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Hyperbaric Facility Safety Creating the Contingency Plan

Analysis of hazards and risk assessment allows us to understand the true nature of the potential incident we are attempting to manage. This is an important first step in designing a contingency plan. There are several other important considerations that affect the design of the plan. Realizing the potential damage or injury helps us to identify appropriate staff responses. These responses should minimize the impact of the incident. It is important to consider what personnel are available to help (e.g., additional staff members, code team, and emergency responders) and how these individuals are capable of participating in the plan. Designing contingency plans with available personnel in mind drives minimum facility staffing decisions. It is also important to consider what equipment is available (e.g., personal protection, patient transportation, fire-fighting, and crash cart). All the considerations discussed above are likely to vary among different hyperbaric facilities.

Analysis of hyperbaric facility risks is a difficult process. It begins with identifying the hazards in a hyperbaric facility. These hazards could be from a variety of sources: equipment related (e.g. loss of power, loss of gas supply, control system malfunction); operational (e.g. untrained or unprepared staff); medical (e.g. pressure injuries, medical complica- tions); and environmental (e.g. contaminants, external disaster). The actual risks associated with a hazard depend on the probability, frequency, and severity of the potential losses.

Hyperbaric emergency procedures usually address a variety of problems ranging from mechanical malfunction to medical complications—important events that do not seem to share a common trait but cover a wide range of situations. Such a variable group of events must be discussed in a broad context. This chapter will discuss emergency pro- cedures within the framework of the entire hyperbaric safety program. In this broader context, events that may or may not be emergencies belong together. That is why this dis- cussion will replace the term “emergency procedure” with the term “contingency plan.”

In general, fire prevention is described in terms of the Fire Triangle model. For a fire to occur, a fuel, an oxidizer, and an ignition source must be present. Fire prevention in a hyperbaric chamber must account for an increase in the oxygen component of the atmosphere in terms of both oxygen fraction and partial pressure. The resultant increase in oxygen renders what might be inactive fuels and ignition sources in a “normal” air environment active, which increases the risk of a fire.

Safety in a hyperbaric chamber begins with design and specifications that are incorporated in construction codes such as the ASME Boiler and Pressure Vessel Code. ASME and related codes establish minimum standards for materials utilized in the construction of a chamber and how those materials are fabricated.^₂ Subcodes address specific requirements for pressure vessels intended for human occupancy and the viewports utilized in the chamber.³ ASME codes focus on maintenance of the structural integrity of the chamber during routine operations as well as providing safety components such as pressure relief valves to reduce the potential for catastrophic failure of the chamber in the event of overpressure resulting from fire or other mishap. A chamber will undergo inspection, testing, and be stamped to indicate that it has been manufactured in compliance with the applicable pressure vessel code. In many locales, only stamped pressure vessels are allowed to be utilized.

For some accidents there is a clear “smoking gun.” However, most accidents are caused by a combination of factors, each of which contributes in some manner. Often these factors accumulate over some period of time preceding the accident. This chapter addresses the factors that foster conditions under which accidents are more likely to happen and discusses some of the steps to be taken to avoid them. Also included is a case history illustrating several of the factors.

Learn Hyperbaric Facility Safety

There are two distinct aspects to the field of hyperbaric medicine that influence safety: 

We receive a number of phone calls each week from folks inquiring how to become a Certified Hyperbaric Technologist (CHT).  The added qualification of CHT is administrated by the National Board of Diving and Hyperbaric Medical Technology (NBDHMT).

When treating patients with hyperbaric therapy in the monoplace chamber using 100% oxygen, the supervising hyperbaric physician may order air breaks to be provided to the patient at certain intervals during the treatment.

This article will provide you with some background on liquid oxygen, which is the most common form of bulk storage for this gas. The manufacture, storage, basic design of a liquid oxygen converter, and general safety practices will be covered. Again, keep in mind that working around oxygen has its hazards, but working around a liquid oxygen system can be outright deadly if you have not been properly trained.

We are often asked the question, "Does participation in a safety director course automatically designate me as a hyperbaric safety director?" There seems to be some midunderstanding around this issue.

The development of a comprehensive maintenance program for a hyperbaric system and its supporting equipment is essential for a safe and cost-effective operation. The chamber and its operational systems, the chamber room, and the equipment used in and around the chamber should be maintained at the highest operational level. This should also include the cleanliness of all elements of the interior and exterior systems.