The first edition of Hyperbaric Facility Safety: A Practical Guide is an integral part of virtually every hyperbaric facility’s reference library, serving as the go-to standard for a hyperbaric safety program.
After 20 years, the second edition will be available in early 2020! The editors W.T. “Tom” Workman and J. Steven “Steve” Wood have endeavored to establish a comprehensive balance between those hyperbaric providers who have a keen interest in the underlying design standards and regulatory framework and those who need to “get it done.”
The second edition is structured into two parts. Part 1 explains the various regulatory agencies that may influence the field of hyperbaric medicine (including international perspectives), while Part 2 emphasizes a nuts-and-bolts approach to hyperbaric safety program development and how the safety program integrates all aspects of a hyperbaric facility.
The editors, along with the 80 chapter authors and contributors bring experiences from clinical hyperbaric medicine, the U.S. Air Force and Navy, the UHMS Hyperbaric Facility Accreditation program, hyperbaric chamber engineering, manufacturing, and regulatory/standards development.
The fundamental premise of medicine embodied in the Hippocratic Oath, Primum non nocere (“First, to do no harm”) is, at its core, an admonition to provide medical care that is safe.
The field of hyperbaric medicine has undergone a sea change since the publication of the first edition of this text. The number of facilities worldwide has increased substantially, yet the field faces monumental challenges. Economic pressures from health care funding agencies have placed a glaring spotlight on the accepted clinical conditions as the gimlet eye of evidence-based medicine has further challenged years of case experience that formed the foundation of the clinical condition lists. In the United States, the growth of wound treatment, using hyperbaric oxygen as an adjunctive therapy, has further constricted the number of conditions treated, as most wound clinics are not structured to provide hyperbaric therapy for patients with serious or unstable conditions. But despite changes in the practice and application of hyperbaric oxygen therapy, the guiding tenant for providers of HBO2 must be to deliver therapy safely.
There are two distinct aspects to the field of hyperbaric medicine that influence safety: technology (hardware) and the operators of that technology (software). HBO is a technology-based therapy, supported by a long history of engineering and manufacturing refinement. The military and commercial diving roots of hyperbarics resulted in an initial pool of technologists who were trained to rigorous standards. Many of the pioneers in the field transitioned to the clinical and research sides of hyperbarics and brought a strong culture of operational safety.
Codes and standards related to the design, manufacturing, and installation of hyperbaric chambers are well-established and have broad distribution worldwide. Even in countries that don’t have a mandatory regulatory scheme, end users can easily access and reference construction standards that will provide a chamber that is constructed in accordance with a proven safety record. One challenge posed by the existing standards is that due to the inherent inertia of the code/standard-writing process, the introduction of new materials and technologies often outstrips the code/standard process, resulting in the potential for stifling of innovation or the introduction of new technologies that might not be fully proven. Even in countries with a strong regulatory climate, it is not uncommon to see chamber designs that pose substantial risks due to their design or construction in widespread use. The bottom line is a chamber built, installed, operated, and maintained in accordance to accepted standards is rarely a factor in accidents.
Human factors—acts of omission or commission—play a role in the majority of hyperbaric safety-related incidents. The demographic change in the background of the people who operate chambers poses a great risk to the field. The growth of the field since the early 1990s resulted in a thinning of the experienced talent pool and the rise of a new generation of hyperbaric technologists. The risk- and cost-averse nature of modern health care has further restricted the use of HBO2 predominately to medically-stable patients treated in an outpatient setting. The number of clinical facilities with the staff and equipment capability to manage seriously ill patients has dropped precipitously (at least in the United States), resulting in the need to transfer patients hundreds of miles to receive lifesaving treatment. Without a mandate to treat acute indications, facilities reduce technical staff, support equipment, and the specialized training necessary to provide high-level care is leading the hyperbaric field into a crisis of experience. The “old hands” (technologist and physician pioneers) in the field who set the bar for HBO2 and were the fearless innovators who pushed the envelope of HBO2 applications, are leaving the field due to retirement (or death). The challenge to the new generation of hyperbaric professionals is to preserve the institutional memory of the first generation and transmit it to the successors.
In developing the second edition of Hyperbaric Facility Safety: A Practical Guide, the editors have taken a more pragmatic approach to the organization of this edition, based on a conversation we had several years ago. We were discussing, with some vigor, an esoteric point within a subsection of NFPA code, when Tom commented on the small number of people in the industry who really cared about the minutia of regulatory code. That’s the reality. Though chamber operators might find it useful to know the background of why they do what they do, they are more interested in how to do the job—the nuts and bolts of safety. With that concept in mind, this edition is divided into two major focus areas.
First, we look at the codes and standards that influence our field. Depending upon your location in the world, as many as 15 or more agencies’ codes, standards, regulations, or laws may need to be conformed with in order for a facility to operate. Chapters cover the regulatory environment and take an in-depth look at the various systems that make up the modern hyperbaric chamber. We have also revamped information on the international aspects of the regulatory environment. Contributors from around the world completed a questionnaire that surveyed the practice of hyperbaric medicine in their respective countries. This data has been summarized in a table, with explanatory notes as required.
The second focus area takes a nuts-and-bolts approach to hyperbaric safety. Utilizing the expertise of key figures in the hyperbaric field, the reader will find a comprehensive compendium of resources that can be useful towards the development of a state-of-the-art hyperbaric safety program.
The editors express their sincere thanks to all of the contributors for their hard work and dedication to the production of this text. We hope that this edition will become a well-worn addition to your safety library.
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