Featured News

How exciting to be in the field of Hyperbaric Medicine!  The worldwide communication of everyone continually and enthusiastically working together through the UHMS (Undersea and Hyperbaric Medical Society -Regular & Associate Members and Staff), BNA (Baromedical Nurses Association), NBDHMT (National Board of Diving and Hyperbaric Medical Technology), Military, Diving Community, UHMS Accreditation Board, Education, Publications, Ongoing Studies, Continuing Education, Regulatory Agencies, Safety, mentoring, comradery and friendships are like no other field of medicine.  Hyperbaric Medicine continues to evolve daily with the talent, support, and dedication of everyone in this field. Contributions from everyone are valuable to our overall success. Even in this age of instant communication, hyperbaric medicine continues to excel in instant worldwide communication.

The BNA Board of Directors works diligently to mentor, support, and educate nurses (RN and LVN/LPN) worldwide.  We encourage you to join this enthusiastic and dynamic board - each new board member brings added talent and perspective to our organization.  In addition, check out the education component available on the BNA website at https://hyperbaricnurses.org. 

The BNA recently celebrated Hyperbaric Nurses Day 40^th anniversary on April 12, 2025.  These outstanding presentations for Hyperbaric Nurses Day are as follows and are available on the BNA website

• Hyperbaric Oxygen for Ulcerative Colitis
  • Dr. Jeff Cooper:  Medical Director for Hyperbaric Medicine at Nebraska Medicine
• Central Retinal Artery Occlusion: An Outcome Analysis
  •  Dana Winn, BSN, RN, CHRN: Nurse Manager for Hyperbaric Medicine & Wound & Ostomy Services at Nebraska Medicine, and Kari Fowler, BSN, RN, CHRN: Hyperbaric Nurse at Nebraska Medicine
• Late Radiation Injury
  • Dr. Warren Gude (pre-recorded):  Medical Director for St. Luke’s Wound and Hyperbaric in Idaho
• That Would Never Happen Here: The Role of RCA² and Just Culture in Responding to Serious Safety Events
  • Eric Hexdall BSN, RN CPPS, ACHRN-ADMIN: Program Manager -Duke Regional Hospital         

Previous educational presentations are available on the BNA website as well.

BNA members will attend the ASM. You are invited to visit the BNA booth to learn more about the BNA, connect with familiar friends, make new friends, and just have fun!       

Welcome to Atlanta, Georgia, and the 2025 joint Undersea and Hyperbaric Medical Society (UHMS) and Aerospace Medical Association (AsMA) Annual Scientific Meeting.

Atlanta boasts a rich history in aerospace and undersea exploration, making it a fitting host for this year’s ASM. Here are some historical highlights:

Aerospace Legacy in Atlanta

• Hartsfield–Jackson Atlanta International Airport: Originating as Candler Field in 1925, this airport evolved into a major aviation hub. During World War II, it served as Atlanta Army Air Field, a critical site for military aircraft servicing and pilot training.
• Delta Air Lines: Headquartered in Atlanta, Delta began operations in the 1920s and has grown into one of the world's largest airlines, significantly contributing to the city's aerospace prominence.
• Georgia Tech Research Institute (GTRI): Established in 1934, GTRI has been instrumental in aerospace research, including defense technologies and systems engineering, supporting both military and civilian aerospace advancements.
• Air Force Plant 6: Located in nearby Marietta, this facility was pivotal during World War II for producing B-29 Superfortress bombers. Post-war, it continued to serve aerospace manufacturing needs and is now operated by Lockheed Martin.

Undersea Exploration Connections

• Lake Lanier's Submerged History: North of Atlanta, Lake Lanier covers the remnants of several communities submerged during its creation in the 1950s. The lake's depths have intrigued divers and historians exploring its underwater past.
• Deep-Sea Coral Systems: Off Georgia's coast lies the world's largest known deep-sea coral system, discovered on the Blake Plateau. This ecosystem, though not directly in Atlanta, highlights the state's undersea research significance.
• University of Georgia's Marine Programs: The University of Georgia conducts marine research and educational programs, contributing to the understanding and conservation of undersea environments.
• Georgia Aquarium: The Georgia Aquarium, located in downtown Atlanta, is one of the largest aquariums in the world and the largest in the Western Hemisphere. Opened in 2005, it houses over 11 million gallons of water and thousands of animals across hundreds of species. Notably, it is the only aquarium outside of Asia to feature whale sharks, the largest fish species on the planet.

Atlanta's intertwined histories of aviation innovation and undersea exploration underscore its relevance as a venue for discussions on advancements in aerospace and hyperbaric medicine.

We expect an incredible meeting for both organizations. While we know there are significant budgetary challenges for many of our peers, we still hope to host over 1500 attendees.

If you want to chat during the ASM week, find or text me.  

~

Last month, the UHMS membership voted to approve a change to its Constitution and Bylaws. Specifically, we added Vision and Values statements to our Mission Statement, and what we term our VVM.

We did this to increase the depth, direction, and identity of the UHMS. Each component of the VVM element plays a distinct yet interconnected role in shaping strategy, culture, and public trust.  

The UHMS vision is to be the global leader in advancing the science, technology, safety, and clinical practice of undersea and hyperbaric medicine, fostering collaboration, innovation, and education to improve patient outcomes, enhance operational safety, and expand the frontiers of hyperbaric medicine.

The vision underscores our commitment to leading undersea and hyperbaric medicine (UHM) advancements.  

UHMS Core Values are summarized below.

1. Patient Safety & Quality Care
   UHMS prioritizes patient and provider safety by enforcing evidence-based standards and best practices across all hyperbaric medicine activities.
2. Scientific Excellence & Innovation
   – The society drives progress through rigorous research, scientific inquiry, and the integration of innovative technologies and treatments.
3. Education, Professional Development, & Certification
   – UHMS fosters lifelong learning by offering robust educational programs and certifications to advance professional expertise across the field.
4. Collaboration & Interdisciplinary Cooperation
   – It promotes global partnerships among clinicians, researchers, industry, and regulators to elevate care and expand scientific understanding.
5. Ethical Integrity & Advocacy
   – UHMS upholds high ethical standards and actively advocates for sound healthcare policy, keeping members informed and engaged in regulatory issues.
6. Accreditation & Best Practices
   – The society ensures hyperbaric facility excellence by maintaining rigorous accreditation standards that safeguard patients and verify clinical competence.
7. Public Awareness & Community Engagement
   – UHMS raises awareness about hyperbaric  medicine’s value through outreach and education, promoting informed decisions and improved access to care.

To view the UHMS Constitution and Bylaws, click the link About the UHMS - Undersea & Hyperbaric Medical Society.

The Importance of Certification

Certification is a hallmark of professional experience, competency, and commitment to best practices. Whether you are a physician, nurse, or technician, obtaining and maintaining your certification in hyperbaric medicine demonstrates your expertise and adherence to the highest standards of patient care. UHMS strongly encourages physicians in our field to pursue certification through ABPM/ABEM subspecialty board certification or PATH CAQ and NPPs to achieve PATH CAE; we also promote all nurses who participate in the care of hyperbaric patients to become Certified Hyperbaric Registered Nurses (CHRN), and technicians to be certified as Certified Hyperbaric Technologists (CHT) or Certified Hyperbaric Specialists (CHS). These credentials not only enhance your professional standing but also elevate the credibility of our specialty within the broader medical community.

Please review our position statement on Certification Matters: UHMS POSITION STATEMENT.

Facility Accreditation: A Commitment to Excellence

Hyperbaric Facility Accreditation by UHMS remains the gold standard for ensuring safety, quality, and adherence to clinical best practices. Accredited facilities demonstrate their commitment to patient safety, operational excellence, and compliance with industry guidelines. If your facility is not yet accredited, I strongly encourage you to explore the process. Not only does accreditation improve patient trust and regulatory compliance, but it also serves as a proactive approach to risk management and liability reduction.

Maintaining Safety Diligence in Hyperbaric Systems

Safety is the foundation of everything we do in hyperbaric medicine. The risks associated with hyperbaric oxygen treatment (HBO₂) demand unwavering diligence in maintaining equipment, conducting regular safety drills, and ensuring proper staff training. UHMS provides comprehensive guidelines and resources to help facilities uphold the highest safety standards, including routine inspections, emergency preparedness protocols, and compliance with NFPA 99 and ASME PVHO-1 standards. I urge all members to prioritize safety in their daily operations and take advantage of UHMS educational offerings on hyperbaric safety.

The Value of UHMS Membership

Your membership in UHMS is more than just an affiliation—it is an investment in your professional growth and the advancement of hyperbaric medicine. As a UHMS member, you gain access to cutting-edge research, clinical practice guidelines, educational opportunities, networking events, and advocacy efforts aimed at shaping the future of our specialty. Additionally, membership provides exclusive discounts on conferences, workshops, and certification programs that support your career development.

The UHMS tent is wide open, so please come in and join us to make our specialty vibrant and viable for generations to come!

UHMS Finances

I am pleased to report that UHMS's financial position remains strong.

Our balance sheet remains healthy, with operating, savings, and investment accounts continuing to hover at near-all-time highs.

Member Benefits

Remember, UHMS members receive three free CE/CME credits upon joining or renewing. This benefit represents an immediate $40 savings for Associate members and $60 for Regular members annually. 

Associate Member Town Hall

Members are invited to attend the UHMS Associate Council town hall meeting on the second Thursday of every quarter, where invited speakers present on relevant topics that apply to our specialty.

Corporate Partners

If you are a UHMS Corporate Partner, please attend our monthly Corporate Partner Town Hall meeting series. These are held on the 1^st Wednesday of every month at 12 PM and are intended to be an open forum for discussing the challenges and successes your businesses and practices are experiencing and to create momentum and collaboration where appropriate.    

If your organization wants to educate the UHMS membership about the care provided or the goods and services offered, consider joining our Corporate Partnership Program. See https://www.uhms.org/corporate-memberships.html.  

MEDFAQs

The UHMS offers its version of "ask the experts." MEDFAQs can be found at the following URL: https://www.uhms.org/resources/medfaqs-frequently-asked-questions-faq.html, It is a valuable tool for our membership.

If you are familiar with MEDFAQs, check back, as new Q&As are posted regularly.

Research

The UHMS Research Committee continues to be very active. We hope to announce some good news in the new year on the IRB front, where members of our community can come to the UHMS for the Institutional Review Board's needs.

We are soliciting donations from our members for two research initiatives. One is the Continuous Glucose Monitor study (https://www.uhms.org/cgm-hyperbaric-oxygen-study), and the Multicenter Registry for Hyperbaric Oxygen Treatment at Dartmouth (MRHBO₂) continues seeking funds for free hospital membership. The MRHBO2 is funded entirely via grants, not by the registry's participating hospitals - https://www.uhms.org/donate-to-the-multicenter-registry-for-hyperbaric-oxygen-treatment.html.

Remember that donations to the UHMS Funds for Research and Policy Advancement are tax-deductible. For more information, check out the UHMS website –  https://www.uhms.org/funding.html.   

QUARC

To better understand the field's challenges, log in and visit the QUARC page – https://www.uhms.org/resources/quarc.html. Here, you will find impending legislation and other relevant policies on the provision and limitations of HBO₂ coverage and the UHMS's responses and guidance.

The chairs of QUARC request that you please let us know as soon as possible if there are any unusual denials or challenges with physicians gaining access to insurance panels for HBO2 services—jpeters@uhms.org.

UHM

If you are a UHMS member, we are happy to announce a new search feature for previous issues and articles from UHM/UBR - https://www.uhms.org/publications/uhm-journal/download-uhm-journal-pdfs.html. Currently, the feature works with keywords.

Looking Ahead

This year, UHMS remains committed to expanding educational initiatives, strengthening industry partnerships, and advocating for policy advancements that benefit our field. We encourage you to engage with us, participate in upcoming events, and contribute to the ongoing dialogue that shapes hyperbaric and undersea medicine.

Thank you for being an integral part of our society. Your expertise, dedication, and continued engagement make a difference in advancing the science and practice of hyperbaric medicine.

If you have a suggestion or comment on how we can better serve you, please email me at jpeters@uhms.org or call 561-776-6110 extension 100.

Sincerely,
John Peters
Executive Director
Undersea and Hyperbaric Medical Society

This update highlights cases where hyperbaric oxygen treatment was used for Idiopathic Sudden Sensorineural Hearing Loss (ISSNHL). The Registry has accumulated a substantial number of cases, and we are beginning a comprehensive data analysis.

Here is just a brief overview:

• Total number of cases entered = 556; 256 with complete pre-and post-treatment pure tone average data
• Mean improvement in Pure-Tone Average (PTA) was 14 dB (p<0.0001)
• The mean percentage of Word Recognition improved significantly
• Mean Quality of Life measures increased moderately
• Patient satisfaction with treatment was generally positive, but long-term follow-up results will require more in-depth analysis.

Graphs corresponding to the above bullet points follow below.

Although ISSNHL is a UHMS-approved indication for Hyperbaric Oxygen Treatment, access to hyperbaric facilities varies, and referral patterns seem to reflect different levels of acceptance of HBO₂ as a potentially beneficial treatment. Analysis and publication of registry data is a valuable tool for educating us and establishing stronger treatment guidelines and recommendations.

If you plan to attend the 2025 AsMA-UHMS Joint Annual Scientific Meeting in Atlanta and would like to learn more about the Multicenter Registry for Hyperbaric Oxygen Treatment, please look for our Registry review poster (B14) and come by to chat!

This year’s Annual Scientific Meeting of the Undersea and Hyperbaric Medical Society marks a bold and forward-looking milestone as we gather in Atlanta, Georgia, in proud partnership with the Aerospace Medical Association (AsMA). This joint meeting reflects the evolving intersections between hyperbaric, undersea, and aerospace medicine—fields that once seemed distinct but are increasingly linked by common physiological principles and collaborative clinical interests. From managing decompression sickness and gas laws to advancing our understanding of oxygen physiology at altitude and depth, our specialties are aligned now more than ever before.

The 2025 meeting promises to be a landmark event. We have assembled a robust, interdisciplinary program that spans clinical hyperbarics, diving medicine, aerospace physiology, human performance under pressure, and the future of extreme environment medicine. Attendees can expect cutting-edge research, engaging panels, and a cross-pollination of ideas among military, civilian, academic, and clinical sectors. This collaborative platform enhances the quality of scientific exchange and reflects the UHMS’s commitment to increasing our field’s visibility and fostering unity with allied specialties.

I encourage every member of our society to attend, participate, and contribute their voice to the dialogue. Whether your interests lie in wound care, dive operations, spaceflight medicine, or safety protocols, this meeting has something to offer. Let Atlanta be the place where we not only honor our shared history but also chart the course forward together.

Owen J. O’Neill, MD, MPH, FUHM
President, Undersea and Hyperbaric Medical Society

In Italy, low-pressure monoplace hyperbaric chambers are increasingly being installed in both medical and non-medical facilities.

These facilities advertise the use of such devices as a treatment method for conditions relevant to hyperbaric medicine, often referencing scientific evidence and therapeutic guidelines that support the effectiveness of Hyperbaric Oxygen Therapy (HBOT) administered in multiplace hyperbaric chambers, which are currently the only legally authorized systems in Italy and can reach operating pressures of up to 6 ATA.

The European Committee for Hyperbaric Medicine (ECHM) published the European Code of Good Practice for Hyperbaric Oxygen Therapy, which defines HBOT as the administration of oxygen at a pressure higher than local atmospheric pressure. It specifies that the pressure level, treatment duration, and the partial pressure of oxygen must conform to the current state of the art in the field. It also establishes that three essential elements define HBOT: oxygen partial pressure, environmental pressure, and the use of a hyperbaric chamber.

The Undersea and Hyperbaric Medical Society (UHMS), in the latest 15th Edition of "Hyperbaric Oxygen Therapy Indications", states that therapeutic pressure must not be lower than 2.0 ATA, typically for a period between 90 to 120 minutes.

As such, administering HBOT requires the use of hyperbaric chambers. According to EU regulations, hyperbaric chambers are considered medical devices as well as high-pressure equipment. Previously, they were governed by Directive 93/42/EEC on medical devices, but since May 2021, the new EU Medical Device Regulation (MDR 2017/745) has been in force, which enforces stricter certification criteria for medical devices. The MDR demands scientific evidence for efficacy and safety, which these low-pressure chambers currently lack.

Furthermore, pressure equipment is also subject to Directive 2014/68/EU concerning the harmonization of laws on pressure equipment across EU Member States.

The 7th ECHM Consensus Conference (Lille, 2004) defined HBOT as: "The administration of oxygen at a pressure not lower than 2.0 ATA for a minimum of 60 minutes." This remains the current standard of care.

In 2023, the ECHM published the 2022 revision of the European Code of Good Practice for HBOT, which reaffirmed the consensus that the term "hyperbaric oxygen therapy" can only be used when the oxygen partial pressure exceeds 1.5 ATA for at least 60 minutes (excluding compression and decompression times).

Hyperbaric chambers must meet two sets of technical standards:

• UNI EN 14931:2006, which defines safety and functional requirements for human-occupied hyperbaric chambers.
• UNI EN 16081:2012 - A1:2013, which sets specific requirements for fire suppression systems, installation, and functional testing.

In the United States, the FDA (Food and Drug Administration) authorizes the use of low-pressure hyperbaric bags only for altitude sickness and emergency evacuation using devices such as the Gamow bag.

Oxygen is classified as a drug (CAS No. 7782-44-7; ATC V03AN01). Proper HBOT involves medical-grade oxygen (≥ 99.5%) administered at pressures above atmospheric, in compliance with the official drug data sheet.

Recently, so-called low-pressure hyperbaric chambers have entered the market in several countries, including Italy. These devices typically operate at a maximum pressure of 1.45 ATA (146.92 kPa). They use oxygen concentrators that never reach 100% purity—oxygen concentration decreases from ~93% at 5 L/min to ~90% at 10 L/min, which is their maximum flow rate (as per: Caire Inc.).

Oxygen is administered using non-monitored reservoir masks in continuous-flow, open-circuit systems, unlike multiplace chambers where inspired oxygen concentration is monitored. These chambers also lack internal monitoring or alarms to detect potentially dangerous levels of oxygen (>22.5%)—a risk since excess oxygen is vented into the chamber environment.

To date, scientific literature provides little evidence supporting HBOT at pressures lower than 2.0 ATA. All recognized indications for HBOT require pressures between 2.0 and 2.8 ATA.

The SIMSI considers that these low-pressure chambers do not meet the minimum requirements for safe and effective HBOT as established by international standards. Therefore, it is unacceptable to equate these chambers with certified hyperbaric chambers that comply with the aforementioned regulations.

Due to the unregulated spread, lack of scientific validation, and potential safety risks, multiple scientific societies have expressed their opposition to the use of these low-pressure devices for HBOT.

• In 2010, the South Pacific Underwater Medicine Society, commissioned by the Australian and New Zealand Hyperbaric Medicine Societies, concluded that there was no clinical evidence supporting the therapeutic benefits of these chambers and did not recommend their
• In 2015, the Canadian Undersea and Hyperbaric Medical Association (CUHMA) published guidelines emphasizing the need for continuous oxygen monitoring in hyperbaric chambers and clearly opposed the use of pressures below 1.5 ATA or oxygen concentrations below 100%, except in approved research settings.
• In 2017, the UHMS published a position paper against the use of low-pressure hyperbaric chambers: UHMS Position Statement on LP Chambers (PDF)

In conclusion, SIMSI states that:

1. Low-pressure hyperbaric chambers are currently not suitable for administering HBOT as defined by the current standards of hyperbaric They do not meet the minimum requirements in terms of exposure pressure, structural design, or safety.
2. HBOT should only be administered according to the guidelines outlined by the 10th ECHM Consensus Conference: ECHM Consensus Guidelines
3. Public administrations should implement authorization and accreditation procedures for any type of hyperbaric medical device (regardless of the gas used—air, oxygen, or mixed gases) to ensure user safety.

This represents the current state of the art regarding the use of HBOT, pending future technical and scientific advancements that may validate new devices and treatment protocols.

Presidente SIMSI, Dott. Alfonso Bolognini
Working group SIMSI
Dott. Alfonso Bolognini Presedente SIMSI
Dott. Pasquale Longobardi Vice Presidente SIMSI Dott. Corrado Costanzo consigliere SIMSI
Dott. Luigi Santarella consigliere SIMSI Dott. Massimo Spalletta consigliere SIMSI Dott. Stefano Mancosu consigliere SIMSI
Sig. Gianluca Baroni Tecnico iperbarico Ravenna Sig. Antonio Sanna Tecnico iperbarico Sassari

References

• European Committee for Hyperbaric Medicine (available at www.echm.org)
• European Code of Good Practice for Hyperbaric Oxygen Therapy (available at http://www.echm.org/ECHM-Documents.htm)
• Undersea and Hyperbaric Medical Society (UHMS) (available at www.uhms.org)
• Indications for Hyperbaric Oxygen Therapy. Definition of Hyperbaric Oxygen Therapy (available at www.uhms.org/resources/hbo-indications.html)
• Food and Drug Administration, CFR_Code of Federal Regulations Title 21.
• Kot J, Desola J, Simao AG, Gough-Allen R, Houman R, Meliet J-L, et al. A European code of good practice for hyperbaric oxygen therapy. Int Marit Health [Internet]. 2004;55(1-4):121–30. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15881548
• Hyperbaric Oxygen Therapy Comittee U. Hyperbaric Oxygen Therpy Indications. 13th editi. Weaver L k., editor. Undersea and Hyperbaric Medical Society; 2014. 1-415 p.
• Kot J, Houman R, Müller P. HYPERBARIC CHAMBER AND EQUIPMENT. Multi- and Monoplace Chambers. In: MATHIEU D, editor. Handbook on Hyperbaric Medicine. First. Springer; 2006. p. 611–36.
• Mathieu D. Handbook on hyperbaric medicine. 1st ed. MATHIEU D, editor. Handbook on Hyperbaric Medicine. Dordrecht, The Netherlands: Springer; 2006. 812 p.
• Mathieu D. Recommendations of the 7th European Consensus Conference on Hyperbaric Medicine [Internet]. 2004. Available from http://www.echm.org/documents/ECHM 7th Consensus Conference Lille 2004.pdf
• Committee USC& UOT. Low-Pressure Fabric Hyperbaric Chambers [Internet]. 2017. p. 1–3. Available from https://www.uhms.org/images/Position- Statements/Low_PressureSoft_Chamber_UHMS_Position_Statement_Final_9-30-2017.pdf
• Board of Directors of the Undersea and Hyperbaric Medical society. UHMS position statement on lowpressure, soft-sided hyperbaric chambers. UHM. 2017;44(6):612.
• Canadian Undersea and Hyperbaric Medical Association (CUHMA) Guidelines to the Practice of Clinical Hyperbaric Medicine and Provision of Hyperbaric Oxygen Treatment (2015). Available at https://cuhma.ca/_Library/Documents/CUHMA_Standards_of_Practice_Guidelines_1st_Edition.pd f
• Real Decreto 1277/2003 que regula la autorización de centros y establecimientos sanitarios, (BOE 254/2003, October 10th).
• Mathieu D, Marroni A, Kot J. Tenth European Consensus Conference on Hyperbaric Medicine: recommendations for accepted and non-accepted clinical indications and practice of hyperbaric oxygen treatment. Diving and http://www.eubs.org/?p=583). Hyperbaric Medicine 2017; 47(1):24-32). (available athttp://www.eubs.org/?p=583).

The Undersea and Hyperbaric Medical Society (UHMS) Board of Directors has reaffirmed its commitment to excellence in hyperbaric medicine through updated guidance for "With Distinction" (WD) accreditation. While the core framework remains largely intact, a notable update has been introduced to the credentials qualifying a facility’s Medical Director under Criterion #1—the inclusion of the Certificate of Added Qualification (CAQ) in Undersea and Hyperbaric Medicine issued by UHMS.

Under the latest update, a facility’s Medical Director may now fulfill Criterion #1 by holding a:

• Certificate of Added Qualification (CAQ) in Undersea and Hyperbaric Medicine issued by UHMS

This inclusion reflects UHMS’s commitment to recognizing multiple pathways to clinical excellence in hyperbaric medicine.

This is in addition to previously accepted qualifications:

• Board certification by ABEM, ABPM, or the Osteopathic Conjoint Committee.
• Completion of an ACGME-approved (or equivalent) Undersea and Hyperbaric Medicine fellowship.
• Designation as a Fellow (FUHM) of the UHMS.

The inclusion of the CAQ recognizes UHMS’s evolving educational framework and provides an alternative, structured pathway for professionals who demonstrate specialized expertise in hyperbaric medicine.

Overview of the "With Distinction" Framework

To receive WD recognition, a hyperbaric facility must:

• Meet Criterion #1 (mandatory) and
• Earn at least 6 out of 10.5 total possible points across nine defined criteria.

Each criterion carries a fixed-point value (no partial credit) and must be fully met for the point to be awarded. Criteria #1–#5 must be actively met at the time of the survey, while Criteria #6–#9 must have been fulfilled within the last three years (or four years for previously WD-accredited sites).

Criteria Overview & Scoring

Important: Even if a facility meets all WD criteria, final designation is based on the entire survey evaluation, not just the WD point score. Facilities that meet the WD criteria may still be asked to complete Point of Actions (POA) requested by the Accreditation Council.

Conclusion

The addition of the CAQ by UHMS to Criterion #1 reflects UHMS's recognition of multiple credentialing pathways for medical directors committed to advancing excellence in hyperbaric medicine. This change enhances access to WD consideration while maintaining rigorous standards.

Facilities are encouraged to review their qualifications and documentation in light of this update and direct questions to the UHMS HFA Office at derall@uhms.org or beth@uhms.org.

Congratulations to these Facilities!

January 2025

New:

Republic of Singapore Navy
Singapore

Reaccredited:

Concord Hospital
Concord, NH

St. George Regional Hospital
St. George, UT 

February 2025

Reaccredited:

*Reading Hospital*
Wyomissing, PA

*UPMC Carlisle*
Carlisle, PA

March 2025

Reaccredited:

Loma Linda University Hospital-Murrieta
Murrieta, CA

North Shore University Hospital
New Hyde Park, NY

Samaritan Albany General Hospital
Albany, OR

* With Distinction*

By Glenn Butler and Eric Koleda

Diabetic Veteran lower limb amputations are being conducted daily, when Lower Lifetime Cost Civilian Limb Preservation Programs utilizing Hyperbaric Oxygen Therapy are more successful at saving money, saving limbs and lives.

The worldwide Diabetic Patient population is growing exponentially. The over 2.2 million diabetic Veterans have a significantly greater incidence of diabetes and other comorbidities than the civilian population that increases their risk for Lower Limb Amputation (LLA). The VA Statistics provided our team demonstrated a 22-year (2000 to 2022) average annual VHA DFU LLA rate of 36,197 of which 24,433 DFU Veterans died on average post 3-year LLA. The National VA Diabetic Veteran Foot Ulcer (Wagner II-III) population is increasing rapidly due to VA untimely and inadequate care intervals, resulting in an epidemic increase in largely preventable Lower Limb Amputations.

The estimated 2.2 million VHA diabetic Veterans have a legal, ethical, and moral right to be provided with real information, timely clinical care and a legal “Informed Consent” regarding all accepted clinical alternatives to amputation and immediate access to a Veterans Health Administration-created VA-Community Care Network (CCN) Civilian Hospital DFU programs and Hyperbaric Oxygen Therapy (HBOT) capability per VA and CMS guidelines.

Our analysis of VA-supplied DFU LLA data concludes that the combination of underdiagnosis, inadequate clinical staffing, delays of in-person exams and limited access to civilian HBOT protocols has contributed to the escalating rates of DFU-related morbidity and mortality among veterans. Addressing these issues through improved diagnostic practices, enhanced clinical infrastructure, and timely referrals to specialized CCN Civilian Hospital Wound and HBOT  centers is critical to mitigating the impact of DFUs and LLA on the veteran population.

Negative VA Statistics- The VA data analysis provides disturbing details regarding a two-plus decade long DFU epidemic. More than 796,340 U.S. Veterans have died prematurely from DFU LLAs in 22 years, more than all Veterans Killed in Action (623,982) since the beginning of World War I.

The 22-year average annual VA DFU Amputations is 36,197 of which 24,433 DFU Veterans die on average, post-three-year LLA. The VA DFU LLA mortality rate is 64-71 percent within three years post-LLA surgery.

Positive CMS Statistics- These VA Statistics are in stark comparison to a Civilian 74 percent Heal rate who received timely HBO₂ treatments.  In a large 2018 retrospective civilian study, the effect of HBO₂ on Wagner grade 3 and 4 DFU was evaluated using a retrospective observational real-world data set. The study reported an overall healing rate of 74.2% at the population level, for >2 million wounds.

When a subgroup of civilian DFU patients with only Wagner grade three or four DFU were considered, the healing rate was only 56.04%. The use of HBO₂, without filtering for the number of treatments received, improved the healing rate to 60.01% overall. However, healing rates for this same subgroup, however, were improved to 75.24% for patients who completed the prescribed number of hyperbaric treatments.

Despite these contrasting VA/CMS statistics, there appears to be a systemic inability by the VA to make clinically appropriate referrals of DFU Veterans to a Veteran Health Administration-created VA Community Care Network (CCN) Civilian Hospitals that are equipped with Hyperbaric Oxygen Therapy (HBO₂) capabilities. The VA’s reluctance to make this limb lifesaving Veteran DFU referrals out of the VA System and into CCN affiliate Hospitals may be a misguided cost containment effort.

The VA Civilian Community Care Network- In 2018, several New York area Health Systems and over 1,500 other civilian Hospitals nationally signed up with the Veterans Health Administration to become VA Community Care Network (CCN) Provider Hospitals under the MISSION Act of 2018 (Maintaining Internal Systems and Strengthening Integrated Outside Networks),  This act of Congress was put in place to address the inability of the VA to provide timely medical care and to expand Veteran access to immediate care in an organized civilian sector Hospital network when CMS / VA / FDA / UHMS  approved Medical Services were unavailable within the VA, especially for veterans in remote or underserved areas. This mandate extends to the Veteran‘s ability to access Hyperbaric Oxygen Therapy (HBO₂), where the VA follows CMS, FDA, and UHMS Indications and guidelines.

The VA MISSION Act of 2018states “The Secretary shall subject to the availability of appropriations, furnish hospital care, medical services and extended care services to a covered Veteran if the VA Department does not offer the care or services the Veteran requires.” The VA does not offer HBO₂ chambers in any of their 172 VA hospitals across the country. Therefore, the VA-CCN Civilian Hospital System was, in part, created for this purpose.  Further, it states, “the decision to receive hospital care, medical services, or extended care services under such sub-paragraphs from a (civilian CCN) health care provider specified in subsection (c) shall be the election of the Veteran.” 

Informed Consent-The Veteran Administration has been mandated to refer patients to civilian services it cannot provide. VA Physicians and staff are also medically and legally obligated to provide the doctrine of “Informed Consent” seeking to ensure that doctor’s, tell patients of their diagnosis; and that those patients understand the nature and purpose of recommended interventions, that the treatment is fully funded by CMS or the VA, and, most importantly, that patients are made aware of the burdens, risks, and expected benefits of all options under the AMA Code of Medical Ethics Opinion 2.1.1. 

Minimal History of VA referrals for HBO₂-According to the VHA data from 2002 to 2022, only 548 DFU Veterans on average per year receive HBO₂ which is 1.5 DFU Veterans per day across the entire U.S.

The VHA cannot deny Veterans access to HBO₂ as it is a CMS, FDA, VA-Optum and Tricare-approved and funded treatment option. Veterans, their families, and Caregivers must advocate for timely clinical information, referrals, and treatment within the CCN medical sector.

Significant Cost of Care-The Community Care Network Hospital System was created to help  Veterans access to immediate medical care and reduce morbidity and mortality rates, improve Veteran and family quality of life, and save taxpayer money. The VA’s own cost report data demonstrates that the VA is spending 4-6 times the veteran’s actual Lifetime Cost of Care as compared to an average civilian CMS DFU patient care cost comparison, all while living substantially longer in the process.

Referring DFU Veterans to CCN Hospitals would save the VA money-Under the Veterans Access, Choice and Accountability Act of 2014 and the MISSION Act of 2018, there are provisions for CMS cost coverage and paying for CCN hospital care and medical services provided to veterans with non-service-connected disabilities.

 CMS pays for most Veteran HBO₂ treatment-With the average age of DFU “At-Risk” LLA Veterans over 66.2 years old, many Veterans are covered for CCN care and HBOT under the Center for Medicare and Medicaid funding mechanisms, costing the VA less to make these referrals.

Despite the VHA receiving millions in additional personnel funding, the VA remains chronically understaffed and has consistently neglected to update antiquated clinical practices and implement the very successful CMS Civilian Diabetic management model being delivered by affiliate VA Community Care Network Civilian Hospitals, which offer Hyperbaric Oxygen Therapy per Tricare, CMS, FDA, and UHMS guidelines. 

Minimal VA cooperation- For over three years, Glenn Butler and affiliate Hospital Physicians attempted to meet with the three lower New York State VA Medical Centers or receive any DFU information from the national VA headquarters in Washington D.C.

Finally, Eric Koleda, a USAF Veteran and National Director for State Legislative Efforts for TreatNOW, a non-profit Veteran advocacy organization, requested Congressman Gregory Murphy, MD (R-NC) to petition for the latest VHA DFU data. Finally, in July 2022, VHA Deputy Under Secretary for Health, Dr. Steven L. Lieberman, MD, was required to forward a raw data report to Congressman Murphy’s office and staff, who shared the VA data report. Eric Koleda analyzed the VA data and created a formal 50-page report, which was forwarded to the US Congress in October 2022.

Why does the VA rarely make Veteran DFU HBO₂ referrals to Civilian CCN Hospitals?While the VA is mandated to use HBO₂, Dr. Steven Lieberman, now former VA Under Secretary for Health, confirmed the Veteran Administration does not own or operate Hyperbaric chambers within its 172 National Hospital system or 1,000+ regional clinics. He cited a lack of “significant medical necessity” and that HBO₂ required a specialized facility and staffing for which the VA was not equipped. This policy leaves a major gap in care for Veterans in which the VA-CCN Hospital system with HBO₂ capability has been created to address to avoid Amputations.

High VA Cost of Care- The VA has not made itself available to meet with local New York VA Community Care Provider representatives to facilitate DFU Veteran referrals. It is estimated that the VA has expended approximately $12.5 billion in Lifetime costs over the past two decades on Veteran DFU Lower Limb Amputations (LLA). The civilian sector, hospital, and clinical track record can offer the VA superior clinical outcomes, including the duration and quality of life, plus a significant reduction in lifetime care costs to the American Taxpayer. 

In Conclusion,

We all have an obligation to assist our veterans to assist them within our capabilities. Community Care Network Provider hospitals are contractually obligated to provide our services, including vascular testing, surgery, wound care, and HBO₂ services. The Veterans Administration, per the Mission Act and AMA Informed Consent Medical Ethics opinion, is mandated to inform the Veterans of all their CMS-approved medical options, and to see that appropriate referrals are made.

Diabetic Veterans with DFU have a legal right to demand and receive “Informed Consent” which includes all CMS-approved clinical interventions. This includes vascular testing, surgical interventions, wound care, social and nutritional counseling, and HBO₂ therapy.

They have the right to demand that they be referred to a CCN Hospital with HBO₂ capability.

Civilian CCN Hospitals should engage the VA – Hospitals that have contracted to become VA Community Care Network providers with wound care and HBO₂ capability are obligated to formally contact their nearest VA Medical Centers, CMO, and Podiatry departments to offer their DFU HBO₂ services and request referrals.

Other Veteran CMS HBO₂ Indications-We are currently investigating other very serious Veteran care issues in which HBO₂ is a CMS-approved therapy that the VA is not currently offering to Veterans.

Hemorrhagic Cystitis- There is a significant number of Prostate cancer cases in the VA system. Those fortunate enough to be identified early receive Radiation Therapy, and a percentage equal to the civilian sector develop hemorrhagic radiation cystitis. HBO₂ is probably not part of an “Informed Consent” discussion with the Veterans Urology Physician.

Head / Neck - Plastic Surgery reconstruction. Most H/N Cancer cases have received radiation therapy as a part of their initial cancer management.  Compromised flaps in irradiated fields are a common complication, and HBO₂ should be added to the Plan of Care to optimize the surgical outcome.

Acknowledgments:

The effort to provide Veterans with civilian support and HBO₂ would not be possible without:

• Life Support Technologies staff and our CCN Hospital - Physician partners.
• Eric Koleda, TreatNOW State Legislative Director
• Robert Beckman, PhD, TreatNOW Executive Director
• Joel Goldstein- CEO of the BART Foundation.

References

1- The Veteran Diabetic Foot Ulcer (DFU) Epidemic: A U.S. Department of Veterans Health Administration (VHA) Hyperbaric Oxygen Therapy (HBOT) Services Review Report, October 2022, TreatNOW.org

2- VHA Diabetic Lower Limb Morbidity / Mortality rates (2000-2022)

3- William J. Ennis, Enoch T. Huang, and Hanna Gordon. Impact of Hyperbaric Oxygen on More Advanced Wagner Grades 3 and 4 Diabetic Foot Ulcers: Matching Therapy to Specific Wound Conditions. Advances in Wound Care. Dec 2018.397-407.http://doi.org/10.1089/wound.2018.0855

4- The 1997 CDC report titled, “Hospital Discharge Rates for Nontraumatic Lower Extremity Amputation by Diabetes Status

5- Fife CE, et al., Factors influencing the outcome of lower-extremity diabetic ulcers treated with hyperbaric oxygen therapy. Wound Repair Regen. 2007 May-Jun;15(3):322-31. Doi: 10.1111/j.1524-475X.2007.00234.x. PMID: 17537119

6- VA MISSION Act of 2018 11th Congress (2017-2018)  S.2372 W

7- Ama-assn.org, Code of Medical Ethics Opinion 2.1.1

8- CMS / UHMS / VHA Hyperbaric Indications list