Although National Fire Protection Association (NFPA) code 18.104.22.168 explains the role of hyperbaric safety directors and their responsibilities, an individual's job description may vary from one facility to the next. As the safety director for Swedish Edmonds Center for Wound Healing and Hyperbarics in Edmonds, Washington, I have a great deal of responsibility. I take pride that the hospital I work for is committed to supporting me in my role to ensure the safety of both the patients and staff during day-to-day hyperbaric operations. As the safety director, I am responsible for providing training to all staff in our facility, as it pertains to hyperbaric operations, monthly staff emergency training, or just hyperbaric orientation for all new employees hired in our facility.
It’s absolutely crucial to provide hyperbaric therapy department orientation to every new employee from the secretary to the wound-care provider. This orientation time is what I call “basic training.” Everyone receives one-hour orientation/education pertaining to the operation and safety guidelines of the hyperbaric department. In the event an emergency evacuation is needed and the certified hyperbaric technologist (CHT) needs assistance, everyone receives both basic chamber door operation and gurney operation training and is signed off after orientation time.
Staff training never ends. All staff in our facility participates in monthly hyperbaric emergency procedure training on one of the following topics:
- Otic barotrauma
- Sinus barotrauma
- Hypoglycemia/hyperglycemia patient
- Unresponsive patient oxygen toxicity/seizure
- Gas embolism
- Loss of oxygen pressure/contaminated air
- Power loss
- Severe weather
- Fire in the chamber room
- Fire in the building
- Fire in the chamber
These emergencies and the emergency-response procedures are in plain sight, laminated, and attached to the railings of each chamber.
Every month, I select an emergency topic, and the staff is taught the appropriate emergency response for the specified emergency according to the clinic’s hyperbaric emergency procedures policies.
Example: Unresponsive patient
CHT immediate actions:
- Note time and depth.
- Notify MD.
- Abort treatment.
- Start ascent to surface @ 5 psi/min.
- Check vital signs.
- Start basic lifesaving (BLS ) protocols as appropriate.
- Check blood glucose.
- Call for assistance as appropriate.
All staff members are in-serviced on three critical components:
- Type of emergency
- The CHT appropriate response
- The appropriate response of all first responders to the chamber room
Constant and adequate communication between the CHT and wound-care staff is a must at all times. Every shift, I communicate my needs for staff assistance for patient change-outs/ prepping to the charge nurse in wound care so she can coordinate with the backup CHT who works in wound care primarily through the day. I then provide a hand radio to the charge nurse, hyperbaric nurse, and backup CHT so I can maintain constant direct communication with everyone in the event that I may need them for any reason, especially an emergency.
Another responsibility of mine as a safety director is to educate the medical community on both the benefits and risks of hyperbaric therapy. Occasionally I have the opportunity to present to medical providers and other medical professionals. I enjoy this because this enables me to be part of the hospital outreach program, educating the medical community on the evidence-based science and benefits hyperbaric therapy and the conditions we treat in our facility.
Without a doubt, a hyperbaric program with a good safety program in place is also a successful one. The more we educate the staff, the better the outcome in the event of an emergency. One important message for other wound care and hyperbaric facilities is to offer every clinical and nonclinical staff member a UHMS-approved forty-hour introductory to hyperbaric medicine course. I have found that this not only improves hyperbaric safety awareness among staff but also greatly improves staff knowledge in the science and benefits of hyperbaric therapy.
Final note: When it comes to hyperbaric safety, establishing a “basic training” process for the entire staff in your facility will not only better prepare the staff for an emergency but also will improve the day-to-day operation of the hyperbaric program. The entire wound-care staff is more inclined to be vigilant in coordinating care with the CHT as they will have a better sense of time constraints in the hyperbaric environment.