Do you have to attend a safety director course to be a safety director of a hyperbaric program? In other words, is attending the course a recognized standard?

Thank you for your question. The UHMS HBO2 safety committee can provide information to assist you in answering your question, but the ultimate responsibility for these types of questions rests with the medical director and safety director of your facility.

The hyperbaric oxygen safety committee is not aware of any codes that require safety directors to attend a safety director’s course. However, for centers seeking UHMS accreditation, there are several survey probes specific to the responsibilities and qualifications of a safety director.  One of which is to have successfully completed a UHMS or NBDHMT-approved hyperbaric safety course.  Following UHMS accreditation criteria would be considered best practice for a facility safety director.  It is our suggestion that even the most experienced individual would benefit from attendance in a course.  The matter of validating a “qualified person” to be the safety director and “qualified safety course” is the responsibility of the hyperbaric facility.  The NFPA definition of a qualified person is: “A person who, by possession of a recognized degree, certificate, professional standing, or skill, and who, by knowledge, training, and experience, has demonstrated the ability to perform the work.” An argument can be made that the knowledge and training achieved through a safety director’s course may satisfy a portion of this definition in the NFPA.

Regarding the position of safety director for the hyperbaric facility:

• A safety director is required by the NFPA 99, Health Care Facilities Code. This applies even if your state has not adopted NFPA 99 and if you are not in a Health Care Facility. The NFPA 101 Life Safety Code refers us to 99 and states that as far as the Life Safety Code is concerned, all hyperbaric facilities must meet 99, therefore it is a law and enforcement would be from the local authority having jurisdiction.
• NFPA 99, 2018 edition, chapter 14.3 Administration and Maintenance, specifically 14.3.1.3.2 and A14.3.1.3.2, outlines the requirement for someone to be designated as the safety director.
• We strongly encourage that all hyperbaric facilities own copies own a copy of the NFPA 99 and 101 books in their library, if you do not have these two, there is read only, free access to all the NFPA codes at http://www.nfpa.org/
• The Canadian standard has language regarding the SD position but does not require a course. 18.2.2 Safety director, The safety director shall be appropriately knowledgeable, qualified and competent by training or experience, in the operation, maintenance, and repair of all the mechanical, electrical, liquid, and gas systems of the hyperbaric facility and shall be acceptable to the regulatory authority having jurisdiction. This person should be involved in all aspects of planning regulations and use of the hyperbaric facility. Note: While not necessarily one of the chamber operators, it is suggested that the safety director be the senior of the chamber operators and a certified hyperbaric technologist or equivalent.
• A UHMS accreditation survey expects that there is a safety director.
• We are not aware of a certification available for the safety director, this is in part because there are many different types of operations. You may work for a large complex multi lock chamber with critical care, inpatients, outpatients, etc. You may work for a small wound care operation with a couple of monoplace chambers. The safety director needs to be someone with experience and training to meet the needs of the facility. The UHMS Guidelines for Hyperbaric Facility Operations is available from the on-line store at UHMS.org and contains information regarding minimum qualifications. https://www.uhms.org/
• The person designated as the safety director should be certified or working on certification as a Certified Hyperbaric Registered Nurse (CHRN) or Certified Hyperbaric Technologist (CHT) and has attended or will be attending a safety director course.
• The National Board of Diving and Hyperbaric Medicine has a position statement regarding the safety director, http://www.nbdhmt.org/index.asp
• Please see the UHMS web site for listings of safety director courses.

Respectfully,

The UHMS Safety Committee

DISCLAIMER

Neither the Undersea and Hyperbaric Medical Society (UHMS) staff nor its members are able to provide medical diagnosis or recommend equipment over the internet.  If you have medical concerns about hyperbaric medicine you need to be evaluated by a doctor licensed to practice medicine in your locale, which can provide you professional recommendations for hyperbaric medicine based upon your condition. The responsibility of approving the use of equipment resides with the physician and safety director of the facility.  Information provided on this forum is for general educational purposes only.  It is not intended to replace the advice of your own health care practitioner and you should not rely upon it as though it were specific medical advice given to you personally.

What level and credentials due HBO technicians need? I heard EMT, Paramedic, LPN, RN... can you clarify?

Thank you for your question. The UHMS HBO2 safety committee can provide information to assist you in answering your question, but the ultimate responsibility for these types of questions rests with the medical director and safety director of your facility.

Regarding:  Credentials for personnel staffing hyperbaric chambers.

The level of training and experience of the hyperbaric chamber operators and inside attendants varies depending on the country of origin, complexity of the chamber(s) and level of care provided. There are Physicians, Nurse Practitioners, Life Support Technician, Chamber Technician, Physiologist, Researcher (medical), Respiratory Therapist, Diver Medic, Physician Assistant, Corpsman, Medical Services Specialist, EMT, Paramedic, Registered Nurse or LPN and others that are employed as hyperbaric chamber operators and inside attendants. The list of resources below is not all inclusive; it is a sampling of some of the qualifications and standards available.

• The National Fire Protection Association, NFPA 99, Health Care Facilities Code, 2018 edition, 14.3.1.4.2 “The medical director of hyperbaric medicine and the safety director shall jointly develop the minimum staff qualifications, experience, and complement based on the following:
• Number and type of hyperbaric chambers in use
• Maximum treatment capacity
• Type of hyperbaric therapy normally provided “

• The National Board of Diving and Hyperbaric Medical Technology (http://www.nbdhmt.org/), Scope of practice for Certified Hyperbaric Technologists states” The purpose of this document is to describe the training and competencies necessary to become certified as a hyperbaric technologist. CHT® is not an entry-level qualification, rather an additional certification beyond the applicant’s qualifying profession (refer to qualifying pathway list). As of January 2019, the qualifying pathway list includes: Respiratory Therapist, Physician Assistant, Active Duty Military Corpsman, EMT/Paramedic, Registered Nurse or LPN, Nurse Practitioner and Physician

• The Undersea and Hyperbaric Medical Society (https://www.uhms.org/) has recommendations on staffing qualifications in the most recent UHMS Guidelines for Hyperbaric Facility Operations, and there are hyperbaric staffing requirements listed in the UHMS Facility Accreditation documents.

• Certified Hyperbaric Technologist is not required in Canada if they are trained and certified as a chamber operator such as what is offered under the Divers Certification Board of Canada and the CSA standard for Hyperbaric Chamber. the Canadian Undersea and Hyperbaric Medical Association (CUHMA) (formally the Canadian Chapter UHMS) has a "Guidelines to the Practice of Clinical Hyperbaric Medicine and Provision of Hyperbaric Oxygen Treatment" with references on qualifications of staff. 

• The Australian Standard AS 4774.2-2002 lists requirements for personnel staffing hyperbaric facilities.

• The European Code of Good Practice for Hyperbaric Oxygen Therapy lists requirements for personnel staffing hyperbaric facilities. Also reference the Educational and Training Standards for the Staff of Hyperbaric Medical Centers, European Committee for Hyperbaric Medicine / European Diving Technical Committee.

• South Africa uses the Risk Assessment Guide for Installation and Operation of Clinical Hyperbaric Facilities publication, under the authority of national hyperbaric association (SAUHMA), and specifies registered healthcare providers with appropriate hyperbaric training for attendants with current BLS training. Chamber operators require appropriate training, certified by SAUHMA.

• We are aware of others such as Mexico and Japan that have standards for chamber operators and inside attendants as well.

• Reference Hyperbaric Facility Safety: A Practical Guide, Best Publishing, Workman

There are military, commercial diving and tunneling competencies and standards for chamber operators and inside attendants in those ocupations.  

DISCLAIMER
Neither the Undersea and Hyperbaric Medical Society (UHMS) staff nor its members are able to provide medical diagnosis or recommend equipment over the internet. If you have medical concerns about hyperbaric medicine you need to be evaluated by a doctor licensed to practice medicine in your locale, which can provide you professional recommendations for hyperbaric medicine based upon your condition. The responsibility of approving the use of equipment resides with the physician and safety director of the facility. Information provided on this forum is for general educational purposes only. It is not intended to replace the advice of your own health care practitioner and you should not rely upon it as though it were specific medical advice given to you personally.

Is it recommended and or necessary to designate a Medical Director for each location that HBO2 is administered or does it suffice to designate a Medical Director for an organization that administers HBO2 at multiple sites?

Published Date:      03/2016
Review Date:         03/2019
Due Review:          03/2022

Thank you for your question. The UHMS HBO₂ safety committee can provide information to assist you in answering your question, but the ultimate responsibility for these types of questions rests with the medical director and safety director of your facility.

The UHMS Safety Committee is of the consensus opinion that it is best practice to designate an individual hyperbaric medical director for each hyperbaric facility. The medical director’s role is to assume the primary medical responsibility for the facility’s hyperbaric operations. We recommend utilizing the ”UHMS Guidelines for Hyperbaric Facility Operations, 2^nd Edition” to guide the staffing of your hyperbaric facility. We expect that the medical director for the hyperbaric practice to be credentialed at the facility and maintain appropriate state medical licensure. Program design should allow for multiple levels of medical supervision for organizations with multiple sites. Having a medical director that provides oversight to all locations provides continuity between the individual sites.

There may be situations where a single medical director is prudent. For example, we are aware of at least two locations in the United States where one medical director and staff operate out of two separate hospitals. The procedures, personnel, patients and equipment are shared between the hospitals as if they were simply on separate floors of the same hospital. In this type of scenario, we agree that one medical director is sufficient. Local jurisdictions and medical privileges differ between states and Advanced Practioners (such as Physician’s assistant and Nurse Practioners) play a role in the process as well.

The references below may assist you in determining the best design for your hyperbaric program:

• The 4^th edition of the UHMS accreditation manual (2018) lists the requirements for the medical director. This is available to the public on the UHMS web site https://www.uhms.org/
• UHMS position statement: Credentialing, Privileging and Supervision of Hyperbaric Oxygen Therapy in the U.S.A. https://www.uhms.org/
• UHMS Position Statement: Minimum-staffing guidelines of multiplace hyperbaric facilities https://www.uhms.org/
• Position Statement: National Board of Diving and Hyperbaric Medical Technology has a position statement regarding Physician Attendance and Supervision of Hyperbaric Oxygen Therapy (2010-01) April 2010 (Rev. July 2013) http://www.nbdhmt.org/index.asp
• Code requirements do not seem to indicate a requirement for a single medical director. The NFPA 99 Health Care Facility’s Code puts the responsibility for this decision on the governing body.
• While the NFPA 99 has specified a safety director since 1968, the NFPA 99 Health Care Facility’s Code Handbook (page 544) has a corollary to the question of a requirement for a medical director in section 14.3.1.3.2: “Can a single safety director be responsible for multiple facilities in different locations?” The answer: “Some organizations manage multiple hyperbaric facilities in different regions and have designated a single safety director for all their facilities. The intent of the requirement is not to discourage that type of support structure, but there must be an individual at each facility who assumes the responsibilities of the safety director described in this chapter.”
• The medical director for the hyperbaric facility is cited in NFPA 99. There are two mentions, 14.3.1.4.2 - The medical director of hyperbaric medicine and the safety director shall jointly develop the minimum staff qualifications, experience, and compliment based on the following….” And - A.14.3.1.3.2 …. Due to a conflict of responsibility, the same individual should not serve as both medical director and safety director.”  There are also a few other mentions of “hyperbaric physician”.

DISCLAIMER
Neither the Undersea and Hyperbaric Medical Society (UHMS) staff nor its members are able to provide medical diagnosis or recommend equipment over the internet.  If you have medical concerns about hyperbaric medicine you need to be evaluated by a doctor licensed to practice medicine in your locale, which can provide you professional recommendations for hyperbaric medicine based upon your condition. The responsibility of approving the use of equipment resides with the physician and safety director of the facility.  Information provided on this forum is for general educational purposes only.  It is not intended to replace the advice of your own health care practitioner and you should not rely upon it as though it were specific medical advice given to you personally.

Clinical Hyperbaric Facility Accreditation Manual 2005 Edition ( Revision 1)

Credentialing and Privileging Requirements For Hyperbaric Medicine Physicians

Can one use and/or obtain a third party (AEM) maintenance company for servicing and repair of their hyperbaric chambers and still meet current accreditation requirements as well as keep in compliance with the Joint Commission?

Revision Date: 08-2019

The UHMS HBO2 safety committee can provide information to assist you in answering your question, but the ultimate responsibility for these types of questions rests with the medical director and safety director of your facility.

Regarding:  The use of a 3^rd party or in-house staff to provide Alternative Equipment Maintenance (AEM), or the necessity to use the Original Equipment Manufacturer (OEM) for service and repair of hyperbaric chambers.

The SC can provide information only and the responsibility of maintaining compliance with the UHMS Accreditation Program and The Joint Commission is with the administration, the medical director and hyperbaric safety director of the facility.

We are not aware of a specific survey probe from a UHMS accreditation survey that requires you to use the manufacturer. There are several references regarding record keeping, PM schedules, and the maintenance of original design specifications.

The Joint Commission (TJC) does have standards for certain facilities that identify when OEM is required and when you can use AEM. Both CMS (December 2013) and The Joint Commission (July 2014) have specific guidelines for hospital preventive maintenance programs.  In the most recent revisions there were changes related to AEM Programs.  The CMS document has the best guideline on how to appropriately place a piece of equipment on an AEM program and should be read carefully.

Below is a summary of the CMS Hospital Equipment Maintenance Guidelines that was published in a memo on December, 2013 (see attached: survey-and-cert-letter-14-07.pdf).

Memorandum Summary

S&C 12-07-Hospital Superseded: We are updating previously provided guidance to clarify:

• Hospital facilities, supplies and equipment must be maintained to ensure an acceptable level of safety and quality.
• A hospital may adjust its maintenance, inspection, and testing frequency and activities for facility and medical equipment from what is recommended by the manufacturer, based on a risk-based assessment by qualified personnel, unless:
  • Other Federal or state law; or hospital Conditions of Participation (CoPs) require adherence to manufacturer’s recommendations and/or set specific requirements. For example, all imaging/radiologic equipment must be maintained per manufacturer’s recommendations; or
  • The equipment is a medical laser device; or
  • New equipment without a sufficient amount of maintenance history has been acquired.
  • Hospitals electing to adjust facility or medical equipment maintenance must develop policies and procedures and maintain documentation supporting their Alternate Equipment Management (AEM) program. They must adhere strictly to the AEM activities and/or frequencies they establish.

There may be good reasons to either use OEM, AEM or a combination of both.  Alignment with TJC, CMS and the NFPA requirements, warranty issues as well as defining who is qualified to work on your equipment are important to consider. (It is also possible that the manufacturer will refuse to sell OEM parts and require that their own technicians perform the work.) Hyperbaric chambers are considered by the FDA as class 2 devices. As such, the manufacturer’s recommendations should be followed. Documentation of maintenance and compliance with the manufacturer’s specifications are required to be kept on all equipment per NFPA 99 Codebook, the UHMS Accreditation Manual and the UHMS Hyperbaric Facility Guidelines. UHMS Accreditation Manual, Fourth Edition, HBOM 2.1, HBOM 1.0 – 7.1; NFPA 99, 14.3.4.2.1.1; HFG Section 2, 3, 4

Listed below are some things you may want to consider in addition to the above comments when choosing whether to use the manufacturer, your own staff or a 3^rd party contractor for maintenance:

1. This issue should be raised during the initial procurement and/or installation contract. Sometimes it is impossible to get an OEM to agree to another contractor performing maintenance, but it is worth the question before a contract is signed.
2. A new facility usually has a warranty period and it is unwise to make changes or use other contractors until this period has expired.
3. The OEM, where still available or in existence, may have proprietary software installed, making this difficult to circumvent.
4. In some cases, the OEM does not offer services that are to the satisfaction of the chamber owner; as such, the owner should be allowed to employ a contracting company on the basis of:

• Proven competence and track record
• Ability to service equipment and provide expertise
• Value-added service that offers at least some degree of investigation into the quality and safety of the maintainer.

5. A hyperbaric facility may contain aspects not covered by the chamber OEM – examples are compressors, filtration systems, gas supplies, electrical supplies, computer (patient) monitoring systems, medical equipment and so on. It would be wiser to contact these OEM’s for servicing, unless the chamber OEM has modified the equipment and provided some form of warranty for these changes.
6. It is vital to determine that the external (AEM) contractor has a full and working knowledge of the chamber. They must demonstrate this competence to the satisfaction of the chamber owner.
7. We encourage you to be mindful of the competence of the person(s) completing the work, observance of safe work behaviours, and the quality of maintenance documentation provided to you. Also, consider the need for follow-up testing after maintenance work has been conducted.
8. The contractor must offer a warranty for their work for a period of time after the work has been completed. This is not the same as an OEM warranty when the system is new.
9. The contractor should show proof of liability insurance in the event that a mistake is made that would jeopardize the integrity of the chamber or cause harm to personnel or occupants.

DISCLAIMER
Neither the Undersea and Hyperbaric Medical Society (UHMS) staff nor its members are able to provide medical diagnosis or recommend equipment over the internet.  If you have medical concerns about hyperbaric medicine you need to be evaluated by a doctor licensed to practice medicine in your locale, which can provide you professional recommendations for hyperbaric medicine based upon your condition. The responsibility of approving the use of equipment resides with the physician and safety director of the facility.  Information provided on this forum is for general educational purposes only.  It is not intended to replace the advice of your own health care practitioner and you should not rely upon it as though it were specific medical advice given to you personally.

If a CHT is involved with off-label treatment is there any threat to their certification?

Published Date:   5/2016
Review Date:       5/2019
Due Review:        5/2022

This question is best answered by the National Board of Diving and Medical Technology. Please contact them at http://www.nbdhmt.org/index.asp and consider the Code of Conduct and CHT Resource manual attached.

DISCLAIMER
Neither the Undersea and Hyperbaric Medical Society (UHMS) staff nor its members are able to provide medical diagnosis or recommend equipment over the internet.  If you have medical concerns about hyperbaric medicine you need to be evaluated by a doctor licensed to practice medicine in your locale, which can provide you professional recommendations for hyperbaric medicine based upon your condition. The responsibility of approving the use of equipment resides with the physician and safety director of the facility.  Information provided on this forum is for general educational purposes only.  It is not intended to replace the advice of your own health care practitioner and you should not rely upon it as though it were specific medical advice given to you personally.

I am looking for specific information regarding MA's and/or CNA's that have completed the 40 hour HBO training course and what the allowed duties are with hyperbarics. Does a CHT or a person with 40 hour training who also has either RRT, EMT, RN do to also be present with the MA/CNA after supervised orientation? Thank You. If more information is needed regarding what I am asking, please contact me.

Thank you for your question. The UHMS hyperbaric oxygen safety committee (SC) can provide information but the ultimate responsibility for these types of questions is with the medical director and safety director of your facility.

There are numerous resources available to guide you in the decision-making process to determine the scope of practice appropriate for your hyperbaric staff. This decision ultimately lies with your institution’s administrative leadership at the behest of the hyperbaric Medical Director and hyperbaric Safety Director. The UHMS hyperbaric oxygen Safety Committee recommends the following guidelines for your review:

• The “UHMS Guidelines for Hyperbaric Facility Operations, 2nd edition,” identifies that chamber operations staff “performs patient care duties appropriate to his or her scope of practice”.
• Technical staffing guidelines within the same document state the expectation that a minimum of one CHRN / CHT is to be present during chamber operations.
• The UHMS accreditation survey manual also states the recommendation of the presence of at least one CHRN / CHT during chamber operations.
• The National Fire Protection Association, NFPA 99, Health Care Facilities Code, 2018 edition, 14.3.1.4.2 states: “The medical director of hyperbaric medicine and the safety director shall jointly develop the minimum staff qualifications, experience, and complement based on the following:

(1)    Number and type of hyperbaric chambers in use

(2)    Maximum treatment capacity

(3)    Type of hyperbaric therapy normally provided “

• The National Board of Diving and Hyperbaric Medicine Technology (NBDHMT) identified in October 2015, CNA / MA is no longer a qualifying pathway to recertify as CHT - effective Jan 1, 2016.
• We encourage you to refer to your hospital practice guidelines that would define the scope of practice for each employee commensurate with their level of training and qualifications.
• We also encourage you to review your state’s scope of practice for RMA, CMA, and CNA.
• The level of training and experience of hyperbaric chamber operators and inside attendants vary depending on the country of origin, complexity of the chamber(s) and level of care provided.
• There are Physicians, Nurse Practitioners, Life Support Technician, Chamber Technician, Physiologist, Researcher (medical), Respiratory Therapist, Diver Medic, Physician Assistant, Corpsman, Medical Services Specialist, EMT, Paramedic, Registered Nurse or LPN and others that are employed as hyperbaric chamber operators and inside attendants.
• Certified Hyperbaric Technologist is not required in Canada if they are trained and certified as a chamber operator such as what is offered under the Divers Certification Board of Canada and the CSA standard for Hyperbaric Chamber. The Canadian Undersea and Hyperbaric Medical Association (CUHMA) (formally the Canadian Chapter UHMS) has a "Guidelines to the Practice of Clinical Hyperbaric Medicine and Provision of Hyperbaric Oxygen Treatment" with references on qualifications of staff.
• The Australian Standard AS 4774.2-2002 lists requirements for personnel staffing hyperbaric facilities.
• The European Code of Good Practice for Hyperbaric Oxygen Therapy lists requirements for personnel staffing hyperbaric facilities. Also reference the Educational and Training Standards for the Staff of Hyperbaric Medical Centers, European Committee for Hyperbaric Medicine / European Diving Technical Committee.
• South Africa uses the Risk Assessment Guide for Installation and Operation of Clinical Hyperbaric Facilities publication, under the authority of national hyperbaric association (SAUHMA), and specifies registered healthcare providers with appropriate hyperbaric training for attendants with current BLS training. Chamber operators require appropriate training, certified by SAUHMA.
• We are aware of others such as Mexico and Japan that have standards for chamber operators and inside attendants as well.
• Reference Hyperbaric Facility Safety: A Practical Guide, Best Publishing, Workman
• There are military, commercial diving and tunneling competencies and standards for chamber operators and inside attendants in those occupations.
• Please reference the UHMS Safety Committee’s response to a related MEDFAQ question on 1/25/2016.

Respectfully,

The UHMS Safety Committee

DISCLAIMER

Neither the Undersea and Hyperbaric Medical Society (UHMS) staff nor its members are able to provide medical diagnosis or recommend equipment over the internet.  If you have medical concerns about hyperbaric medicine you need to be evaluated by a doctor licensed to practice medicine in your locale, which can provide you professional recommendations for hyperbaric medicine based upon your condition. The responsibility of approving the use of equipment resides with the physician and safety director of the facility.  Information provided on this forum is for general educational purposes only.  It is not intended to replace the advice of your own health care practitioner and you should not rely upon it as though it were specific medical advice given to you personally.