition of Hyperbaric Facility Safety: A Practical Approach is an integral part of numerous hyperbaric facilities’ reference libraries, serving as the go-to standard for a hyperbaric safety program. W.T. “Tom” Workman’s experience with the U.S. Air Force’s hyperbaric medicine program and development of innovative pressure vessel systems, coupled with his implementation and administration of the Undersea and Hyperbaric Medical Society’s Hyperbaric Facility Accreditation Program, have given him a breadth of knowledge unmatched in the hyperbaric technical community.

With his retirement from the UHMS, Tom has undertaken the challenge of updating this classic text. Assisting Tom as co-editor is Steve Wood. Over 30 years ago, Steve transitioned from critical care respiratory therapist to hyperbaric technologist. His varied career has taken him from patient caregiver to chamber manufacturer, consultant, and contract service provider.

Tom and Steve have been working with an international team of contributors to produce a completely revised and updated second edition of Hyperbaric Facility Safety. The editors have endeavored to bring a balance between those readers who need to “get the job done” and those who have a keen interest in the underlying regulatory framework. Given the international growth of the hyperbaric field, the editors have reached out across the globe to assemble a summary of the international regulatory aspects of the field.

This new edition will be structured into two sections:

  1. A nuts-and-bolts approach to hyperbaric safety program development and how the safety program integrates all aspects of a hyperbaric facility
  2. A section devoted to explanations of the various regulatory agencies that may influence the field of hyperbaric medicine

The second edition will be published by Best Publishing Company in the summer of 2019.

CLINIC IN FOCUS: Milpark Hyperbaric Foundation

  • Deane Nesbitt Jr.
  • Volume 09 - Issue 4

This summer I sponsored a campaign to raise funds for the Milpark Hyperbaric Foundation. Some might wonder why a Canadian musician would be interested in doing this for a facility in Johannesburg, some 13,000 km away.

I had hyperbaric oxygen therapy myself because of internal radiation burns following treatment for prostate cancer. As I live in Toronto, after extensive research I chose to have my treatment at the Judy Dan Research and Treatment Centre. It’s an achievement for any organization to be able to combine professionalism with friendly empathy, and the Judy Dan Centre does that superbly.

One of the professionals at the Judy Dan Centre is Daniel Gericke, who, fortunately for me, has become a good friend. Among his many qualities is modesty about his achievements, and so it took me over three years before I discovered that he was instrumental in bringing about the creation of the much-needed Milpark Hyperbaric Facility. The facility provides treatment to patients whether or not they can afford to pay for it.

Because of Johannesburg’s need for hyperbaric facilities, because of Daniel’s involvement, and because of the success I had had with HBOT in healing internal radiation burns, it was a nobrainer for me to join those who are raising funds for Milpark.

Apart from donating funds, posting write-ups about Milpark, and soliciting donations, I can contribute my music. As a musician, composer, and film score writer, I can donate DVDs of short films with my music as a “thank you” to other donors to Milpark. One such film that would be a natural because of its association with Africa is Change for Chimps, featuring Jane Goodall. It tells the story of a young girl who discovers how chimpanzees have been mistreated (hardly a strong enough word) and vows to do something about it, eventually making a presentation to her hero, Jane Goodall.

Along the way, all of us have been helped by those we can never repay. In such cases, I have always liked the idea that “passing it on,” helping out someone else that needs help, is a way of saying thank you. Supporting Milpark Hyperbaric is a way of doing that for me.

As the young girl, Kendra, states in Change for Chimps, “Dr. Jane Goodall says that you don’t have to change the whole world. You only have to change one little piece of it, and if I make a difference here and you make a difference there, all our pieces will come together and our world will be a better place.”

About the Author

DEANE NESBITT JR. is a Canadian composer, recording artist, and film score writer. He has composed the soundtracks for two recent short films, Change for Chimps, featuring Jane Goodall, which has won awards both in Baltimore and Toronto, and Legacy of War, featuring veterans of World War II, which was screened last November 11 at the Canadian War Museum.
Deane’s music has been aired over 300 radio stations across the US and Canada. One American reviewer ranked his most recent CD in the best 100 music CDs of 2015 and the Best Dramatic Music of the year. His music has been performed in Toronto at several locations, including Massey Hall and the Canadian National Exhibition.
Deane started his career as a lawyer, practicing commercial law for 16 years. While still practicing law, he performed in Europe, where he met and played piano for Hollywood legend, Greta Garbo. He then became involved with the investment business, co-founded an investment management firm, and wrote an award-winning illustrated history of a Canadian investment bank founded in 1912.
Deane has served as a director on over a dozen boards. He presently is on an advisory board for Johns Hopkins medicine, Baltimore, and on the board of the Sharon Francis Institute for Regenerative Medicine, Toronto. He holds degrees in arts and law from McGill University and a certificate from the Owner-President Management Program, Harvard Business School. A family man, Deane’s other interests have included hiking, kayaking, landscape painting, photography, and flying. His website is .

Our Aquatic Affair: Remembering our original language with life through breath and water

  • Dove Joans
  • Volume 09 - Issue 4

Dove Joans is a creative conservationist who has been researching this evolutionary subject since 1977 through the sciences, arts, empirical evidence, and education, with a focus on protecting wildlife, oceans, and cultural heritages. The opinions expressed in this article are strictly hers based on her ongoing research.

What do we do when one is lost, overwhelmed, and feeling alone in our challenges or grieving over the loss of a loved one? Start with what we have . . . our breath.

We begin our lives with a breath and we end our lives with an exhalation, yet in between an inhale and an exhale lies trillions of possibilities.

How is that?

We acknowledge that in our bodies, we breathe . . . 70 trillion cells with life. Then, there’s 10 molecules of water surrounding each cell of energy. That’s 700 trillion molecules of “water cells” communicating with each other, every second of every day.

Possibilities. Hope. Connection.

So, how may we live with this precious gift we’ve been given? Breath. To share, to hold, to give, and to behold as the beautiful key to our existence. A mystery to unfold, just like Nature.

The science behind Nature (with the big “N”) is designed into our very nature down into our DNA. To emphasize this story of communications, Nature has the first and last word of the day, in a sunrise and in a sunset . . . two phenomena we humans love to watch and experience as an important memory, which we in turn store in our cell memories, secured by H20.

“Our nature in Nature” is a cellular and mathematical design we can find in 99% of all life forms for two reasons: connectivity and regeneration. Maybe this sounds familiar to you.



The science of breath is for sharing. The 99% factor and the 7% equation can assist in supporting this concept. The 99% factor is the universal respiratory exchange we each share with 99% of all living forms through our DNA. Our respiratory system is an active part of the respiratory exchange: “breathing air, absorbing oxygen into the bloodstream, and breathing out carbon dioxide.” Plants do it, animals do it, we do it.

This type of sharing is discussed in an article, “Genetics, DNA, plants and humans.” (

The 7% equation is our connectivity to life on a tangible and daily level.

I watched a great TEDx talk ( from astrophysicist and GoogleX co-founder, Tom Chi, who speaks on “Everything is Connected.” He reminds us that every day we are breathing out 7% of our cells (DNA), which is becoming part of our planet’s circulatory system. Then, we are also breathing in 7% new cells molecules. The cell molecules we breathe out travel across our globe via “airstreams,” making new life (DNA structure) for a plant, animal, or another human being.

It is exciting that all life on Earth, through cells, are transmitting, receiving, exchanging, transforming, and storing matter, energy, and information.




What do we find ourselves doing in anger and fear? Most likely, “holding our breath.” This type of breath holding is something we typically do unconsciously in moments of tension, worry, and frustration. Essentially, it is the opposite of letting go, the natural exhale, thus cutting off the air supply to our cells, which doesn’t allow proper cellular function like thinking clearly or processing information.

Holding our breath in stressful circumstances often goes unnoticed, yet ultimately affects all of the functions of our body and mind. Learning new types of relaxed breathing can determine what brain waves we are triggering and the DNA coding we’re able to access.

Try engaging in some type of exercise for 20 minutes or more each day, such as walking, swimming, stretching, bicycling, dancing, or a sport you enjoy. Choose an activity in which you reconnect with your breath, so “relaxed” signals can be sent to your sensory systems, which naturally gets recorded into our memories.

To learn more from a yoga perspective, please click on this link: Are You Holding Your Breath? Here’s How (and Why) to Stop Pausing



Breath is given to us how? By the courtesy of the ocean (and the heartforward dynamics of Nature itself, with examples of those mathematical equations found in a wave, the palm of our hand, a leaf, or in a seashell). We exist, live, and thrive because of the water element of our planet, mainly, the ocean! The ocean is in every breath we give and take.

So while we’re busy going about our day on a farm in Ohio, in a skyscraper in Manhattan, or in a recording studio in Nashville, we’re able to do that only from the gift of the sea. If that seems far-fetched or impossible, we are daily reminded of the essential aquatic connection and dependence though our blood, sweat, and tears.

  • Our Blood—moves like an ocean wave, in a vortex motion, the “spiral of life.”
  • Our Sweat—controls and balances our bodies’ temperature and is made up of mostly water with small traces of dissolved solutes.
  • Our Tears—have about the same osmolality as blood plasma, with half the salinity of the ocean.

Still, we share saltwater tears with other nonhumans like dolphins, whales, elephants, horses, dogs, pigs, and chimpanzees. For those who have experienced nonhuman experiences or have animal companions, you might have noticed and felt their array of deep feelings, with the powerful reactions that often accompany grief like crying, just like we do.

Sweat and tears systems have evolved in humans as an aquatic feature, as an excretory system for salt. Yet, have we forgotten these essential water connections? What might be the key in bringing us back to remembering?




Imagine our lives no longer being about control, but about consciousness. This concept may sound confusing, yet I’m referring to the continual trying to control the outcomes, especially how Nature is divinely working. We are unlocking many mysteries in life when we work alongside this powerful and creative force, for example, when we learn helicopter maneuvers from a dragonfly’s life or when we study spiders and silk worms to determine the strength in fibers.

We would let out a big sigh of relief knowing our breath is working together with Nature, ourselves, and one another, exhaling out the tension, realizing that trying to control is a struggle against our very nature and connection with life.

Breath + water has been given to us for the remembering. Water is giving us breath, and both are giving us our ability for connectivity with all of life. Empirical evidence from 40 years of research in the cognitive sciences of animal communications, especially dolphins, has shown me this.

In the second part of this series, “Our Aquatic Affair: Dolphin in the Womb,” we’ll be exploring the connections humans have with cetaceans from the womb to the moon, touching upon telecommunications, as well as quantum physics.


About the Author

DOVE JOANS, aka DOLPHINGIRL, is a creative conservationist, author, speaker, and explorer with The Explorers Club in the cognitive sciences of dolphin communications since 1977.

Dry Run

  • Darren Mazza, CHT
  • Volume 09 - Issue 4

During the initial hyperbaric history and physical (H&P), the provider will prescreen each patient for contraindications as well as relative contraindications. Confinement anxiety or claustrophobia is fairly common. An estimated 10% of monoplace patients experience confinement anxiety. I, for one, am severely claustrophobic!

A patient once asked the provider and me to demonstrate the process of sliding into the chamber because the patient was very anxious about going into the chamber. I will never forget that moment when I suddenly got the gut feeling of dread, my palms started to sweat, and I tried to maintain my composure. Everything I had ever said to comfort a patient suddenly left me. I was now on the other side of the comfort zone!

I had to dig deep inside myself to find the strength I needed to do this, without displaying my fears to the potential patient. As I laid down on the gurney, my heart started racing and I kept telling myself, “I’m OK, I’m OK,” but then the tech closed the door. I wanted to scream, but I stayed focused on what I was trying to demonstrate for the patient. I made it through the agonizing 2-3 minutes laying there, but it was one of the hardest things that I had ever done. This gave me a clearer insight to what some hyperbaric patients experience.

Having gone through the process made me take a much closer look at what can be done upfront for a new hyperbaric patient who is claustrophobic. Although the provider can offer medication to the patient prior to their first hyperbaric treatment, I have found a somewhat successful method of resolution for the patient’s anxiety. Every new hyperbaric patient gets scheduled for a “dry run “before the first hyperbaric treatment. Providing a dry run for the patient accomplishes several things.

First, having patients sit on the gurney outside the chamber gives them time to emotionally prepare themselves without being under any time constraints. Second, this opportunity makes the patient feel in control and know the CHT will be with him or her the entire time. Gaining the patient’s trust is the goal. The third critical part of this dry run is for the CHT to slide the patient into the chamber. I always inform the patient what I’m going to do next, step by step. I have found the most important thing I say to the patient is, “I’m going to slide you into the chamber but will not close the door until both the intercom is turned on and you tell me you are ready!”

Once inside, I talk with the patient, informing him or her of the next step, such as placing the intercom phone back down or turning the TV volume on. This provides the patient with a similar experience as to what it will be like when hyperbaric therapy begins. I then tell the patient to lie there for a few minutes while I continue sitting next to him or her. This will allow the patient to have a clear and realistic understanding of what will be encountered on a daily basis.

Take home message: Take the time and schedule a dry run for your next potential patient. This may help eliminate his or her fears and the uncertainty he or she may have regarding a monoplace hyperbaric environment. It has been my experience that this will decrease the patient’s confinement anxiety.

About the Author

DARREN MAZZA has been the CHT and safety director at the Center for Wound Healing and Hyperbarics at Swedish Edmonds in Washington since 2008. He began his health-care career working as both an EMT and an emergency room preceptor in Sacramento, California. In 2005, he moved his family to Idaho, where he was department head of the hospital’s outpatient wound-care and hyperbaric center. With more than 28 years in health care, he has been able to apply his past to his current role in the hyperbaric industry, making him a more responsible CHT and safety director.

UHMS Announces a Cost-Effectiveness Study of HBO2 for Radiation-Induced Cystitis and Proctitis

  • Renée Duncan, UHMS Communications Coordinator
  • Volume 09 - Issue 4

In July 2018, a working group with members from two committees of the Undersea and Hyperbaric Medical Society (UHMS) initiated a cooperative study with Dobson DaVanzo & Associates, LLC, to carry out an investigation of the cost effectiveness of HBO2 when applied as a treatment for radiation-induced cystitis and proctitis.

“Dobson and DaVanzo (D&D) is a health economics and policy consulting firm based in Vienna, Virginia, with an impressive track record in providing consulting services to groups conducting medical research, especially when the intent is to access and analyze large databases,” noted Dr. John Feldmeier, co-chair of the UHMS Research Committee. “These consultants have already purchased access to CMS records from 2012 to 2017, which we will employ in accomplishing the study,” he added. The study is being funded through an unrestricted grant from Healogics, Inc.

Who & What

The UHMS working group is composed of Drs. John Feldmeier and John Kirby, co-chairs of the UHMS Research Committee, and Drs. Helen Gelly, Marc Robins and Caroline Fife of the Quality, Utilization, Authorization and Reimbursement Committee.

“It was our QUARC colleagues who brought forward the concept of employing CMS data to complete a cost-effectiveness review of hyperbaric oxygen treatments for late tissue damage from radiation,” said Feldmeier.

The initial thrust was to investigate mandibular radiation necrosis treatment and prevention. Ultimately, however, the working group concurred that radiation injuries to the bladder and rectum would be the best objects of this study design.

Access to Data

The rationale for this choice includes the fact that many patients with mandibular osteoradionecrosis have an oral surgeon as the managing clinician. “We were concerned that many of the charges would not be accessible in the CMS database because if care was provided by a dental specialist, some costs may not be submitted to Medicare,” noted Feldmeier. Charges could be submitted to dental insurance providers or be cash billings.

“Also, we felt that we would have more success in stratifying and matching patients according to the severity of their radiation injuries for bladder and rectum by identifying procedural and surgical interventions commonly applied to these injuries,” said Feldmeier. One of the obvious restrictions of using CMS billing data is that the corresponding medical records are not available because of HIPAA restrictions.

Refining the Process

This working group, along with consultants from D&D, have met on a regular basis since July 2018. The biggest challenge they have reported has been to develop surrogate measures of severity for patients in both the hyperbaric-treated group and non-hyperbaric group to ensure that both cohorts of patients comprised patients with comparable severity. The dilemma, Feldmeier notes, is how to match these comparative groups without access to the clinical records. However, by stratifying both groups using billing codes that indicate interventions consistent with severe radiation injury, the team can more readily identify those patients who are intended to be the object of the study.

Both radiation-induced cystitis or proctitis vary significantly in the severity of involvement. A single episode of blood in the stool or urine after radiation therapy might be coded as radiation proctitis or cystitis but would likely progress to complete resolution spontaneously or with minimal intervention. The team’s intent is to compare two groups of patients who have a substantial injury that is likely to progress without effective therapy. The approach will be to restrict the study to patients who require interventions such as frequent transfusion or a surgical corrective procedure indicative of the severity of their injury.

Final Steps

The team’s expectation is that this study will be presented at next year’s annual meeting in Puerto Rico, with publication in a peer-reviewed journal shortly thereafter.

“Those of us who have treated radiation injuries with hyperbaric oxygen have seen consistent dramatic clinical response,” said Feldmeier. “If we can make the case that hyperbaric oxygen is not only an effective clinical intervention but also effective in reducing the cost of managing these difficult disorders, we believe that CMS and other third-party payors will take note of the cost savings and readily approve hyperbaric oxygen as appropriate for patients suffering from serious manifestations of radiation-induced rectal or bladder damage.”

— Based on an original UHMS article in by Dr. John Feldmeier at:

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