SAFETY continued vide emergency treatment on a 24/7 basis. Today, however, few of these facilities offer emergency treatment 24/7, and some of those facilities do so only intermittently. Non-diving patients being treated for wound healing therapy dominate hyperbaric chamber usage. The Undersea and Hyperbaric Medical Society (UHMS) identifies hyperbaric facilities based upon the level of care that can be provided. For example, Level One facilities have a hyperbaric program that offers a full scope of services for the hyperbaric patient. They are typically hospital-based fa- cilities that cover all recognized indications, including 11
apy model is much more profitable than emergency hyper- baric treatment for pressure-related diving injuries. In the past, hospitals and other hyperbaric treatment facilities un- derwrote the additional costs associated with providing 24/7 access to emergency hyperbaric treatment as a public service for those who required it. Now, because of the negative eco- nomic impact, concerns for staffing and training considera- tions, and the potential for legal liability, most hyperbaric treatment facilities have ceased to provide 24/7 access to emergency hyperbaric treatment. For the recreational diving community, this is a critical safety issue. Recreational divers are regularly diving in locations where they believe emergency hyperbaric treat- ment will be available at nearby treatment facilities that have, in the past, been available to treat injured divers when they needed it most. Unfortunately, this may not be the case at all and, if injured, they may have to endure long delays in treatment as they must be transported to a distant treatment facility willing and able to provide the emergency care they need. From a diver safety perspective, there is an urgent need to correct this decreasing availability in the U.S. healthcare sys- tem and make emergency hyperbaric treatment available to those who require it. This may be especially true as divers are increasingly attracted to artificial reef shipwrecks in deeper water off the Gulf Coast of northern Florida. The UHMS has been working to address this situation within the U.S. healthcare system by alerting governmental organizations. In a letter to the editor of the Journal of Un- dersea and Hyperbaric Medicine on 22 August 2020, Doctors Frank Butler and Richard Moon described the decreasing availability of emergency access to hyperbaric oxygen ther- apy in many U.S. areas. This lack of treatment capability pres- ents significant challenges to providing optimal care for divers who suffer decompression sickness or arterial gas em- bolism. Options for addressing this critical issue include: 1) Direct federal or state grants to hyperbaric treatment fa- cilities that offer emergency hyperbaric treatment.
emergency life- or limb-threatening injuries, and are available for treat- ment of the emergent patient 24/7. Level Two facilities have a hyperbaric program that provides a reduced scope of service for the hyperbaric patient (does not treat emergency pa- tients). They are typically in hospital settings and not available 24/7. These programs provide high quality care to outpatients Monday through Friday and are not equipped or staffed for emergency indications. Level Three facilities have a hyperbaric program that offers appropriate hyperbaric
The above graph, provided by Dr. Matias Nochetto, VP of Medical Services at DAN, demonstrates the change in hyperbaric chambers avail- able 24/7 and those only available from 9:00 AM to 5:00 PM between 2006 and 2025. Even fewer 24/7 facilities may be available if the div- ing injury requires more complicated treatment modalities, such as the need for a ventilator.
therapy in the non-affiliated setting (non-hospital-based nor affiliated with a hospital). Level Four facilities are in interna- tional locations. The graphic on the opposite page was provided by John Peters, Executive Director of the UHMS and identifies the UHMS-accredited Level One Hyperbaric Facilities in the U.S. According to Dr. Matias Nochetto, DAN VP of Medical Services, DAN does not limit its Recompression Chamber Network (RCN) to UHMS-accredited facilities, nor to hos- pital-based ones (see chart above). The primary focus of the RCN database is facilities that are willing and able to treat divers; whether they do any other Hyperbaric Oxygen (HBO) indications is secondary to them. In addition, about 80% of the chambers in the RCN are not in the US, and very few international chambers seek UHMS accreditation. DAN has its own recompression facility classification system, where it factors in technical capabilities, operational capabil- ities, placement, availability, and communication with DAN. Two notable examples of such facilities are Catalina and Pa- cific Grove (CA, USA). As a business enterprise, the scheduled wound healing ther-
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