Posted by: RRW | September 21, 2013

HBOT did not help Vets with TBI – VA study

20130921-102744.jpg

Scientists found no significant benefit to a popular idea of using a pressurized chamber to force oxygen into the brain to heal mild brain injuries suffered by tens of thousands of Iraq and Afghanistan combat veterans, according to a scientific study by the Pentagon and Department of Veterans Affairs published this week.

USA Today article here.

DALLAS (AP) — Two North Texas businessmen have pleaded guilty to committing health care fraud by making false claims about hyperbaric oxygen therapy.

Stanley Thaw of Frisco and Michael Kincaid of Plano appeared in federal court Tuesday to enter their pleas. They operated oxygen therapy companies in Plano, Houston, San Antonio and elsewhere.

Prosecutors say that from 2008 to 2011 the two conspired to defraud Medicare by making fraudulent claims about the treatment. Hyperbaric oxygen therapy requires that a patient be placed in a chamber to receive increased levels of oxygen, meant to boost the healing process.

The 71-year-old Thaw and the 56-year-old Kincaid admitted to billing multiple times for an attending physician who was not present for therapy.

They’re scheduled to be sentenced Nov. 13 and face up to five years in prison.

Heres the story: http://m.therepublic.com/view/story/e904657aa8eb4647aec95c0ed51c9e04/TX–Health-Fraud-Hyperbaric-Therapy

Posted by: RRW | May 2, 2013

Stroke Reversible with HBOT (Reuters)

Decades-old stroke damage reversible with oxygen therapy, say researchers.

May 2 – Up to 20 years after suffering a stroke, patients in Israel are reporting remarkable improvements in brain function with calibrated oxygen treatments inside hyperbaric chambers. While treating stroke patients with hyperbaric oxygen is nothing new, the fact that it can be effective after so many years is an exciting new development according to specialists at Assaf Harofeh Medical Center. Jim Drury went to see the therapy demonstrated.

http://youtu.be/4wa5Sjm_Nyo

20130502-125021.jpg

20130429-231041.jpg

A jury in Canada is now tasked to ponder reasons how & why 2 children were both found with blood coming from their nostrils & both died at exactly the same time. Investigators seized a Vitaeris (bag chamber) at the mothers home.

More of the story here (NEWS VIDEO)

This is a story I found on: a site dedicated to protecting consumers against faulty bags.

The FDA published a report not long ago regarding a 1.3ATA bag explosion – I love the part where it states “Seller claims that this is a common occurrence with that particular model and compares it with (b)(6), a work in progress.” An explosion of a bag chamber is a “common occurrence” really?

To see the FDA report click here: FDA Report

Thanks to my new Twitter friend @RobertMDenver for exposing these bags and their weaknesses.

20130415-073535.jpg

Posted by: RRW | April 14, 2013

Israel Publishes Paper on Post Stroke & HBOT

Researchers at Tel Aviv University in Israel used hyperbaric oxygen therapy (HBOT) — a well-known method of treating decompression sickness, or “the bends,” in scuba divers — in 74 post-stroke patients whose conditions were no longer improving six months to three years following the stroke.

Article detailing the publication.

20130414-094915.jpg

Posted by: RRW | April 14, 2013

HBOTechBlog is now on Twitter!

Yes it’s time for us to get into social media when information travels faster than light. You can find us with the handle @HBOTechBlog make sure you follow us.

Posted by: RRW | April 11, 2013

Margolis article in Diabetes Care

20130411-105935.jpg

An article that is “best swept under the rug.”

Anti-HBO article by Margolis

20130411-105021.jpg

Great response! Please share this response with your HBO docs and referring physicians who have read the negative article.

The below letter is sent in response to the Margolis Paper (referenced below) on behalf of UHMS President, Dr. John Feldmeier as we have received many inquiries on this:

Dear Members,

The recent article by Margolis et al that reports the failure of hyperbaric oxygen in the treatment of diabetic foot ulcers has created major concerns by the hyperbaric community. This article is one of many published on this topic and other articles including several randomized controlled trials have previously shown a benefit for hyperbaric oxygen in achieving healing and preventing amputation.

I have read the Margolis article several times and believe that there are several serious criticisms that can be leveled at the article. First of all, it was not a randomized controlled study. Statistical techniques were applied to the results to compensate for the design not being randomized and controlled, but certainly still fall short of this standard. The study failed to use transcutaneous O2 measurements in the selection process of patients. Many have previously shown the importance of baselineTCPO2 measurements and response to an oxygen challenge for selecting patients appropriate for HBO2 intervention. The authors state that patients were determined to not be ischemic by their treating physicians. No methodology is described and certainly no consistent studies were applied. Certainly, ankle-brachial indices would be appropriate in most patients and even angiographic studies in some. A careful read also shows that one half of the patients received fewer than 29 treatments. Finally, the groups were mismatched in terms of their Wagners scores with the hyperbaric group including 45.7% and the non-HBO group containing only 18.4% of wounds with Wagners grade of 3 or more,

It is important that readers of the hyperbaric literature are equally critical in reading both negative and positive reports. It is also important that clinicians in hyperbaric oxygen carefully select patients likely to respond to treatment by applying selection criteria that have been shown to predict for a successful course of treatment.

A positive study for HBO2 in diabetic foot ulcers consisting of a systematic review was just published in the Mayo Clinic Proceedings. The authors conclude that “quality of life could be improved in selected patients with HBO.” This study consisted of a meta-analysis of 624 patients.

Our Authorization, Utilization, Quality and Reimbursement Committee is preparing a comprehensive review to be posted on the website readily available to our members. Dr. Enoch Huang will be presenting a review of this topic for the UHMS annual scientific meeting in June in Orlando.

Finally, I urge all our member experts to forward letters to the editor of Diabetes Care pointing out these deficiencies and any others detected after a careful and critical review of the paper.

John J. Feldmeier, D.O. FACRO, FUHM

President

Undersea and Hyperbaric Medical Society

References:

1. Margolis D, Gupta J, Hoffstad O, Papdopoulus M, Glick H, Thom S, and Mitra N. Lack of effectiveness of hyperbaric oxygen for the treatment of diabetic foot ulcer and the prevention of amputation. Diabetes Care published online February 19,2013.

2. Liu R, Li L, Yang M, Boden, Yang G. Systematic review of the effectiveness of hyperbaric oxygen in the management of chronic diabetic foot ulcers. Mayo Clin Proc.2013;88(2):167-175

OKLAHOMA CITY – A Senate panel passed a bill Wednesday to set up a pilot program to treat veterans and service members with brain injuries and post-traumatic stress disorder in hyperbaric chambers.

The Senate passed House Bill 1942 by a vote of 17-3. The measure moves to the Senate floor.

Sen. Frank Simpson, R-Ardmore, the measure’s Senate sponsor, said the FDA is studying hyperbaric chambers as a treatment option.

Sen. Rob Standridge, R-Norman, said that because there is no conclusive evidence that the treatment works, promoting it may give false hope to those who have a brain injury or PTSD.

Simpson replied that some studies have shown that the conditions of some patients have improved as a result. Hyperbaric chambers have been used successfully to treat diabetic wounds, he said.

Simpson said he hopes to secure $3 million to $5 million in state funds for the pilot program. The location for the proposed program has not been determined.

Sen. Dan Newberry, R-Tulsa, said he has serious concerns that state funds are being sought when the research results are not in.

Simpson said the issue can be emotional, adding that some service members returning from duty have a high rate of suicide, deal with disintegrating families, and self-medicate with alcohol or drugs.

If the treatment worked, he said, it would return some veterans to being productive members of society and pay for itself.

For the original article click here

For those of you that love reading, here is an article for you.  It doesn’t cover everything about HBOT, but what it does is it highlights the benefits of HBOT from its effects on inflammatory cells, tissue repair, all the way to cartilage & bone formation, and it has pictures too!  I hope you enjoy it – its worth the read.  I would use this article for marketing especially every time a physician challenges the effects of HBOT.

The Effects of Hyperbaric Oxygen Therapy on Bone Distant From Sites of Surgery

Fair question right?  Who has experienced 5 HBO cancellations out of 6 or 7 on the schedule in one day?  Did you feel like you did something wrong the day before?  Were you off your game?  Moody?  Did you bring your issues to work again when you were supposed to check them at the door?  Lots of questions to ponder right?  Well you should ponder them, patient compliance can also depend on how well you treat your patients on a daily basis – no matter how bad they treat you.  In a patients’ mind “they are sick” and you are well and they are there to be taken care of – not to be treated badly by you, especially since they have a choice of where to go and who to see.  This article will explore the possible link between patient satisfaction and hyperbaric compliance as well as how patient satisfaction affects everyone in healthcare.

PATIENT SATISFACTION: Medicine has done a 180 in just a very short timeframe and more and more healthcare workers and providers are wondering “What gives”? Patient Satisfaction for one is a huge variable in the future of healthcare as well as in the financial future of every hospital in the United States.  To put it simply; If your patient’s rate your hospital low on patient satisfaction, your hospital receives less money from Medicare, and in reverse – If your hospital ranks high in patient satisfaction, your hospital gets paid what it deserves to get paid (what was originally billed).  Crazy right?  What about those patients who are never happy?  Sometimes it seems that none of them are ever happy – short answer, they are not exempt from patient satisfaction.  The argument could be made that the same percentage of “Never happy patients” are the same across the board in other hospitals (governments argument – not mine).  Is it unfair?  Some do say it is and there are studies and articles written about how unfair it is – but let’s get real, patient satisfaction no matter how flawed & unfair everyone says it is, is here to stay.  This means we ALL have to change our ways, adjust our attitudes, or just leave the healthcare field altogether.

PATIENT SATISFACTION & YOU: Yes you in the wound care and/or hyperbaric department.  Patients that are dissatisfied that fill out a survey sent by a 3rd party (not your facility) can identify exactly who was rude, mean, did not explain the procedure well, registered them incorrectly, never looked them in the eye, never smiled, was grumpy etc in the patient satisfaction survey.  They can point the finger at you without you even knowing it.  Just like you filling out the survey at a restaurant when the food was bad and the service even worse – this is what is happening in healthcare.  In one instance it is really good because it holds each and every person in the facility “accountable” for their behaviors and actions or inactions, in another instance it is bad because the folks that usually fill out surveys tend to be the one’s that are dissatisfied with the level of service or care.  It seems that with the advent of patient satisfaction surveys the deck is stacked against you (the provider, the RN, the CHT) right?  Let’s not lose sleep over this just yet, believe it or not there are some simple solutions you can implement to “change the culture” from within your own department – even if there is just one of you.  Here are some:

  • You know that the deck is stacked against you to start because usually the dissatisfied patient is the one the fills out the patient satisfaction surveys.  SOLUTION: Encourage all of your patients to “Please fill out the patient satisfaction surveys”,  let them know that each of them has a voice to “Change” healthcare for the better to their benefit. Ensure that they know who the 3rd party is that sends them the survey so they do not think it’s a bill and just toss it aside.
  • Change your attitude towards patients.  Treat every one of them with respect and dignity, imagine them as a family member (grandfather, grandmother, or even your own parents) and see how you would rate yourself or how they would rate you if they were in fact related to you.
  • Act early & often.  This means that when a patient is dissatisfied right now, do not let them stew and get angrier by not resolving what is bothering them prior to them leaving your facility.  Get your director, program manager, or charge nurse and explain to them what happened so that the issue can be resolved right away – not a day later.
  • Use AIDET (Acknowledge, Introduce, Duration, Explanation, and Thank you).  Some facilities have their own versions of AIDET but the concept is pretty much similar. 
  1. Acknowledge is simple, say hello to the patient, make eye contact and smile (smiling does not cost you anything – but failure to do so may cost you your job).  Keeping your eyes on the screen and saying hello to the patient is rude and inappropriate, so is holding your pointer finger up to their face while you’re on the phone.  Drop everything and speak to the human being in front of you the way you would want to be addressed. 
  2. Introduce yourself, who you are, your position, how many years you have been doing what you have been doing and keep a smile on your face like you are glad to see them – even if you aren’t.  Your grumpiness shouldnt be their problem, it’s yours and you should have checked it at the door. 
  3. Duration speaks towards how long they should expect to be at your facility – especially for new patients.  Telling them 5 minutes every 15 minutes will just undo everything you have done so use “Disney” time (When they say 30 minutes they usually get to you in no more than 15 minutes – thereby raising their customers expectations of service). 
  4. Explanation; now comes the link towards compliance.  Explaining the procedure does a couple of things to the relationship between you and the patient, it builds trust and it builds confidence.  You build trust by being knowledgeable about what you are doing and saying to the patient and you build confidence in them that you actually know what you are doing and saying as well.  Why is this important you say?  Well if  a patient does not trust what you are saying  and thinks you are a bumbling idiot they more likely than not wont trust you to lock them in that chamber for two hours everyday, that is why the explanation of the procedure is everything.  You cannot rush the explanation nor should you try to use big words such as “neovascularization” without knowing how to define it to the patient in simple terms, in fact everything you say to all your HBO patients during the explanation of the procedure should be broken down into understandable & simple terms.  And at the end of the explanation you must allow the patient to ask you questions in order to verify their understanding of the procedure.  Often times the explanation is rushed and questions are never answered which can lead to a patient being clueless the minute they start the treatment thereby possibly resulting in them getting barotrauma or worse, calling you a liar because (according to them) you never told them certain things about the treatment. 
  5. Thank you.  Is it so much to ask for you to thank your patients for coming into their appointments?  At the end of the day if you do not have a patient to treat – you are just a liability (expense) not an asset to the organization and therefore thank your patients for keeping you busy and employed probably isn’t too much to ask.  So make sure you thank each and every one of your patients when you have a chance.

As much as the patient satisfaction surveys are stacked against most of us in healthcare, its main purpose to bring the “Care” back into healthcare.  If I got a dollar for every time I saw a healthcare provider / clinician be rude to a patient I would be Bill Gates.  Being held accountable is going to be a major part of the healthcare reform that is ongoing – this is a good thing.  In this day and age there is no room for rude staff members in healthcare any longer and this in the long run will make our patients happier and possibly even healthier.  As a side note on how serious hospitals are taking this patient satisfaction thing; I have sat in monthly leadership meetings for many years with the CEO of the hospital going down the list of directors seeking their “poor performers” & “bad attitude” staff members and discussing the “plan” for these staff members (many of them have been let go), even some contractors have lost their contracts – all based on bad attitudes and patient satisfaction survey results despite being a profit center for the hospital.  This is how serious these organizations are taking patient satisfaction.

In conclusion, I would say that “Yes” there is a possible link between patient satisfaction and patient compliance (at the very least it does help) but it is probably not the only thing that is keeping the patients coming in for their treatments or vice versa.  Surely there are other factors that affect patient compliance some of which I have not mentioned in this article such as personal & financial responsibility, socio-economic, etc.  With that said, the one sure thing to stay would be the patient satisfaction surveys and the ability of organizations to weed out bad behaviors within their organization to create better overall patient experiences thereby increasing patient satisfaction.

FOR MORE INFORMATION ON AIDET CLICK HERE

Posted by: RRW | February 11, 2013

Real HBO2 vs. Soft HBO – When will this end?

Image

Let me paint a picture for you.  A patient comes into a hospital based HBO unit with a re-attached finger (re-attachment was a week ago), the finger is black and the patient says hyperbaric oxygen therapy did not help the finger – in fact it made it worse and why am I here?  I ask the patient, what kind of hyperbaric chamber did you go into?  The response (although not shocking) was, a portable soft, blue and white chamber, we went to 1.3 atmospheres for many hours a day for a whole week and the finger is worse, it was pink after surgery and now its grayish black.  There were a couple of responses that came to mind (all of them were negative), but instead of adding to a patient’s anxiety level, I decided to focus on what we can do now – I got the doctor to do the HBO consult, got all the paperwork done, and immediately treated the patient twice a day for two days, over the weekend, and by today (8 treatments in) the finger was completely black and the physician had to give the patient a realistic assessment that the index finger is no longer salvageable and may have to be amputated.

QUESTION 1: Do you think this patients finger could have been saved if the patient went to a hospital based or a free standing non-soft chamber facility and got the appropriate HBO treatment?

QUESTION 2: Do you think the soft-chamber facility is liable for this patient losing their finger because they “assumed” they can actually treat a post surgical reattachment of a finger at 1.3 ATA in a soft chamber and actually expect a good outcome?

QUESTION 3: Do you think this soft chamber facility will get shut down by the District Attorney and the Feds? I will answer that one for you – YES, and in fact the owners may face jail time & a lifetime of fines to boot.

So why do these places continue to parade around as if they can actually treat such indications?  Don’t get me wrong, I am sure there are certain “none life & limb threatening” indications that these soft chambers are magically indicated for & there probably is a place for them…somewhere.

Do I sound bitter?  Yes I am bitter! This is not the first time I have seen this happen and it will not be the last.  This time it was different.  This time it was a little girl who will grow up without a right index finger for the rest of her life because “someone” thought that their soft chamber could do exactly what a hard chamber can do.  Was it for money?  Was it to say that their chamber can treat basically every indication a hard chamber can treat? Or was it medical malpractice?  I believe it was all of the above and that it was wrong.

The hyperbaric community needs to send a strong message to those soft chamber facilities in their communities that treating indications requiring at least 2 Atmospheres for 90 to 120 minutes on 100% oxygen inside of a soft chamber at 1.3 ATA on AIR IS WRONG! Otherwise more and more patients will fall victim to this type of tragedy. Here is a hint: Send these patients to an appropriate facility and save yourself a lawsuit!

The FDA is now aware of this situation and so is the local FBI office – so here is a WARNING to those with soft chambers that think they can get away with treating medicare approved indications in their chambers at 1.3 ATA, it is only a matter of time before you make this type of mistake and go down for it – do not risk short term income for a long term jail sentence, it isn’t worth the risk or the lawsuit!

Last QUESTION: How would you feel if this was your child?

Comments welcome & so is hate mail so bring it!

Posted by: RRW | June 13, 2012

HYPERBARIC TECH JOB OPENINGS

There are several job openings for CHT’s (Certified Hyperbaric Techs).   Paradigm Medical Management is looking for the following:

Location 1: Sharon, Pennsylvania (Hospital HBO Center) – FULL TIME HBO Technologist (Must be a CHT).

Location 2: Los Angeles (Next to Beverly Hills), California (Hospital HBO Center) – FULL TIME HBO Supervisor / Lead Tech (Must be a CHT).

Location 3: Los Alamitos, California (Hospital HBO Center) – FULL TIME HBO Technologist (Must be a CHT).

Location 4: San Francisco, California (Hospital HBO Center) – PER DIEM / PRN HBO Technologist (Must be a CHT).

Come join a great team of people who are Friendly, fun to work with, and where you’ll find a family oriented business sense with fantastic benefits, performance based bonuses / prizes, and YEARLY company learning trips (this year it’s Vegas). You will be surrounded with winning individuals driven to be the best without the corporate stuffiness

Please send your resume or shoot an email of interest in the position right away to: Denise Chouinard: mail to:dchoui@pmmhealthcare.com

Mr Lance Bark, DMT, CHT was arrested for manslaughter today

Dr. George Daviglus was charged with manslaughter today

LAUDERDALE-BY-THE-SEA, Fla. -

Broward Sheriff’s Office detectives have arrested one man and are waiting for a second to turn himself in three years after a deadly explosion at a Lauderdale-By-The-Sea hyperbaric treatment facility.

Lance Bark, 51, a medical technician, is under arrest on charges of manslaughter and aggravated manslaughter. George Daviglus, , 82, a doctor, is facing the same charges and is expected to turn himself in later this week.

It was May 1, 2009, when a fiery blast inside a hyperbaric chamber injured a 4-year-old Italian boy who was being treated for cerebral palsy and killed his 62-year-old grandmother, Vicenza Pesce. The boy, Francesco Martinisi, died several weeks after the incident.

The explosion made international news. An Italian television station had earlier aired a story showing Martinisi’s father climbing into a chamber with him, saying he hoped oxygen therapy would help his boy’s condition.

On Wednesday, police said negligence instead killed him.

BSO Detective Frank Ilarraza said an investigation showed that Martinisi was not properly grounded and that static electricity started the fire. He also said the machines were not properly maintained.

“The chamber was dusty inside, and that started a fire inside a chamber,” Ilarraza said.

Bark was supposed to be in charge of safety. BSO said he and Daviglus failed.

Posted by: RRW | February 17, 2012

Official Sheriff’s Hyperbaric Explosion Report

CASE CLOSED?????

Below is the official Marion County Sheriff’s Report of the incident.  Included in the report is the cause of death (blunt force and thermal injuries).  The manner of death was accidental explosion.

Interesting enough, a comment made in the official report by another “tech” at a similar facility nearby states “THAT THERE REALLY IS NO CERTIFICATION TO ENABLE SOMEONE TO RUN SUCH A CHAMBER” (Whoa!!!!, wrong!  The NBDHMT has a certification for that; CLICK HERE TO SEE IT).

The 2nd statement was:  BRENDA MCDUFFEE RUNS THE CHAMBER AT THIS FACILITY AND EXPLAINED THAT SHE HAD BEEN TRAINED IN TEXAS.   SHE STATED THAT THE TRAINING INVOLVED IS NOT SO MUCH AS TO HOW TO RUN THE CHAMBER, BUT MORE OF THE EFFECTS OF THE CHAMBER ON THE HORSES. WHEN QUESTIONED AS TO STANDARD PROTOCOLS REFERENCE THE CHAMBER, SHE TOLD WRITER THAT THERE ARE NONE; HOWEVER AT THE FACILITY WHERE SHE WORKS THEY HAVE INITIATED THEIR OWN PROTOCOL THAT LISTS MEASURES TO ENSURE THE SAFETY OF THE HORSE AS WELL AS THE OPERATOR.

There are no standard protocols? Hmmm. I know that there are some NFPA requirements for Class C chambers.  Time will tell I am sure.

UPDATE:  In a press interview McDuffee stated: “The hyperbaric community is relatively small, we’re all very well connected and everyone keeps up on all the safety protocols,” said McDuffee of The Sanctuary. “This is probably the most safety minded piece of equipment that anyone running these type of chambers does. The protocol books are huge.”  Here is that press interview.

MY QUESTION IS: Are there protocols or not????

MARION COUNTY SHERIFF’S OFFICIAL FULL REPORT ON HYPERBARIC EXPLOSION


The Marion County Sheriff’s Office investigation into an explosion last week that left one woman dead and another hospitalized was completed Thursday and concluded that the blast was an accident.

Read the article here:

Below is an excerpt from a highly skilled and FBI trained bomb technician & Instructor who has been investigating fires and explosions for 22 years.  Thank you very much RED DIVER1 for the quick response.

FROM RED DIVER 1 Depending on the volume and pressure of each gas present at the time of the explosion, it MAYBE possible that a spark could produce an ignition of the gases to sustain a rapid deflagration or explosion causing the chamber to rupture as the direct result of gas overpressure.

Several factors must be present to support this theory. First off, the Lower Explosive Limit or LEL must be known. Wikipedia defines the LEL as the lowest concentration (percentage) of a gas or a vapor in air capable of producing a flash of fire in presence of an ignition source (arc, flame, heat). At a concentration in air below the LEL there is not enough fuel to continue an explosion. Concentrations lower than the LEL are “too lean” to explode but may still deflagrate (burn or rapidly combust).

The Upper Explosive Limit or UEL is the highest concentration or percentage of a gas or a vapor in air capable of producing a open flash of fire in the presence of an ignition source. In this case the possibility of a spark resulting from a metal horse coming into contact with another metal surface inside the chamber, could be sufficient to cause a rapid deflagration. The resulting gas overpressure would cause the chamber to violently rupture causing heat, fragmentation and a blast pressure wave in the immediate area.

Oxygen enriched atmospheres lower the LEL and increase the UEL. An atmosphere devoid of an oxidizer is neither flammable or explosive regardless of the fuel gas concentration. Increasing the fraction of inert gases in an air mixture raises the LEL and decreases the UEL (keep in mind the fire triangle).

Methane gas has a LEL of 4.4% (at 138 degrees C) by volume, meaning 4.4% of the total volume of the air consists of methane. At 20 degrees C the LEL is 5.1 % by volume. If the atmosphere has less than 5.1% methane, an explosion cannot occur even if a source of ignition is present. When methane (CH4) concentration reaches 5.1% an explosion can occur if there is an ignition source. LEL concentrations vary greatly between combustible gases.

To prove this theory, the volume, temperatures and partial pressures of the affected gases would have to be known values to identify the upper and lower flammability/explosive limits.

In summation, it would be possible for a rapid deflagration or explosion to occur if the explosive limits are within range.

BY,

RED DIVER 1

Bomb Tech Extraordinaire

A comment from Steve Wood posted today on the blog states:

“The troubling part of this incident is that it was an explosion, and, at least based on press reports,there was not a fire that led to a structural failure (as in the 1996 Yamanachi Kosai fire in Japan).  Following a presentation on veterinary HBO at the UHMS meeting in Maui, a group of us were having a typical bar conversation, and during the discussion, we raised the potential risks of methane in veterinary chambers (the presenter had mentioned the use of HBO in treating GI-related issues in horses). Consider the explosive potential of a large methane release in an oxygen-pressurized (or air pressurized for that matter) chamber – the ignition energy is so low that even a very small static spark, much less than a steel-on-steel percussion spark, could trigger an explosive event.  Obviously, the jury is still out in this case, but I’d suspect that methane is a factor in this incident.”

Steve does bring up a great point with the Methane and LEL/UEL (Lower explosive levels and Upper explosive limits).  I spoke to a friend who happens to be an Arson and Explosives Investigator for the last 22 years in the L.A. County Sheriff’s Bomb Squad about this today and he agreed that even in normal non-hyperbaric conditions, the combination of 5 to 6% Methane, above 21% oxygen, a very small ignition source, and perfect conditions can cause an explosive event.  Now increase the amount of oxygen, seal it all up in a hyperbaric chamber, add double the amount of pressure and a huge spark and the result speaks for itself.  We are not saying this actually happened – but it is definitely a possibility and cannot be ruled out.

Here is some reference material on this subject: (If you are a safety director anywhere, this is great reference material to have around)

Avoiding Static Ignition Hazards in Chemical Operations

 

Investigation of Fire  & Explosion Accidents in the Chemical, Mining, and Fuel Industries (A manual, Kuchta)

 

Facts About Methane that are Important to Mine Safety

Gas Explosion Handbook (Combustion Properties of Fuel/Air mixtures)

As it stands, it may be quite some time before the details of what actually happened is released.

A couple of questions for the industry (Ron please post these questions on hyperbariclink.com as well if you do not mind)

1.  Does anyone remember exactly what happened in 2009?  The cause of the fire and death of two people?

2.  What caused the accident in 2009?  Where is the report from the investigating agency so that IDIOTS & WING-NUTS out there learn a little something before they make the same mistake again.

3.  Do animal chambers get some sort of FDA 510k pre-market notification?  The FDA regulates pet food, I could not find anything about HBO chambers for animals on their website.

4.  What are the manufacturing regulations for animal chambers?  PVHO stands for Pressure Vessel for HUMAN Occupancy, is there one for animals? PVAO? Catchy.

Looking forward to some great responses.

Posted by: RRW | February 14, 2012

Still No Oversight Of Hyperbaric Oxygen Chambers?

In a published article back in Oct 2011 (phillyburbs.com), the author pointed out some very interesting things regarding the lack of regulations that are governing hyperbaric facilities, especially those not in a hospital setting. It is great to see that Tom Workman is still pushing for UHMS accreditation of hyperbaric facilities in and out of hospital settings (albeit, it is still seen as cost prohibitive by some hospital and free-standing centers). I believe that this accreditation is important and should be supported 100%.

In a very short span of three years, the hyperbaric community has suffered several accidents that have resulted in deaths unlike ever seen before in the United States. It is becoming apparent that either complacency, lack of training, lack of safety procedures, and quite possibly lack of luck combined with the exponential increase in hyperbaric chamber usage in the US as well as a lax regulatory system is causing more and more unfortunate hyperbaric events. The most unfortunate part of it is that these were not plastic gammow bag chambers – these accidents were solid hyperbaric chambers.

I do not understand why people want to “Bury” this negative smear on the “oh so perfect hyperbaric safety record” that we have enjoyed up to 2009. Shhh, keep it quiet and no one will pay us any attention and we can just continue to be complacent. Well there you have it, we have swept that 2009 accident under the rug and therefore NOTHING has changed. Unless we talk about it and contribute to increase and enforce the safety standards we will have more of these unfortunate events. I am sure even the “Good ol boys club” will agree with what I just said.

Take a look at RICHARD BARRY, CHT for example. Richard has been working tirelessly for almost 5 years (maybe more) that I know of to get some answers regarding flammability & materials testing inside the chamber in order to come up with a “NO FAIL” list of items including wound care dressings and supplies to MAKE HYPERBARICS SAFER! The UHMS committee that Richard oversees is called the UHMS Material testing Advisory Committee (MTAC) started in 2010 but Richard and I have discussed this at a very early stage (circa 2007 or so). Do you want to know how much the committee has to raise? $50k, and that’s just to start the process.

Now let us talk about how much he currently has raised in all this time, according to the Nov/Dec 2011 UHMS publication, Pressure – Richard has raised $14K. Surely we are a lot closer to the 50k mark but we sure are waaaaay off. More so than that, let us do some math and count the number of HBO chamber manufacturers and management companies around, surely each one can pony up $1,500.00 each right? Why haven’t they? Let us count how many hospital programs there are out there (last estimates were 1,000 hospital HBOT programs in the US right?), that would mean that each hospital program has to pony up $36.00 each (or 1/3 of a Medicare segment for HBOT).

Wake-up hyperbaric people, it is time to do your part and participate in “OUR OWN SAFETY” as well as those that we treat. No more willy-nilly fly-by-night operations, no more short cuts. Get accredited, give back to your profession, do it right the first time, and support the UHMS MTAC by sending a check to:

Undersea & Hyperbaric Medical Society

Re: Material Testing MTAC

21 West Colony Place, Suite 200

Durham, NC 27705 USA

I wish there was an easier way such as sending the money via PayPal – Richard please let me know if this is possible.

Older Posts »

Categories

Follow

Get every new post delivered to your Inbox.

Join 264 other followers