CHRISTIAN J. LAMBERTSEN MEMORIAL LECTURE
THURSDAY, JUNE 28: 1:00 pm - 2:00 pm
GUEST SPEAKER: Keith Van Meter, MD
LECTURE TITLE: "A long shot to a short shot: Hyperbaric Oxygen augmented ACLS/ATLS spawned by commercial diving medicine experience"
ABOUT THE LECTURE:
The presentation will focus on observations gleaned from a forty-year history of responding to accidents on oil rigs and diving platforms in the Gulf of Mexico to care for seriously injured commercial divers. This experience afforded a look into the advantage of immediate use of high surface equivalent fraction of inhaled oxygen (SEFIO2) applied in short, intermittent breathing periods in the hyperbaric environment. Divers suffering from exsanguination, cardiopulmonary arrest, crush injury and severe heat shock have been successfully treated coincidentally because of requisite hyperbaric oxygen administration during surface or saturation decompression.
The favorable patient outcomes have been replicated in published animal experiments. In part, the physiological explanation might be better understood by looking into the role of mitochondria in shock. The hyperbaric chamber may be a virtual drawer of a code cart in future emergency medical systems and hospitals to improve outcomes from ACLS and ATLS.
ABOUT DR. VAN METER:
Dr. Van Meter attended George Washington School of Medicine in Washington, D.C. He trained at Tulane University / Charity Hospital in New Orleans, Louisiana. He is currently board certified in Emergency Medicine, Undersea and Hyperbaric Medicine, Pediatric Emergency Medicine, and Medical Toxicology. He has performed and published research in a number of topics. His current focus is on the use of hyperbaric medicine as an adjunct to ACLS and ATLS both in the clinical hospital setting and in the pre-hospital arenas.
Dr. Van Meter is the President and Medical Director of an emergency physician group which staffs a number of contracts in Louisiana and Mississippi. He is lead physician for a first response flight team that treats offshore, injured commercial divers on-site. He is the Medical Director for Baromedical Research Institute, a facility that specializes in research in the field of Hyperbaric Medicine. He is a Clinical Professor both at LSU Health Sciences Center and Tulane University School of Medicine.
Since 1989, Dr. Van Meter has served as the Chief of the Section of Emergency Medicine at LSU Health Sciences Center in New Orleans. He has provided steadfast leadership at Charity Hospital’s Level I Trauma Center before and during Hurricane Katrina and afterward at the Interim LSU Hospital. At University Medical Center in New Orleans, he participates in the training and education of physicians on the front lines of emergency and hyperbaric medicine.
CHRISTIAN J. LAMBERTSEN, MD, DSc (Hon) MEMORIAL LECTURE
About Dr. Lambertsen:
Dr. Christian J. Lambertsen received a B.S. Degree from Rutgers University in 1938 and a M.D. Degree from the University of Pennsylvania in 1943. During his medical school period, he invented and first used forms of the initial U.S. self-contained closed-circuit oxygen rebreathing apparatus, for neutral buoyancy underwater swimming and diving. As a student, he aided the early Office of Strategic Services (O.S.S.) in establishing the first cadres of U.S. military operational combat swimmers. Dr. Lambertsen became a U.S. Army medical officer on graduation from medical school in early 1943, and immediately joined the O.S.S. Maritime Unit on active duty through its period of function in World War II. He joined the University of Pennsylvania Medical Faculty in 1946, and became Professor of Pharmacology in 1952. While a faculty member he combined diving research and further underwater rebreathing equipment developments for the Army and Navy. In 1967 he served as Founding President of the Undersea Medical Society (now Undersea and Hyperbaric Medical Society.) Dr. Lambertsen is recognized by the Naval Special Warfare community as "The Father of U.S. Combat Swimming.” His hand has touched every aspect of military and commercial diving. Dr. Lambertsen’s active contributions to diving began during WWII and became even more progressive in the post-war period through the evolutions of the U.S. Navy Deep Submergence and Naval Special Warfare developmental programs.
ERIC P. KINDWALL, MD MEMORIAL LECTURE
FRIDAY, JUNE 29: 1:00 pm - 2:00 pm
GUEST SPEAKER: Eugene Worth, MD
LECTURE TITLE: "HBOT and Diabetic Foot Ulcers: Do We Have a Leg to Stand On?"
ABOUT THE LECTURE:
Use of hyperbaric oxygen as a means of therapy for the terrible complications of diabetes began in 1979 (Hart and Strauss). There have been at least 9 randomized controlled trials, of which 7 showed beneficial effects of hyperbaric oxygen as an adjunctive therapy combined with advanced wound care. Recently, there have been 3 negative studies (Margolis, et al; Fedorko, et al; and Santema, et al.) All three of these studies have been published in the same journal, Diabetes Care. (I wonder if that is by coincidence.)
In this presentation, I will trace the history of HBOT and DFU. One of the overarching weaknesses in all of the trials is a simple fact: None of us practice ‘standard wound care’ or ‘advanced wound care’ in the same way. We can do a better job, and in today’s regulatory environment, we must improve.
Finally, I will review papers disproving some regulatory fallacies. HBOT and DFU is cost-effective in a community limb salvage protocol. Hemoglobin A1c (HbA1c) has little or no bearing on whether a DFU will heal. Tight HbA1c control may lead to premature death from hypoglycemic episodes.
My goal for each DFU is to leave the patient with an ambulatory extremity. Failure to do that hastens morbidity and mortality. In summary, fasten your seatbelt. I will challenge current paradigms and lay out a pathway to improve patient care. Yes, we have a leg to stand on!
ABOUT DR. WORTH:
Eugene R. Worth, MD, M.Ed., FABA, ABPM/UHM
Dr. Eugene Worth is a retired Medical Director for Hyperbaric Medicine. He was most recently at Dixie Regional Medical Center in St. George, Utah. Dr. Worth received his A.B. and MD degrees from the University of Missouri-Columbia, in Columbia Missouri. He then completed an internship and residency in Anesthesiology at the University of Missouri-Columbia Hospital and Clinics. He is a board-certified Anesthesiologist and has served in private and academic practices. His subspecialty area was cardiac and major vascular anesthesia including heart transplantation. He has practiced wound care and hyperbaric medicine since 2002 and is subspecialty board-certified in Undersea and Hyperbaric Medicine. He retired from daily practice on July 3, 2017 after 38 years as a physician. He is currently a private consultant and owner of Worth Hyperbaric Consulting, LLC. He and his lovely wife live in Kearney, Missouri.
Dr. Worth completed a 3-year NIH-sponsored medical informatics fellowship (1994 – 1997) at the University of Missouri-Columbia. His Masters Degree is in Education, with an emphasis in curriculum and instruction and educational technology. His research involved using electronic mail discussion groups as “virtual colleagues,” enhancing information transfer to clinical practice by asymmetric communication.
Dr. Worth has practiced undersea and hyperbaric medicine since 2002. In April, 2006, he became the medical director of Hyperbaric Medicine at the Utah Valley Regional Medical Center, Provo, Utah. In 2013, he was named the medical director at Dixie Regional Medical Center in St. George, Utah. He was an adjunct assistant professor for the Duke University Undersea and Hyperbaric Medicine program since 2013.
Dr. Worth is a long-time member of the Undersea and Hyperbaric Medical Society. He has served on the Education and Safety Committees. He is a physician surveyor for the UHMS Accreditation Team.
He is a recreational diver (PADI Advanced Open Water and Enriched Air) and a NOAA Diving Medical Officer. He has 30+ scientific publications, including two book chapters. He has given numerous presentations in anesthesiology, medical informatics, hyperbaric medicine and diving medicine.
Dr. Worth is the recipient of a number of awards and distinctions in undersea and hyperbaric medicine. In 2017, he received the founding “Circle of Excellence Award” from the Baromedical Nurses Association. This award recognizes mentoring and support of hyperbaric nurses worldwide. He is a reviewer for the journal, Undersea and Hyperbaric Medicine.
FABA = Fellow of the American Board of Anesthesiology
ABPM/UHM = Sub-specialty certified in Undersea and Hyperbaric Medicine by the American Board of Preventive Medicine.
NOAA = National Oceanic and Atmospheric Association
ERIC P. KINDWALL, MD MEMORIAL LECTURE
About Dr. Kindwall:
Dr. Kindwall is known by so many as the "Father of Hyperbaric Medicine.” Whether you knew him personally or simply by reputation, we have all benefited from his efforts, passion, wisdom, knowledge, energy and vision. Dr. Kindwall has played a great role in growing and shaping the specialty of Undersea and Hyperbaric Medicine. He was likewise instrumental in molding the UHMS into what it is today. Dr. Kindwall began diving in 1950. He cultivated his interest in the field and during the Vietnam War served as the Assistant Director of the U.S. Navy School of Submarine Medicine. He also was the Senior Officer responsible for the Diving Medicine Program. In 1969, after leaving the Navy, Dr. Kindwall became Chief of the Department of Hyperbaric Medicine at St. Luke’s Medical Center, Milwaukee, Wis. Shortly after the Undersea Medical Society was created in the mid-1960s, Dr. Kindwall identified the need for standardized education in the field. He created the UMS Education and Standards Committee to help elevate course content and ensure instructor competence. This committee later became our Education Committee. When the AMA initiated its Continuing Medical Education program, Dr. Kindwall persuaded the organization to recognize the UMS as a grantor of CME credits. In 1972, Dr. Kindwall felt that the Society’s members would benefit from improved communication. He created our first newsletter and was named editor. Dr. Kindwall chose the name Pressure because clinical hyperbaric medicine was rapidly developing. Even though the UHMS had not yet incorporated "Hyperbaric” into the Society’s name, he wanted a title for the newsletter that would encompass all who worked with increased atmospheric pressure. He stated: "The Society’s goal then, as it is now, is to serve all who deal with the effects of increased barometric pressure.” That same year, Dr. Kindwall recognized the need to have a relationship with Medicare to help provide insight on reputable clinical management. The UMS followed this lead, and a Medicare Panel was created. The recommendations were presented to the U.S. Public Health Service. The challenge was that no reliable hyperbaric medicine clinical guidelines were available that addressed appropriate applications of Hyperbaric Medicine. To remedy this deficit, the UMS Executive Committee created an Ad Hoc Committee on hyperbaric oxygen therapy. Dr. Kindwall was named Chair. The committee created the first Hyperbaric Oxygen Therapy Committee Report. Again, this text was published 10 years before the UHMS incorporated "Hyperbaric” into its name. The report was sent to HCFA and the Blues and became their source document for reimbursement. Dr. Kindwall updated the text two more times and thus was the Editor and Chair of the Committee and text for three of its 12 editions. Dr. Kindwall later worked to expand the available information on the specialty by creating one of the first complete texts on the field. He created Hyperbaric Medicine Practice in 1994 and later updated and revised his text two more times. The Society’s first journal, Hyperbaric Oxygen Review, has also has been influenced by Dr. Kindwall. His love for research and education was clear: He became the initial editor, creating a journal that at first consisted of review articles and one original contribution. Over the years,it has grown to one full of original research. Dr. Kindwall’s presence is felt in so many of the UHMS’ activities and initiatives. Much of what we all take for granted – what is just "there” and "available” – has his touch and influence. Some of us have been blessed to have had a closer impact by Dr. Kindwall’s life, but I think that I can easily say that each of us has been influenced in some way.