Featured News

The UHMS Annual Scientifi c Meeting (June 15-18) in San Diego, California is quickly approaching. Many thanks to the UHMS ASM Committee members for their hard work through the fall and winter to bring the ASM program together. I think this meeting promises to be very educational and enjoyable.

Thursday, June 15th, off ers two pre-courses. One is “Approaches to Safety for the Hyperbaric Professional: Life After the 40-hour Course” and the second is “Fitness to Dive: Introduction to the Routine Medical Evaluation of Recreational Divers.”

We have added a third keynote address going forward. The keynote addresses have always been named for individuals who have made signifi cant contributions to our specialty. The two current keynote addresses are named for Dr. Eric Kindwall (featuring a clinical hyperbaric topic) and Dr. Christian Lambertsen (featuring a diving topic).

This new third keynote address will be named in honor of other giants in our fi eld with the name rotating every fi ve years in order to acknowledge the many individuals deserving of this recognition. The topic will be safety and technical development. For the next fi ve years, this keynote will be named in honor of Dr. Jeff Davis followed by Dr. George Hart for the fi ve years after that.

This year’s UHMS ASM keynote addresses are as follows:

• Friday, June 16th: Eric P. Kindwall Keynote: Hyperbaric Oxygen and Infl ammatory Bowel Disease by Dr. Parambir Singh Dulai. A promising new indication for HBO.
• Saturday, June 17th: Christian J. Lambertsen Keynote: SEALAB by Dr. Kevin Hardy. A very San Diego diving topic.
• Sunday, June 18th: Jeff Davis Keynote: Historical Perspective: Safety Development by Dr. John Feldmeier. The inaugural third keynote address.

I hope to see you all in San Diego.

- Pete Witucki

A forensic patient is one who is under the legal custody of law enforcement or correction facility. The United States has over 2 million individuals who are incarcerated.¹ Of these individuals, 800,000 were found to have chronic conditions requiring medical care. Comparatively, incarcerated patients have double the chronic disease burden than that of the general population.² The Supreme Court Ruling in Estelle v. Gamble (1976) ensures that all incarcerated patients have a right to medical care. This right has required the correctional health system to send more patients to local hospitals for care which, ultimately, could include hyperbaric for acute or chronic conditions. Some of the chronic conditions identified at high levels in the incarcerated patient population are diabetes and cancer–two conditions that often precipitate the need for hyperbaric therapy.

“The proportion of inmates reporting having ever had diabetes or high blood sugar in 2011–12 was 899 per 10,000 prisoners, almost twice the rate reported in 2004 (483 per 10 000).”³

“Incarcerated individuals were diagnosed with cancer at a later stage more frequently compared to those recently released or never incarcerated.”⁴ “Cancers originating from the gastrointestinal system...were the most common cancers in all three groups (incarcerated, 25.5%; recently released, 32.8%; and never incarcerated, 17.8%, respectively). Other cancers commonly diagnosed among those incarcerated included those in the thoracic region (97% of which lung), the male reproductive organs (62% were prostate), and leukemia and lymphomas.”⁴

In the United States, we need to be proactive in providing safe, efficient, high-quality care for this specialized patient population to reduce evident disparities. In this article, we will discuss: care of the forensic patient in the multiplace hyperbaric chamber, challenges in this population and recommendations for standard of care and policy creation. Once a referral for hyperbaric therapy is initiated, the consultation should be initiated in a timely fashion, comparable to the general population. These patients may come to the hyperbaric facility as an inpatient or outpatient.

During consultation, the hyperbaric staff discusses the risks and benefi ts with the forensic patient. Also, one must be cognizant that these patients still maintain the right to refuse treatment if desired.

“All patients, including prisoners and their appointed surrogate medical decision-makers, have the right to be properly informed of medical conditions, prognosis, diagnosis, risk and treatment alternatives through the process of informed consent.”⁵

After completing the consultation, if treatment is deemed necessary and desired, discussion will occur with the correctional facility point of contact for coordination of transport times and/or availability of transport to the chamber for treatments. Based on the security level of the forensic patient, conversations will occur between chamber staff and the correctional facility regarding safety and security measures. Receiving medical treatment at outside facilities creates a high-risk situation in the transport of the forensic patient, which is why there are regulations and procedures to ensure no unnecessary harm occurs.⁶ During transport, every eff ort should be made to avoid co-mingling between the forensic patient and the general population.

Throughout the duration of transport and treatment, the accompanying law enforcement officer should maintain direct line of sight of the forensic patient. Although the officer will not be in the chamber with the patient, all measures will be taken to ensure the safety of the forensic patient, staff, and other patients during the treatment.

Working with a forensic patient presents unique considerations which need to be addressed prior to the start of treatment. During consultation, discussions about emergency procedures with the forensic patient should be limited to just the basics to eliminate potential security breaches and damage to equipment. Patient safety should always be in the forefront of the medical professional’s mind, but may need to be adjusted slightly to ensure that forensic patients do not maliciously cause undue harm during a hyperbaric treatment.

The restraint process should be predetermined; specialized plastic restraints should be used in leu of traditional metal handcuffs. This will eliminate the possibly of sparks therefore mitigating fire risk. Restraint policies for patients in custody will be determined by the correctional facility’s restraint policy, which is different from the hospital restraint policies for patients who are agitated or combative.

The hyperbaric clinician should determine whether appropriate care can be delivered with restraints in place. For example, during the compression stage of the hyperbaric treatment where restraints are implemented, discussion on how the forensic patient must be able to complete a Valsalva maneuver should be discussed.

A particularly challenging portion of forensic patient care in the multiplace hyperbaric chamber is limited by immediate staff availability should a security breach occur. Depending on the dive profile utilized, it may take up to five minutes for secondary staff to be able to provide assistance. To create a controlled environment where all parties feel safe the following must be considered: safety protocols should be developed and followed, staffing guidelines should be adjusted for level of security, education for staff on effective communication, and comingling should be minimized with staff and other patients.

Should a situation present where the forensic patient is threatening or hostile during the hyperbaric treatment, the inside hyperbaric attendant should first notify topside staff. Then, the inside staff can attempt de-escalation techniques learned through effective communication training. If these attempts are unsuccessful, an emergency security response should be initiated. The forensic patient should be removed from treatment through an adjacent chamber with secondary staff and escorted off the premises by the correctional facility offi cers with assistance from hospital-based security. With safety being paramount, further treatment after high-risk behavioral situations will be determined collaboratively between the correctional facility and hyperbaric staff.

As chronic illnesses increase, the number of forensic patients we encounter in hospital and clinic-based settings will become more prevalent. Hyperbaric clinics need to be proactive in creating policies and standards of care prior to encountering this specialized population. Being prepared with these policies and standardizations in place ensures the safety of the patients and the hyperbaric staff and equipment.

It is vital to develop a good rapport with local, state, and federal corrections institutions. Collaboration of care between the correctional facility and the hyperbaric center is necessary for safe and effective hyperbaric therapy. It develops and maintains open lines of communication with the correctional facility and ensures that if a safety concern arises, it is escalated and addressed appropriately.

The objective of this article is to educate the hyperbaric community on the increasing incidence of forensic patients requiring hyperbaric treatment. We acknowledge there is little data on the care of the patient in the hyperbaric chamber. We recommend a proactive approach in your hyperbaric facility, by developing policies and procedures to be better prepared to serve this vulnerable population.

Greetings from all of us here at UHMS!

It’s an exciting time as we prepare for our Annual Scientifi c Meeting and pre-courses at the Sheraton Marina on Harbor Isle in San Diego, June 15-19.

San Diego is a destination location and offers plenty of opportunities for meeting attendees and accompanying persons to explore, play, and eat great food. As a bonus, the conference resort is surrounded by the SD harbor with beautiful views. I encourage you to visit the resort’s photo gallery (https://www.marriott.com/en-us/hotels/sansi-sheraton-san-diego-hotel-and-marina/photos/) to get even more stoked about attending the 2023 UHMS ASM.

There’s still time to register, both in-person and virtually (https://www.uhms.org/education/annualscientific-meeting/asm-registration.html). See you at the Welcome Reception!

Operationally, the UHMS continues to focus on carrying out its mission, and all areas of the organization are busy contributing to this effort. I am extremely grateful for the fantastic efforts of our employed members as well as the many, many volunteers who keep the organization moving forward.

Our volunteers are the grease that keeps the gears lubricated and turning and, without you, the organization would come to a screeching halt, so thank you.

If you’re not yet involved and are interested in serving on one of the nearly thirty UHMS Committees, let me know, and we’ll do our best to get you linked up with the appropriate Committee Chairs.

From a governance perspective, during the UHMS April board meeting, the board approved the 2022 audit results presented by MKA, our audit firm, for the past five years. Once again, we had the very best outcome without any recommendations.

Additionally, the board approved the UHMS annual awards recommendation from the Awards Committee. Congratulations to this year’s winners, and we look forward to recognizing them during the Awards Banquet during the ASM.

• Albert Behnke: Michael Strauss, MD
• Excellence in Commercial Diving: Philip Bryson, MD
• Excellence in Diving Medicine: Bob Sanders, MD
• Excellence in Hyperbaric Medicine: Shai Efrati, MD
• Young Scientist/Medical Doctor: Kristi Ray, MD
• Paul Baker: Andrew Melnyczenko, CHT
• Excellence in Critical Care: Geness Koumandakis, CHT

Also, the board approved the FUHM’s Committee recommendation to award Gerardo “Dino” Bosco, MD - FUHM. Congratulazioni!

The UHMS board, during an interim board meeting vote, approved the 2023 elections for the open positions on the Board and Associate Council. Congratulations to those recognized by their peers and elected to serve the UHMS membership.

Winners: 2023 Members-at-Large

• Frauke Tillmans, PhD
• Peter Lindholm, MD, PhD

Winner: 2023 Associate Technician Representative- Elect

• Daniel Hyun, CHT

Winner: 2023 Associate Council Secretary

• Marie Morales, RN, ACHRN

We continue to focus on patient and caregiver safety in the hyperbaric medicine environment by publishing position statements and guidelines and enhancing our Hyperbaric Facility Accreditation process; providing relevant, inexpensive, and plentiful educational experiences; improving value for our members and the specialty as a whole; engaging regulators, payors, and authorities having jurisdiction about the safe and effi cacious practice of hyperbaric medicine and fi nally, publishing the highest quality research in our UHM journal.

UHMS Finances
UHMS YTD through April 2023 with a modest surplus on the profit and loss statement.

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

Heraclitus, a Greek philosopher, coined the saying, ‘Change is the only constant in life.’ Throughout my management career, I can attest that this holds remarkedly true, and the UHMS is not immune to this theoretical statement. It’s with a heavy heart that we are saying goodbye to one of our core team members as they transition into full retirement. Lola ‘Renee’ Duncan has diligently served as managing editor for the UHMS and the Undersea and Hyperbaric Medicine Journal since 2009. Renee is a wonderful human and deeply cares for the work product she produces, and UHMS has benefi ted from her dedication to quality over these past fourteen years. Thank you, Renee, for your eff orts, and I appreciate our friendship.

With Renee’s departure, we welcome Lorrie Coté. Lorrie is an experienced manager and has previously worked with our UHMJ Editor, David Hostler, Ph.D., at the University of Pittsburgh before he transitioned to the University of Buff alo. Welcome Lorrie!

Certification Matters
We continue to receive questions about technician and nursing certifi cation. The UHMS’s position is unchanged in that we believe that all team members involved in providing care to patients in hyperbaric medicine should be certifi ed, and our position statement - The Importance & Recognition of Hyperbaric Certifi cation for Technicians & Nurses can be found here - https://www.uhms.org/images/Position-Statements/position_statement_-_uhms_associates_hyperbaric_certification_recognition_v.10.05.2019_v6_1.pdf.

Scholarship
Congratulations to the Q2 Associate Scholarship Award winners Marjoe Prado and McCraigan True. They will have the opportunity to attend a UHMS-approved Introductory Course in Hyperbaric Medicine at no cost, which is required to sit for UHMS-recognized hyperbaric certification exams.

Member Benefits
As a reminder, 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.

Associates 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, do not miss out on our monthly Corporate Partner Town Hall meeting series. These are held on the 1st Wednesday of every month at 12P 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 off ers its version of “ask the experts.” Called MEDFAQs, it can be found at the following URL – https://www.uhms.org/resources/medfaqsfrequently-asked-questions-faq.html and is a valuable tool for our membership.

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

Research
The Multicenter Registry for Hyperbaric Oxygen Therapy at Dartmouth (MRHBO2) continues seeking funds to keep hospital membership free. The MRHBO2 is funded entirely via grants, not by the registry’s participating hospitals. Please consider supporting this critical need to help keep the barrier to joining low - https://www.uhms.org/donate-tothe-multicenter-registry-for-hyperbaric-oxygentherapy.html.

Remember that donations made 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 fi eld’s challenges, log in and visit the QUARC page – https://www.uhms.org/resources/quarc.html. Here you will fi nd impending legislation, LCD, and other relevant policies on the provision and limitations of HBO2 coverage and the UHMS’s responses and guidance.

The chairs of QUARC are requesting that any unusual denials or challenges with physicians gaining access to insurance panels for HBO2 services, let us know as soon as possible, please – 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-journalpdfs.html. Currently, the feature works with keywords.

If you have a suggestion or comment on how we can serve you better, please email me directly at jpeters@uhms.org or call me at 561-776-6110 extension 100. It is my pleasure to serve you, our membership, and I continue to look forward to hearing from you.

- John Peters

As we start off a new year, here are a few things to help make the survey process easier or maintain your accreditation.

Some organizations are special. They go that extra mile and their successes are a measure of their willingness to do just that. Such dedication deserves to be acknowledged, and we at the UHMS have just the names for such recognition.

We are pleased to honor 15 special hyperbaric facilities this year. These facilities have now been accredited for more than 20 years. With their dedication to excellence, these facilities have put themselves through the rigorous survey process time and time again. They have worked hard to achieve the highest quality in hyperbaric medicine and have demonstrated their willingness to maintain it.

As I think back to the beginning of the accreditation program 20 years ago, facilities like these were instrumental in helping us to develop the concepts, aims, and endpoints of today’s surveys. Their support over the years has not only made the community of hyperbaric medicine stronger but maintained the gold standard for their patient care and, by doing this, they have become models for others to follow.

These hyperbaric facilities have achieved UHMS Hyperbaric Facility Accreditation for 20-plus years:

The Hyperbaric Medicine Service Poudre Valley Hospital
Ft Collins, CO
The Hyperbaric Medicine Service Memorial Hospital
Colorado Springs, CO
Center for Hyperbaric Medicine & Environmental Physiology Duke University Medical Center
Durham, NC
Center for Hyperbaric Medicine Virginia Mason Medical Center
Seattle, WA
HyperbarXS at Kennestone
Marietta, GA
Memorial Hermann Center for Hyperbaric Medicine Memorial Hermann Hospital
Houston, TX
Wound Healing & Hyperbaric Center North Kansas City Hospital
North Kansas City, MO
Wound Healing Institute Advent Health Carrollwood
Tampa, FL
Undersea & Hyperbaric Medicine Clinic Brooke Army Medical Center
Brooks City Base, San Antonio, TX
Center for Comprehensive Wound Care & Hyperbaric Medicine Aurora St. Luke’s Medical Center
Milwaukee, WI
Center for Comprehensive Wound Care & Hyperbaric Medicine Aurora West Allis Medical Center
West Allis, WI
Center for Comprehensive Wound Care & Hyperbaric Medicine Aurora Medical Center, Washington Co.
Hartford, WI
Hyperbaric Medicine Department LDS Hospital
Salt Lake City, UT
Hyperbaric Medicine Department Redlands Community Hospital
Redlands, CA
Hyperbaric Medicine & Wound Care Center Upstate University Hospital
Syracuse, NY

This dedication should not go unnoticed. We have accredited 280 facilities in over 20 years. During this time, these 15 facilities have shown their devotion to their patients and staff with accreditation with the UHMS Hyperbaric Facilities Accreditation program.

Congratulations on achieving this milestone, 20 years is a long journey. I want to thank all involved at your facility for their support of the Hyperbaric Facility Accreditation program.

- Derall Garrett