Technician Training Manual - Mobile Hyperbaric Centers

Transcription

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Technician
Training
Manual
This manual will serve as your primary tool
for reference and orientation as a new
Hyperbaric Technician with Mobile
Hyperbaric Centers.
Version 1.2
Updated June 2015
1
WELCOME
Company Overview
Introduction
MHC Corporate Staff
OPERATIONAL EQUIPMENT CONT’D
3
4
5
HYPERBARIC MEDICINE
What is Hyperbarics?
History of Hyperbaric Medicine
Chamber Classification
Indications
Gas Laws
Terms of Pressure
Dive Terminology
Treatment Protocols
Contraindications
Side Effects/Complications
Governing Organizations
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7
9
10
11
12
13
14
18
19
21
PROFESSIONALISM
Job Description
Administrative Responsibilities
Employee Handbook
22
23-25
26
SAFETY
Safety and Operations Manual
Seizure Protocol
Falls Risk Prevention
Prohibited Items List
Chamber Venting/Bounce
Safety Director
Responsibilities & Log
27
28
29
30
31
32
OPERATIONAL EQUIPMENT
Mechanical Equipment
Chamber Layout
Hydraulic Lift
Compressors
ECU
Chiller
Oxygen Supply
TV Enclosure
K-Bottle
FSS
Control Panel
Generator
Entry Lock
Med-Lock
Maintenance
Preventative Maintenance
Troubleshooting
Reporting a Maintenance Issue
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33
34
35
36
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37
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39
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40
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41
47
48
Clinical Equipment
Hoods
Latex/ Nitrile
Hood Creation
Hood Trim Chart
Hood Accessories
Hood Troubleshooting
Trachea Attachments
Masks
Mask Creation
Mask Fitting
Ancillary Equipment
BP Cuff/ Temp/Glucometer
Resupply and Ordering
Corporate/Hospital
49
49
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51
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52
53
54
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55
56
DAILY TREATMENT ROUTINE
Typical Center Schedule
Daily Treatment Flow
Daily Patient Flow
Daily Logs (Startup/Shutdown)
ECW Electronic Charting
Input of Vitals
Merging Templates
Check out a Patient
Linking Referrals
Changing Schedule
Cancelling a Patient
Pre-Treatment Duties
Assessment/Vitals
Transporting Patients
During Treatment
Chamber Operator
Responsibilities
Chamber Attendant
Responsibilities
3rd Technician
Responsibilities
Treatment Routine
Post-Treatment Duties
Blood Glucose Level
ECW Sign off by MD
Hood Cleaning
Infection Control
Chamber Cleaning
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EDUCATION
Introductory Course to Hyperbaric Medicine
CHT Certification Process
Continuing Education (Recertification)
Center Incentive
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75
76
2
Welcome to Mobile Hyperbaric Centers!
Our company’s mission is: “Safely Heal Patients and Have Fun Doing It”.
We
believe that this mission provides the foundation for establishing successful
hyperbaric centers and embodies the principles behind improving healthcare
delivery in the United States. Our company continues to set the bar in how to best
heal patients with oxygen, and is actively involved in educating the country about
Hyperbaric Medicine. This education is primarily on a local level but also includes
establishing a national training program for healthcare providers and doing
research to better establish the science of Hyperbaric Medicine. As we continue to
establish ourselves as the world’s premier Hyperbaric Medicine providers, we always
continue to recognize that our ultimate success is based on fulfilling our mission
with each individual patient. Each employee of our company plays an integral and
critical role in this success.
Throughout the time you are at Mobile Hyperbaric
Centers (and we hope that it will be a long time), there will be many opportunities
for you to grow and be successful.
Our hope is that you will seek out such
opportunities, embrace them and work towards making your life a fulfilling one.
While we recognize that we cannot make you have fun, because how you perceive
what you do is only up to you, we will continue to strive towards making your
days with us filled with challenges, friendly people and meaning.
Welcome to our team,
3
Handbook Overview
As a member of the Mobile Hyperbaric Centers Team, you must follow and support the
mandatory policies and procedures set forth in this manual. Please keep this booklet for future
reference.
The Technician Training Manual contains important information about clinical policies and
procedures pertinent to your employment with Mobile Hyperbaric Centers (MHC). This manual
will serve as your primary resource for training and orientation as a new Hyperbaric Technician.
It is to be used in conjunction with the MHC Safety and Operations Manual, and the Employee
Handbook.
Philosophy
“Safely Healing Patients, and Having Fun Doing It!”
In order to maintain an atmosphere in which Company goals can be accomplished, Mobile
Hyperbaric Centers (MHC) provides a comfortable and progressive workplace. Most
importantly, MHC encourages a workplace where communication is open and problems are
discussed and resolved in a mutually respectful manner.
As a member of the Mobile Hyperbaric Centers Team, you are required to perform your daily
activities within applicable ethical and legal standards. These standards can be achieved and
sustained only through the actions of all personnel. All individuals must maintain integrity in
business conduct and avoid activities that could reflect adversely on the reputation of MHC,
directors, or other employees. As professional healthcare providers, we must be professional,
courteous, friendly, helpful and prompt in the attention given to patients. Clear communication
with the patient and their family members when speaking of the pertinent details of their care is
key to continually improving the quality of care delivered.
MHC should meet or exceed patients’ expectations of Hyperbaric Oxygen Therapy. Patient
care, safety, and satisfaction are major factors in the success of any program within the Mobile
Hyperbaric Centers network. It is important that employees remain respectful, professional, and
helpful when assisting and communicating with patients.
For us to be Safe, we must always be vigilant in anticipating and avoiding things which may
result in accidents. Checklists are a tried and true way to accomplish this for many routine
things.
For us to Heal patients, we must find ways to have our patients get their hyperbaric therapy
every day. Every day they miss treatment (particularly if it is two days in a row); it negatively
affects their healing. Just as importantly, our ability to heal the patient relies on us teaching
them to be motivated in managing their own health. We need to empower them to gain
control of their healing and motivate them to want to heal. We can do most of this simply by
creating a relationship with them where they look forward to showing up each day.
4
Senior Leadership Team
Ronald Gordon, M.D. (Co-President/CEO)
rgordon@mhcenters.com 216-485-2714
Charles Cowap, M.D. (Co-President/CEO)
ccowap@mhcenters.com 216-485-2705
Vince Ferrini, M.D. (Chief Medical Officer)
vferrini@mhcenters.com 440-221-3410
Neema Mayhugh, Chief Operating Officer
nmayhugh@mhcenters.com 216-443-0430
Steve Fischer, Corporate Compliance Manager
sfischer@mhcenters.com 440-759-6827
Mary Miller, Director of Finance/HR
mmiller@mhcenters.com 216-539-1019
Ron Shook, Manager of Patient Care Services
rshook@mhcenters.com 216-485-2715
Ron Anselmo, Director of Facility Maintenance
ranselmo@mhcenters.com 440-785-6146
Alex Hribar, Human Resources Manager
ahribar@mhcenters.com 216-443-0430
Mary Hujer, New Tech Trainer
mhujer@mhcenters.com 330-721-5127
5
What is Hyperbaric Medicine?
According to the Undersea and Hyperbaric Medical Society(UHMS), the definition of
hyperbaric oxygen therapy is a medical treatment in which a patient breathes 100% oxygen
while inside a treatment chamber at a pressure greater than sea level (>1ATA). In contrast to
attempts to force oxygen into tissues by topical applications at levels only slightly higher than
atmospheric pressure, hyperbaric oxygen therapy involves the systemic delivery of oxygen at
values 2-3 times greater than atmospheric pressure.
How it Works?
HYPEROXYGENATION provides immediate support to poorly perfused tissue in areas of
compromised blood flow. The elevated pressure within the hyperbaric chamber results in a
significant increase in the diffusing distance of oxygen to areas otherwise unreachable.
NEOVASCULARIZATION represents an indirect and delayed response to hyperbaric oxygen
exposure. Therapeutic effects include enhanced fibroblast division, new formation of collagen
and capillary angiogenesis in areas of sluggish vascular supply such as late radiation damaged
tissue, refractory osteomyelitis and chronic ulcers.
Hyperoxia-enhanced ANTIMICROBIAL ACTIVITY has been demonstrated at a number of
levels. Hyperbaric Oxygen causes toxic inhibition and toxin inactivation in certain illnesses such
as Gas Gangrene. It also enhances phagocytosis and white blood cell oxidative killing.
DIRECT PRESSURE utilizes the concept of Boyle’s Law to reduce the volume of intravascular or
other free gas. For centuries, this mechanism has formed the basis for treatment of some
emergent diagnoses such as Cerebral Arterial Gas Embolism (CAGE), and decompression
sickness.
Hyperoxia induced VASOCONSTRICTION is
another important mechanism. It is helpful in
managing intermediate compartment
syndrome and other acute ischemia in injured
extremities. Studies have also shown a
significant reduction in interstitial edema in
grafted tissues.
6
In 1662, a British clergyman named Henshaw, without scientific basis, thought it would be a
good idea to raise the ambient pressure around a patient for therapeutic purposes. He later
built a "domicilium," (shown below) a sealed chamber that could either raise or lower pressure
depending on adjustment of the valves. He reported that acute diseases of all kinds responded
favorably to increased ambient pressure.
In the 19th century, following up on Henshaw's
concept, pneumatic institutes began to sprawl
around the European continent. These large
chambers often were able to accommodate
more than one person and could sustain
pressures of two or more atmospheres. These
pneumatic institutes started to rival the popularity of mineral-water spas.
It was not until 1879 that semi-scientific efforts were made in the field. Fontaine, a French
surgeon, built a mobile operating room on wheels that could be pressurized. He performed over
20 surgeries in the unit using nitric oxide as the anesthetic.
Compressed-air therapy was first introduced into the United States in 1871 by Dr. J.L. Corning.
In the early 1900s, Dr. Orville Cunningham, a professor of anesthesia at the University of Kansas,
noted that patients with heart disease and other circulatory disorders had difficulties
acclimating to high altitudes. He postulated that increased atmospheric pressure would be
beneficial for patients with heart disease. To test his hypothesis (1918), he placed a young
resident physician suffering from the flu into a chamber used for animal studies. The physician
was successfully oxygenated during his hypoxic crisis when compressed to 2 ATM.
Cunningham, realizing that his concepts were
sound, built an 88-foot-long chamber, 10 feet in
diameter, in Kansas City (shown right) and began
treating a multitude of diseases, most of them
without scientific rationale.
7
Shortly after, Henry Timken (of Timken roller bearing company) funded the construction of a new
64 foot “hyperbaric hotel.” This was the largest
hyperbaric chamber ever built. Timkin agreed to
build this chamber on his property after a close
friend of his was successfully treated at
Cunningham’s chamber in Kansas. The
Cunningham Sanitarium was an institution that
focused on clean-air breathing treatment. The
steel ball contained bedrooms for patients, as
well as a dining hall and recreation area.
The American Medical Association (AMA) and
the Cleveland Medical Society, failing to receive
any scientific evidence for his rationale, forced
him to close his facility in 1930.
But scientific evidence did later become available. 
Cunningham tore the chamber down before the Nobel Prize for Medicine was awarded in 1931
to Otto Warburg, who noted the importance of oxygen in metabolism and the suggestion that
higher levels of oxygen in tissues might be associated with improved health.
The advent of the use of hyperbaric oxygen in modern clinical medicine began in 1955 with the
work of Churchhill-Davis, who helped to attenuate the effects of radiation therapy in cancer
patients using high-oxygen environments.
That same year, Dr. Ite Boerma, a professor of surgery at the University of Amsterdam in Holland,
proposed using hyperbaric oxygen (HBO) in cardiac surgery to help prolong a patient's
tolerance to circulatory arrest. He conducted surgery under pressure, including surgical
corrections of transposition of the great vessels, tetralogy of Fallot and pulmonic stenosis.
In 1960, Dr. Boerma published a study on "life without blood." It involved exsanguinating pigs
and removing their erythrocytes before exposing them to 3 ATM of HBO. These pigs were noted
to have sufficient oxygen in the plasma to sustain life when they were given HBO at 3 ATA.
8
Chamber Classification
Hyperbaric treatment chambers are divided into 3 categories; Classes A, B, and C.
Class A hyperbaric chambers, also known as “multiplace” chambers, are generally the largest. The term
multiplace stems from the Class A definition from the NFPA-99 stating any chamber for multiple human
occupancy. Depending on chamber design, this can range from 2 patients at a time to as many as the
design will allow(see right). Multiplace chambers are pressurized with
compressed air versus oxygen. This creates a safer treatment
environment for patients. Another NFPA-99 safety code requires
multi-place chambers to maintain an environment below 23.5%
of oxygen. The unique design of a multiplace chamber allows
pressurization to a depth greater than that of a monoplace.
Oxygen is administered to the patients through masks, or clear
plastic hoods versus filling the entire chamber with oxygen.
Multiplace chambers also allow for direct hands-on patient care
by clinical staff during the entire treatment. as opposed to
monoplace treatments where there is a delay for immediate
hands on care.
Class B hyperbaric chambers, also known as “monoplace”
chambers, are typically referred to as single occupancy
chambers. They are pressurized with 100% oxygen, as opposed
to air , discussed above. Due to the high oxygen concentration
found within a monoplace chamber, there are stricter safety
concerns when treating patients in this environment. Another
potential downside to the monoplace chamber is its relatively
confined interior space. Chamber sizes have increased over time with current operating models ranging
in diameter from 25”-41”. Monoplace chambers offer a more inexpensive method of treating patients.
They also have less operating costs than
multiplace chambers, but are unable
to treat at depths greater than 3ATA.
Class C hyperbaric chambers are
classified for “NO HUMAN
OCCUPANCY”. They are used primarily
in veterinary medicine to treat animals
with specific illnesses.
9
Indications
 Acute Carbon Monoxide Poisoning
- increased COHB causes hypoxic stress

Air or Gas Embolism
-venous gas embolism (VGE) or arterial gas embolism (AGE)

Chronic Osteomyleitis
-infection of bone refractory to antibiotics and debridement

Clostridial Myonecrosis (Gas Gangrene)
-acute clostridial infection of the muscles (c. perfringens >95% cases)

Crush Injury/Compartment Syndrome
-acute traumatic injury resulting in inadequate perfusion and tissue hypoxia

Decompression Sickness
-formation of inert gas bubbles in tissues and/or blood

Arterial Insufficiencies
-Central Retinal Artery Occlusion
-Enhancement of Healing in Problem Wounds

Exceptional Blood Loss Anemia
-patient refusal of blood, cross matching difficulties

Necrotizing Fasciitis
-acute, potentially fatal, infection of fascia and muscle

Delayed Radiation Injury
-bone or soft tissue complications from therapeutic radiation

Osteoradionecrosis
-mandibular necrosis from therapeutic radiation

Thermal Burns
-acute management: wound healing support
-typically not covered by insurance

Idiopathic Sudden Sensorineural Hearing Loss

Compromised Grafts and Flaps
-flap salvage and preservation in compromised tissues
10
Gas Laws
Gas Laws play a key role in understanding how hyperbaric oxygen treatment works.
While there are numerous gas laws, we will focus on the primary four, namely: Boyle’s
Law, Charles’ Law, Gay-Lussac’s Law, and Henry’s Law.
BOYLE’S LAW
-Boyles Law illustrates the relationship between pressure and volume. It
states that the pressure and volume of a gas are inversely proportional
(shown right). A good example of Boyles Law is if you were to place a
balloon in a hyperbaric chamber and INCREASE the pressure to 2 ATA, the
balloon volume will DECREASE to half its normal size.
HENRY’S LAW
-Henry’s Law specifies that the partial pressure of a gas dissolved in a liquid is
directly proportional to the pressure exerted on that gas. Therefore, increasing the
partial pressure of oxygen results in more oxygen dissolved in the blood (shown right).
A more common example of Henry’s Law is opening a can of soda for the first time.
When you open the can of soda you are reducing the amount of partial pressure of
nitrogen dissolved into the soda. Thus, causing the gas to escape which creates the
“bubbling” effect typically seen.
CHARLE’S LAW
- Charles’s Law illustrates the relationship between volume and temperature. It
states that a change in temperature will result a change in the volume of gas. For
example, if you were to submerge a balloon into an extremely cool environment it
will reduce in volume.
GAY-LUSSAC’S LAW
-Gay-Lussac’s law specifies that the pressure of a fixed amount of gas is directly proportional to its
temperature. For example, at the beginning of a hyperbaric treatment (on descent) the increase in
pressure will also cause an increase in temperature.
11
Terms of Pressure
Understanding these terms of pressure that are commonly used in hyperbaric medicine
will help you master key aspects of your job as a technician. The main use of these units
of pressure is for interpretation of the gauges on the chamber control panel. All
hyperbaric chamber gauges are unique and display different units of pressure. Another
use could be to determine the total bottom time of a technician when referring to the
decompression tables for Repeat Designation or “Repet”.
Absoulte Atmospheres of Pressure (ATA) Expressed as Millimeters of
Mercury (mmHg), Feet of Sea Water (FSW), Pounds Per Square Inch (PSI),
and Atmospheres (atm)
Gauge Pressure
(atm)
0
1
2
3
4
Absolute Pressure
(ATA)
1
2
3
4
5
mmHG
760
1520
2280
3040
3800
FSW
0
33
66
99
132
PSI
0
14.7
29.4
44.1
58.8
Air pressure can be specified in several ways; the most popular term used in scuba
diving is "pounds per square inch" or "psi." At sea level, the pressure exerted by the
atmosphere is 14.7 psi. "Per square inch" refers to the surface area subjected to the
weight of the air above it; the units could just as well be "mmHg," "fsw" or "absolute
atmospheres".
12
Dive Terminology

Descent/Compression- is the beginning of the treatment characterized by the gradual
increase in pressure. The air temperature during descent will increase.

Ascent/Decompression- the end of the treatment. When the pressure is gradually
being reduced to allow the dive to arrive back at the surface. The air temperature
during ascent will decrease.

Treatment Depth/ Pressure- the pressure prescribed by the physician.

Decompression Stop- is a specified depth where the dive must remain for a specified
length of time (stop time). This brief pause during the ascent is to allow any excess
nitrogen accumulation to be eliminated. MHC’s decompression stop is typically 3
minutes but can be as long as 5 minutes.

Descent Time- is the total elapsed time from the time the dive leaves the surface to the
time it reaches the bottom. This portion of the treatment usually lasts between 10-15
minutes.

Total Bottom Time (TBT)- is the total elapsed time from the time the dive leaves the
surface to the time it leaves the bottom. This includes 90 minutes at the treatment
pressure+ 10/15 minutes of descent time totaling 100-105 minutes.

Total Decompression Time (TDT)- is the total elapsed time from the time the dive
leaves the bottom to the time it arrives at the surface. This time is also frequently called
the total ascent time. This portion of the treatment usually lasts a total of 15min, and
includes the Decompression Stop.

Total Time of Dive (TTD)- is the total elapsed time from the time the diver leaves the
surface to the time it arrives back on the surface.

Surface Interval (SI)- is the time a diver spends on the surface between dives. It begins
as soon as the diver surfaces and ends as soon as he starts the next descent.
TBT
DT
90 min
min0i
n90
TTD
SI
TDT
13
Treatment Protocols (Treatment Table 9)
Mobile Hyperbaric Center’s goal is to maintain a safe environment for technicians and
physicians while offering the most appropriate treatments for the patients. MHC has
established its own dive protocol based on the USN Decompression Tables (rev. 6). The
standard dive schedule is 45/114 or 2.4 ATA for 90 minutes. This profile is accompanied
by additional safety precautions including oxygen breathing for the last 20 minutes of
the treatment and a 3 minute decompression stop at 1.6 ATA (20fsw). Certain patients
will require an alternate dive protocol, including high risk seizure patients. This is left to
the discretion of the supervising physician at each center. Radiation injuries are to be
treated at 2.4 ATA at all times. All other diagnoses including diabetic ulcers, chronic
osteomyelitis, and failed grafts can be treated at 2.0 ATA if there is a need to
accommodate a specific patient. Again this will be left to the discretion of the
supervising physician. Our standard protocol for attendants and patients is described
below.
KEY:
Standard Path
Air Break
Oxygen in Use
Standard MHC Dive Protocol
-
10-15 minute compression (descent) of the chamber to depth of 2.4 ATA
85 minutes on oxygen with 5 minute air break at 45 minutes
3 minute decompression stop at 1.6 ATA (20 fsw)
10-15 minute decompression (ascent) of the chamber to 1.0 ATA (includes oxygen breathing)
Diagram: Standard Dive Protocol
ASCENT
STEP 8
End at 1.0 ATA
STEP 2
Descent
STEP 1
Start at 1.0 ATA
STEP 3
Reach “depth”
2.4 ATA (45fsw)
STEP 4
45 Min
Oxygen
STEP 5
5 Min
air-break
STEP 6
40 Min
Oxygen
STEP 4
Technician
breathes Oxygen
for the last 20 min
at depth.
STEP 8
Deco-Stop
1.6 ATA for 3 min
14
Treatment Protocols (Seizure)
Patients who have an increased risk of seizures are given an additional oxygen break as
shown below. An additional option would be to also reduce the treatment pressure to
2.0 ATA to further minimize the risk of a seizure. This is less desirable, as it is potentially less
beneficial for other patients in the treatment session. This decision is always left up to the
discretion of the supervising physician.
- 10-15 minute compression (descent) of the chamber to depth of 2.0 or 2.4 ATA
- 30 minutes on oxygen then 5 minute oxygen break followed by
- 30 minutes on oxygen then 5 minute oxygen break followed by
- 20 minutes back on oxygen to complete the treatment
- 3 minute decompression stop at 1.6 ATA (20fsw)
- 10-15 minute decompression (ascent) of the chamber to 1.0 ATA (includes oxygen
breathing)
Diagram: Seizure-Risk Dive Protocol
ASCENT
STEP 9
End at 1.0 ATA
STEP 2
Descent
STEP 1
Start at 1.0
ATA
STEP 3
Reach “depth”
at 2.4/2.0 ATA
STEP 4
30 Min
Oxygen
STEP 5
5 Min
air-break
STEP 6
30 Min
Oxygen
STEP 5
5 Min
air-break
STEP 5
20 Min
Oxygen
STEP 8
Deco-Stop at
1.6 ATA for 3 min
STEP 7
Technician
breathes Oxygen
for the last 20 min
at depth.
**Any deviation from this protocol must be approved by the Chief Medical
Officer in advance.**
15
Treatment Protocols (Repeat Dives)
MHC has established a dive protocol for the instance where a technician might attend
one (1) 90 minute treatment and half of a second treatment, at 2.4 ATA, in one day.
This repeat dive protocol is based off of the USN Decompression Tables (Revision 6). An
example would be if a technician attended DIV 1 or DIV 2 and a half of DIV 4. As seen
on page 14, the standard dive schedule used is 45/114. In the event of a repeat dive, a
new dive schedule must be followed thus increasing the length of the decompression
stop. If the technician has no less than 3 hours and 30 minutes of surface time, the new
dive schedule for the repeat dive is 45/140. The technicians will be rotated just prior to
the normal air break to prevent either technician from exceeding 60 min of TBT. Both
technicians will then breathe supplemental oxygen throughout the ascent (approx. 15
minutes), and during the decompression stop. The decompression stop will be
increased to 5 minutes at 1.6 ATA (20fsw).
Diagram: 45/140 Repeat Dive Protocol
**Any deviation from this protocol must be approved by the Chief Medical
Officer in advance.**
16
Treatment Protocols (No “Deco”)
Mobile Hyperbaric Centers does not require a decompression stop for a dive at 2.0 ATA that has
less than125 minutes of TBT.
ASCENT
STEP 1
Start at 1.0 ATA
STEP 5
End at 1.0 ATA
STEP 2
Descent
STEP 3
Reach “depth”
2 ATA (33fsw)
STEP 4
Technician breathes
Oxygen for the last
20 min at depth.
**ANY deviation from these protocols must be cleared through the Chief
Medical Officer in advance.
MHC recommends at least 24 hours between an airplane flight and the most recent dive. For
example, if a technician or physician is in a dive from 8am-10am on Tuesday, they should not
be in a flight any earlier then 10:00am on Wednesday.
Any questions regarding this policy can be directed to the Chief Medical Officer.
17
Contraindications
Contraindications for Hyperbaric Oxygen Therapy are divided into two categories,
absolute and relative. Absolute contraindications are conditions in which there are no
reasonable circumstance to undergo treatment and that the risk outweighs the
potential benefit. Relative contraindications are conditions in which there are higher
risks of complications, but these risks may be outweighed by substantial benefits.
Contraindications of Hyperbaric Oxygen Therapy
Expressed in 2 Categories, Absolute and Relative.
Absolute
Untreated Pneumothorax
Pregnancy
Relative
Cis-Platinum® (chemo)
URI and chronic sinusitis
High Fever
Emphysema/COPD with CO2
Retention
History of a Spontaneous
Pneumothorax
History of Surgery for Otosclerosis
Seizures Disorders
History of Optic Neuritis
Congenital Spherocytosis
Thorax Surgery
Pacemaker
Claustrophobia
Asthma
Adriamycin® (chemo)
Sulfamylon ® (burn ointment)
Above: Pneumothorax
18
Complications and Side Effects
Hyperbaric Oxygen Therapy is generally a safe procedure, and complications are rare. But, as
with any medical procedure, it does carry some risk. Potential side effects are shown below.
Middle Ear Barotrauma- any traumatic ear injury or pain caused by
an inability to equalize ears during a change in atmospheric pressure. This
is the most common side effect of hyperbaric oxygen therapy. All of the
following conditions predispose patients to ear barotrauma; cleft palate
disfigurement, head/neck radiation, allergies, upper respiratory infection
and intubated/unconscious patients. Severity is calculated by using the
TEED SCALE shown right. Also shown is the anatomy of the human ear .
Prevention of ear barotrauma can be accomplished by educating the
patient on good ear
clearing techniques
and the use of nasal
decongestants.
Treatment for damage
to the middle ear
includes a break from
hyperbaric treatment.
This can range from as
little as a day up to
one week.
Sinus Barotrauma “Sinus Squeeze”- any traumatic injury or pain
caused by an inability of the sinuses to equalize during a change in
atmospheric pressure. This is most commonly caused by allergies,
edema or mucous buildup from the common cold. Prevention of a sinus
squeeze can be accomplished by educating the patient on good sinus
clearing techniques and pretreating with nasal decongestants and
steroids. Treatment for damage to the sinuses includes a break from
hyperbaric treatment until symptoms resolve.
Tooth Barotrauma “Barodontalgia”- is a rare form of tooth pain that occurs when a small amount
of trapped air in a tooth expands on ascent. This is more likely to occur in patients with a new/loose filling
or a recent root canal. Treatment for barodontalgia includes a break from hyperbaric treatment and to
referral to a dentist.
Claustrophobia/Anxiety- Hyperbaric therapy may cause some degree of confinement anxiety,
even in a multiplace chamber. Occasionally, mild sedation is required for such individuals to continue to
receive daily hyperbaric therapy. Treatment for claustrophobia includes a written prescription for an
antianxiety medication by the Primary Care Physician (PCP).
19
Complications and Side Effects
CNS Toxicity “ Oxygen Seizure”- is an extremely rare side effect of hyperbaric oxygen therapy and
results from breathing high partial pressures of oxygen. It is characterized by visual and hearing
abnormalities, unusual fatigue, muscle twitching, anxiety, confusion, incoordination, and convulsions.
Some medications, high fever, and a history of a seizure disorder could make a patient more susceptible
to an oxygen toxicity seizure (OTS). Prevention of an OTS includes identifying patients at risk and ensures
they are on a seizure protocol during HBOT. Premedication with an anticonvulsant such as Ativan® has
been shown to lessen the chance of an OTS in patients with an increased risk. Treatment for an OTS is to
immediately remove the patient from oxygen. A more detailed outline of management of an OTS can be
found in the MHC Safety and Operations Manual.
Visual Changes- Progressive myopia has been observed in some
patients undergoing prolonged periods of daily hyperbaric therapy.
Although the exact mechanism remains obscure, it is apparently lenticular in
origin and usually reverses completely within several weeks after the last
therapy. Myopia is the most frequently reported side effect of hyperbaric
therapy. It has been suggested that hyperbaric therapy causes the
formation of cataracts. Although this has been disproven, in some cases
hyperbaric therapy can cause enlargement of existing cataracts in patients
who have received >100 treatments.
Hypoglycemia- It is typical that a diabetic patient on glucose
management will experience a significant drop in blood glucose levels
(BGL( during a hyperbaric treatment. The typical drop is 50 mg/dl. Careful
monitoring of all diabetic patients BGL is required to
minimize the risk of a hypoglycemic reaction.
Prevention of a hypoglycemic reaction includes
encouraging all diabetic patients to follow a proper
diabetic diet and eat a meal immediately before
hyperbaric treatment. The patient can also be given
juice to accompany them during treatment should
signs/symptoms do arise. Initial Treatment for a
hypoglycemic reaction is to quickly administer either oral
glucose gel or tablets. A more detailed outline of the
management of a hypoglycemic reaction can be found
in the MHC Safety and Operations Manual.
Pneumothorax(otherwise known as a collapsed lung)Is an abnormal collection of air or gas in the pleural
space that separates the lung from the chest wall. This
can spontaneously occur during hyperbaric treatment or
secondary to positive pressure ventilations and
bronchospasms, or holding your breath during pressure
changes. Prevention of a pneumothorax could include a
preliminary chest x-ray to rule out any areas of concern.
Treatment for a pneumothorax can include a needle thoracostomy. The patient should be transported to
the nearest emergency room for chest tube placement.
20
Governing Organizations
The Undersea and Hyperbaric Medical Society (UHMS) is an international, non-profit
organization that is the primary source of scientific information for diving and hyperbaric
medicine physiology worldwide. More information regarding the UHMS can be found
on their website at www.uhms.org
The National Board of Diving and Hyperbaric Medical Technology (NBDHMT) is a nonprofit certifying organization designed to meet the clinical, technical and safety needs
of the discipline of undersea and hyperbaric medicine. Opportunities exist for
certification as a Diver Medic (DMT), as a Hyperbaric Technologist (CHT), as
a Hyperbaric Nurse (CHRN) and as a Veterinary Hyperbaric Technologist (CHVT). More
information regarding the NBDHMT and certification can be found on their website at
www.nbdhmt.org.
21
Job Description
The Hyperbaric Technician provides Hyperbaric Oxygen Therapy to patients referred to Mobile Hyperbaric Centers
(MHC). Hyperbaric Technicians administer and monitor oxygen therapy as well as work collaboratively with all other
disciplines assigned at the center, including hospital locations MHC is assigned to operate in.
Position: Hyperbaric Technician
Facility: Outpatient Multiplace Hyperbaric Department
Administer and monitor hyperbaric oxygen therapy
 Prepare, educate, and orient patients about hyperbaric oxygen therapy
 Safely maintain, operate and attend to the hyperbaric chamber
 Accurately obtain and document patient assessment and vital signs
 Safely transport patients to/from hyperbaric chamber
 Accurately document patient information in Electronic Medical Record (EMR) system
 Clean hyperbaric chamber, clinical equipment and patient care areas with approved cleaning agents
 Maintain daily and periodic equipment maintenance documentation including service logs for the hyperbaric
equipment
 Communicate any abnormal patient assessment findings with center’s physician
 Attend staff meetings and participate in MHC quality assurance programs and safety drills
 Maintain accurate hyperbaric chamber dive log
 Maintain annual competencies, training requirements, licensures, certifications and relevant documentation
required by hospital, MHC and state/federal regulations
 Responsible for periodic education completion per hospital and MHC requirements, including but not limited to:
annual competencies, training and on-site education workshops
 Understand and comply with infection control, HIPAA and Joint Commission regulatory standards per hospital,
MHC and state/federal policies
 Assist Practice Manager/Coordinator with administrative duties when necessary
 Positively interact with fellow staff and patients in a friendly, professional and constructive manner
 Maintain professional boundaries with co-workers, patients and patient’s family members
QUALIFICATIONS





High school degree or equivalent
Valid and current BLS certification
Valid and current EMT licensure
Good computer skills including working knowledge of Microsoft office suite; prior experience with an EMR
system preferred
Good verbal and written communication, customer service and time management skills
Ability to work rotating weekend shifts as needed
22
Administrative Duties
Although the Hyperbaric Technician’s role is primarily clinical, there are also some
administrative duties required. The graph below shows some of the general
administrative duties associated with a hyperbaric patient. It begins with receiving a
referral and continues with sending follow-up letters weekly. Please discuss with your
Practice Manager what your responsibilities will be at your center.
Referral Process- is the initial communication from another Physician requesting that we
evaluate their patient for hyperbaric therapy. If a Physician’s office calls to send us a
patient follow the steps below:
1. Transfer Call to Practice Manager OR
2. Locate MHC Referral Form. Ask the Caller for the
Patient’s Name, DOB, Patient Phone #, Referring
Provider, Their Fax #, and insurance information (if
available)
3. Inform the Caller you will be faxing the Referral Form
and they need to complete the remaining fields,
have the MD sign it, and return it with the patient’s
last clinic note.
Patient Transportation- Sometimes under unique circumstances it is necessary for MHC
to provide transportation to patients who are unable to travel to treatment. Check with
your Practice Manager to understand your responsibilities with transportation at your
center.
Referral
Follow- Up
Letters
H&P
Hyperbaric Patient
Patient
Transportation
Patient’s
1st Day
23
Follow-Up Letters- are created weekly by the Hyperbaric Physician to send out to
referring providers. These letters provide an informative narrative of their patients’
progress at hyperbaric therapy. You could be asked to assist in the preparation and
delivery of these letters.
Patient Wound Photographs- are photos taken on a weekly basis by the Hyperbaric
Physician to measure the patient’s progress and wound healing. It is possible you could
be asked to obtain a patient photo during normal business hours. The proper technique
for capturing an accurate photo will be shown to you during your initial training. Please
refer to the steps below when capturing a patient wound photo.
1. Refer back to the patient’s prior photo to maintain accuracy and consistency
2. Locate Camera and Ruler (shown below)
3. Create a label and write in patient initials, date, and wound # and then place onto ruler
4. Put on gloves
5. Place ruler square to desired wound. Make sure to get Entire Wound and White Scale Box
in the photo!
6. Focus camera, capture image
7. Upload desired image into patient’s folder and subsequently map with 4-D Imaging
Software
Patient Photo
Camera and Ruler
24
History and Physical- is the patient’s initial evaluation by the Hyperbaric Physician. During this
visit it will be determined if the patient is a candidate for Hyperbaric Therapy. This initial visit or
History and Physical (H&P), contains key steps to be completed by all of the hyerpabric staff.
These steps are outlined using a combination of forms now called the “H&P Packet.”
Please refer to the employee intranet for the latest packet. All center employees are meant to
participate in this process.
25
Employee Handbook
The Employee Handbook contains important information about policies affecting
employment with Mobile Hyperbaric Centers (MHC). It describes many employee
responsibilities, both as a healthcare professional, and MHC employee by outlining
programs developed by the company to benefit employees. One of Mobile
Hyperbaric Centers’ major objectives is to provide a work environment that is favorable
to both personal and professional growth.
26
Safety and Operations Manual
Mobile Hyperbaric Centers’ top priority is to assure our facilities are safe for both
patients and employees. This manual focuses on safety policies and procedures
pertinent to your employment with MHC. By following the regulations and policies set
forth in this manual, all areas of our facilities are limited in risk. Please take time to
familiarize yourself with this manual, specifically on key areas affecting day to day
operations. These areas include; patient and facility emergencies, chamber venting
procedures, and the prohibited items list. A copy of the Safety and Operations Manual
must be keep at that control panel in front of the Chamber Operator at all times.
27
Safety (Seizure Protocol)
Some of our patients are at an increased risk for experiencing an oxygen toxicity
seizure. For these patients, MHC has developed a unique treatment profile to further
minimize the occurrence. The Hyperbaric Physician will identify these patients during the
H&P and distinguish this patient by checking “Seizure Protocol” on the Physician
Checklist Form. This information can also be verbally expressed to the clinical staff as a
secondary means of communication. It should be routine for all the technicians to
familiarize themselves with any unique circumstances defined by the Hyperbaric
Physician on the Physician Checklist Form PRIOR to the patient beginning treatment. If a
patient is identified as being on a seizure protocol they need to be identified 2 ways:
1. Red dot is placed on the patient’s plastic rim of the hood (next to name label).
This informs the chamber attendant which patients are on a seizure protocol.
2. A combined list of all patients on a seizure protocol is posted in the control panel
area in plain view. Be sure to use INITIALS ONLY! (shown below) This will inform the
chamber operator which patients are on a seizure protocol.
28
Safety (Falls Prevention)
All patients in our care at Mobile Hyperbaric Centers will have a Fall Risk Assessment
completed by the Hyperbaric Physician. The assessment will be a part of the patient’s
initial history and physical.
Any patient noted to be at a risk for falls will be identified. MHC identifies patients by
giving them a RED silicone bracelet on their first day of treatment, and by keeping a
patient list in PLAIN VIEW in the control panel area (shown below). The patient is
informed this bracelet is to be worn at all times during their course of treatment, no
exceptions. It is the responsibility of all staff to ensure every patient at risk for a fall is
identified daily. It might be necessary to consult with your hospital on the unique
identifiers utilized to remain compliant with JOINT COMMISSION standards.
Falls Risk Wristband
29
Safety (Prohibited Items)
Mobile Hyperbaric Centers’ top priority is to assure our facilities are safe for both patients and
employees. Furthermore, never permit entry of any item into the chamber that may
contaminate the environment. Open or vent any sealed containers to eliminate the risk of
implosion/explosion. Items that may be subject to collapse or rupture include, but are not
limited to, the following: water bottles, endotracheal tube cuffs, and Foley bags.
*Note: Endotracheal tube cuffs and catheter bulbs should be filled only with normal saline, do
not use air. Foley bags must be emptied prior to treatment.
Certain items can result in a fire or explosion of the Hyperbaric Chamber, causing
serious injury or death. Being familiar with items not allowed in the chamber is extremely
important! Prohibited items within the chamber include (but not limited to):
Hearing Aids/Dentures
Shoes/Socks
Jewelry
Watches, Keys
Cell Phones/Pagers
Perfume/Cologne
Lotions/Oils
Cigarettes/Lighters
Batteries
Electronics
Coins/Money
Hair Spray/Gel/Mousse
Nail Polish
Make-up
Medications
Newspapers/Magazines
Metal Objects
Matches
Wool/Nylon/Silk/Satin
30
Safety (Chamber Venting)
In the event where the hyperbaric chamber reaches an elevated percentage of oxygen, it is
necessary to “vent” or “flush” the chamber. This will allow the air to circulate and return the
environment to safe operating parameters (<23.5%). Venting is mandatory to maintain a safe
environment for the patients and staff during a Hyperbaric Treatment. Please follow the steps
below to safely ventilate the hyperbaric chamber.
Chamber Operator
1. Identifies leak by visualizing the oxygen sensor on the control panel (anything above 21 %)
*Note: The oxygen sensor will not alarm until levels reach 23%. It is ideal to identify and correct
a leak before the alarm sounds to minimize the potential for levels to become
unmanageable.
2. Verbally inform Chamber Attendant of elevated oxygen levels and instruct them to inspect
for a leak. Chamber Attendant must begin physically inspecting each patient (see steps
below).
3. Monitor oxygen levels for changes
4. Vent chamber if oxygen level > 23 %
5. Venting protocol: (1) Vent the chamber for a period of 10 minutes (or less if the atmosphere
returns to 21%). To do so, open the press valve and primary exhaust simultaneously. Make sure
to maintain adequate pressure in the chamber. If the Chamber has not reached an oxygen
level less than 23.5% in 10 minutes, turn off oxygen, and continue venting.
6. If you are unable to correct the problem inform the HBOT physician
7. Ascend the chamber if oxygen level > 28%
8. Document the chamber was vented and duration in the Dive Log under the notes section
Chamber Attendant
1. Inspect for a leak by inspecting each patient for trouble areas. Trouble areas include:
a. Neck ring (look for micro-tears or “bunching” and bad positioning of the patient)
b. Caps (check to ensure both side caps are firmly in place)
c. Hose (inspect for holes, and ensure it is firmly attached to neck ring)
d. Helmet (inspect helmet for holes especially around the seal to the neckring)
e. Flow Rate (Ensure flow rate is properly set for the patient needs. The typical range is
20-30 lpm) If the flow is set to high this can cause excess oxygen to leak out the
bottom of the patient’s neck ring.
f. As a last resort, activate the Snooper (use when necessary)
2. Inform Chamber Operator if the source has been identified and problem has been corrected
3. Maintain calm environment in chamber
31
Safety Director Course
As a full time technician, you are required to participate in the Mobile Hyperbaric
Centers Rotating Safety Director Program. The program is designed to allow every
technician to act as the Safety Director on a monthly basis. The Safety Director Course
can be found on the company Intranet and should be completed on the first day of
employment. Successful completion is measured by passing the Safety Director Exam
with an 80%.
Pathway to access the Safety Director Exam
-Intranet/Education/New Full Time Requirements
32
Operational Equipment (Mechanical)
Hypertec HBO Chamber:
The hyperbaric oxygen chamber is fabricated per ASME-PVHO regulations and standards. It is designed
to treat as many as eleven (11) patients at one time with a technician present. The maximum pressure
rating is 3 ATA or 44.1 PSI. The unit is configured with two compartments. The Main Chamber as shown in
diagram above is 84” in diameter x 22’ in length. The second chamber is referred to as the “Entry Lock
Chamber” which is 84” in diameter x 5’ in length. The Entry Lock is utilized periodically to transfer patients
or medical personnel in or out of the main chamber in order to avoid interruption of the dive cycle. The
chamber is also equipped with a “Medical Lock” which is a circular passage. It allows for quick transfer of
small items in/out of the chamber.
Wheelchair Lift:
Description:
Each unit is provided with a wheelchair lift which is utilized to raise patients
from ground level to the level of the chamber control room. Each
location has slight variations with facility connector and therefore loading
and operations should be reviewed per location.
a) Braun UVL Series
The UVL or Under Vehicle Lift is cassette type mount in the side of trailer
which is deployed as needed for patient loading. The unit is operated
hydraulically and has a maximum capacity of 600 pounds. The usable
platform size is 30” in width x 43” in
length. Many safety locks and barrier
features are integrated into the unit and
should be thoroughly understood by the
operator. Please review the
manufacturer’s operation manual for
complete instructions.
Braun UVL Lift
b) Ultron MDC 4048
The Ultron MDC 4048 is a rail style platform lift which is lowered from the
exterior side of the trailer. The unit is powered by a combination of
hydraulic cylinders which activate a chain and sprocket system. The
usable platform size is 40” wide x 48” in length and load capacity of
2,000 pounds. Many safety locks and barrier features are integrated into
the unit and should be thoroughly understood by the operator. Be sure
to review the manufacturer’s operation manual for complete
instructions.
33
Operational Equipment
Air Compressor Package:
Description:
The compressor system is the primary piece of equipment for the mobile hyperbaric operation. The
system is designed to meet federal standards for oil free medical grade air. The compressors are located
in the very rear compartment of the trailer. The compressor package is powered by 480 volts, three phase
shore power supplied by host facility. If main power is lost from host facility the system is rendered
inoperable other than air stored in receivers. As with typical medical grade air systems the package is
designed to deliver twice the required operational air with redundant processing equipment in order to
facilitate service and repairs if necessary. The compressors are controlled by the PICO™ located on the
control panel, and secondarily by a PICO™ on the breaker box below the compressors. The compressors
are turned on by pressing “ALT” three times on the PICO. This should be done routinely at the beginning of
every work day. To shut off the compressors select “OK” on the PICO™ controller. Should an emergency
arise, the compressors can be shut off by pressing the large red button labeled “emergency shut-off.”
Depending on your facility you will be equipped with one of the two compressor packages shown below.
a) Champion Reciprocation Compressors
This system operates four 10 HP Champion two stage reciprocating
compressors delivering 35.4 CFM of free air each @ 175 PSIG for a total
volume of 141.6 SCFM. The compressed air is processed through several
stages beginning with an air cooled heat exchanger. Next, the air travels
through a tube and shell water cooled heat exchanger, and finally
through appropriate particulate and carbon filters. The compressors are
controlled by the PICO™ which monitors all equipment operation and air
quality. The compressed air is stored in two 33 gallon stainless steel air
receivers for delivery at time of chamber pressurization and treatment
cycle.
b) Powerex Scroll Compressors
This system consists of eight 5 HP Powerex™ Scroll compressors delivering
12.1 SCFM of free air each @ 145 PSIG for a total volume of 96.8 SCFM. The
compressed air is processed through refrigerated air dryers and
appropriate particulate and carbon filters. The compressors are controlled
by the PICO which monitors all equipment operation and air quality. The
compressed air is stored in two 33 gallon stainless steel air receivers for
delivery at time of chamber pressurization and treatment cycle.
Daily Visual Inspection:
On a monthly basis a technician should visually inspect equipment
for following:
1. Rubbing stainless steel hoses, copper tubing etc.
2. Check air cooled after-cooler “radiator” surface for blockage
3. Check V-belt belts for glazing/wear
4. Check condition of compressor base vibration mounts
5. Listen and look for air leaks or fluid leaks
6. Listen for unusual knocks, squeals, or chirping noises
*Note: Should any of the above conditions develop contact the Director of Facility Maintenance.
Medina has (2) Kaeser Compressors.
34
Environmental Control Unit - ECU:
Description:
The Environmental Control Unit (ECU) provides cool air to patients
inside the chamber during the treatment cycle. The unit is black
and is located at the front of the chamber. The cooling process
begins by drawing internal chamber air in through the bottom
and over a charcoal filter. Air is then circulated across a set of
chilled radiator coils by means of two pneumatic blower motors.
Finally, cooled air exits on the top side of the unit above the
television.
Operation:
The ECU is turned on manually by the black valve on the upper left hand side of the unit. The air is
circulated by two pneumatic blower motors which should be set at 80 PSI by the regulator on the upper
left side of the unit. It can be adjusted to the desired speed merely by opening the Flow Control Ball
Valve located on the left side above the regulator. As with any air conditioning process there is
condensate which accumulates internally. A collection trough is located below the chilled radiator coils
and requires routine draining. During warmer months this should be done daily at the end each
treatment. During the winter months draining is usually unnecessary. To drain the condensate, manually
turn the drain valve so it is parallel with the brass piping (shown below). (NOTE: Must be done under
pressure). The ECU drain is located on the bottom left hand side of the unit. Medina has (2) Amron units.
ECU ON/OFF VALVE
35
Air Cooled Refrigeration Chiller:
Description:
The refrigeration chiller has two functions. The primary function
is to provide a cooling process for the compressed air system.
This cooling process takes place when air flows through what is
referred to as a tube and shell heat exchanger or “chiller”.
Chilled fluid circulates in the outer shell of the heat exchanger
cooling the air flow in the inner tube. The second function is to
provide the ECU with chilled fluid to allow climate control inside
the hyperbaric chamber.
Operation:
The unit is in continuous operation per manufacturer’s
recommendations. The chiller and its functions are monitored by the
Pico controller. In the event set parameters deviate, warnings are displayed on the control panel. The
CHILLER can be manually shut off by the green power switch located on the control panel.
Daily visual inspection should be performed to monitor fluid levels, temperature and inspect cleanliness of
the intake filter. Daily visual
inspections are mandatory. Should
a malfunction arise be sure to
initially check for the following; fluid
leakage, excess temperature or
foul odor.
*Note- primary service is to refill
chiller fluid reservoir with glycol or
anti-freeze.
Oxygen Supply/Farm
Description:
All clinical hyperbaric chambers require a continuous oxygen supply, typically Liquid Oxygen (LOX). Many
gases liquefied at low temperature can be supplied in large tanks capable of holding tens of thousands
of liters (shown below). This method is more efficient when large volumes are consumed. Cylinders of
oxygen are frequently used as an emergency backup source.
Oxygen Farm
Oxygen Line
Oxygen Pedestal
36
Television Enclosure:
Description:
All our hyperbaric chambers are equipped with an LED
HDTV. It provides entertainment for the patients during
their hyperbaric treatment. The actual tuning controls
for the programs and movies are performed by the
Chamber Operator on the exterior of the chamber
depending on your system set-up.
Equalization & Venting Operation:
The television is encased in a sealed Plexiglas enclosure which is designed to segregate the electrical
circuitry from the pressurized atmosphere of the chamber. This creates the need to circulate air through
the enclosure in order to dissipate heat generated by the television and to equalize the pressure on the
Plexiglas case. The pressure equalization and heat
dissipation is accomplished by means of two
mechanical check valves. One allows external
pressure to enter the enclosure and balance internal
with external and the other is to balance pressure
during dive ascent and heat dissipation resulting from
the operation of the television. Another requirement
for heat rejection is to create an air flow. This is
accomplished by inducing regulated air into the
enclosure at 5 PSI above chamber operating pressure,
approximately 20 PSI.
37
Fire Suppression System (FSS):
In the event of a fire at a Mobile Hyperbaric Centers location, all chambers are equipped with a fire
suppression system (FSS). Fire suppression systems are used in conjunction with smoke detectors and fire
alarm systems to ensure safety at the centers. The extinguishing system includes spray nozzles and hoses
that are located inside the chamber. Mobile Hyperbaric Centers’ systems are compliant with the
National Fire Protection Association (NFPA 99). The Fire Suppression system is routinely tested twice a year.
Description:
Per National Fire Protection Association (NFPA-99) the hyperbaric chamber is required to operate with
two separate fire suppression systems. The first is referred to as a deluge system, where upon activation,
the chamber receives 2 gallons of water per internal floor space square foot within one minute (about
365 gallons). The second “system” is the ability to
operate at least two hand held water nozzles with a
flow rate of five gallons of water for four minutes.
Both systems have been engineered to these exact
specifications. These details are outlined in the
System Evaluation Manual prepared by Coker
Engineering, LLC.
Operation:
Two on-board water storage tanks hold the
required amount of water for activation. The deluge
system tank holds 365 gallons and is located in the
lower bay directly under the area of the control room. The 40 gallon hand line tank is stored in the rear
section of the chamber.
1. Deluge Activation
a. First, remove the white Delran Safety Clevis
b. Next, push the red “Activation Button”
*Note: There are multiple locations for system activation. Activation can be done
at either the control panel, entry lock, or one of two
inside the hyperbaric chamber. Also, system override is
possible by turning the red ball valve to the “Override”
position.
2. Hand Line Activation
a. Activation of Hand Line system is accomplished by
opening the supply by use of the red valve on the hose.
b. Turn the red valve parallel to the supply piping to charge
Hand Line
the hand line.
*Lights and communication will immediately switch to a
battery a backup system*
Note: Some systems are equipped with a sapphire system. Please consult your
trainer for more information related to this.
38
Control Panel:
The control panel houses the instruments and controls necessary for the safe and effective
operation of the hyperbaric chamber and its subcomponents. The control panel layout will vary
depending on your location.
PICO
Chamber Monitors
Fault Lights
Entertainment Volume
Chamber Lights
Communications
Oxygen Sensor
Main Lock
Pressure Gauge
Entry Lock
Pressure Gauge
Entry Lock
Press Valve
Main Lock
Press Valve
Main Lock
Exhaust Valves
FSS Pressure
Gauges
On-Board Generator
Description:
Located on the front of the trailer is a 24 KW diesel generator. This unit is not
capable of supporting patient treatment cycles due to power requirements
of the compressor package. The primary focus of this unit is to support
necessary equipment to allow for safe abortion and evacuation of our
patients. This could occur should we lose main power provided by our host
facility. The unit also provides adequate climate control required for
equipment and fire suppression storage tanks. The generator should be run
for 30 minutes, once a month as part of the safety program.
39
Entry Lock:
The Entry Lock is the secondary treatment compartment of the hyperbaric chamber. Generally, the entry
lock is used for emergency access and removal of patients or as an extension of the hyperbaric
treatment room. There have also been instances where the entry lock is used to transfer large items in/out
of the hyperbaric chamber such as hoods or blankets. Controls for operating the entry lock can be found
on the control panel. Please be aware that the entry lock pressurizes at a faster rate and will need to be
closely monitored when patients or staff are inside. The steps for ASCENDING in the entry lock are outlined
below.
1. Chamber operator changes the secondary pressure gauge to “entry lock”
2. Entry lock attendant or physician will then turn the entry lock exhaust valve 45 degrees (Step 1)
when they are ready to begin ascending. The main lock door must be closed during the ascent in
the entry lock.
3. At 1.7 ATA the entry lock attendant will completely open the exhaust
valve to the complete parallel position (Step 2)
4. At 1.3 ATA the chamber operator will then open the entry lock exhaust
valve located on the control panel.
Step 1
Step 2
MedLock:
The Medlock is a quick access pass thru port designed for transferring small objects in and out of
the hyperbaric chamber. It must be pressurized to the side that will be accessed before it will
open. To send items into the hyperbaric chamber follow the steps below:
1. Pressurize the Medlock to the exterior by turning the black arrow so it faces toward you
2. Gently unscrew each of the four clamps to open
the access door
3. Place contents into Medlock
4. Close access door
5. Line up seals on access door and begin
sealing clamps a little at a time until all
clamps are firmly closed
Turn Here
6. Finally, turn the black arrow away from
you back toward the interior of the
chamber
40
Maintenance
It is the responsibility of all the clinical staff to understand how to complete routine
maintenance of the hyperbaric chamber and all of its subcomponents. This section
briefly outlines technical guidance in troubleshooting and servicing our equipment. The
process for reporting a maintenance concern or equipment failure is also described
below. Any immediate maintenance or equipment questions should be directed to the
Director of Facility Maintenance.
To take a compressor off-line:
If there is a problem with a compressor, and you have contacted the Director of Facility
Maintenance for approval, take the following steps to take the compressor off-line:
1. Take a regular screwdriver and the trailer keys and locate the compartment at the bottom
rear of the trailer (curb side).
2. Open the compartment door; you should then see a simple door with four hour meters on the
front.
3. Using the screwdriver turn the screw above the handle at the same time you turn the handle.
4. Once opened you should see a bank of six circuit breakers. The line indicates a complete
circuit and is in the “on” position. The circle indicates an interrupted circuit and is in the “off”
position. The four large circuit breakers are for the compressors and are sequential beginning
on the right and moving to the left.
5. Move the switch from a line to a circle to take the appropriate compressor off-line.
How to fill the fire suppression system:
If water is lost in the hand line or the main line for the fire suppression take the following steps to
refill the system.
1. Purge air from the main tank (the tank will not refill if there is too much air pressure in the
tank).
2. Locate the proper fill/drain portion of the hand line tank or main line tank fire suppression
system.
3. Attach hose to a water source.
4. It may be necessary to use a female to female adapter.
5. Turn valve from the closed to the fill position.
6. Turn on the water and fill either the hand line or main line tank until the lights returns to green
on the control panel.
7. Turn the valve off to the hand line tank or the main line tank.
8. Turn the water off.
9. Pressurize either tank with the K bottle.
10. Remove the hose and check that the system is maintaining pressure.
11. If pressure is not maintained then double check all valves.
12. If all valves are off then check for leaks in system.
41
Maintenance
Filling the Lift Fluid (Braun ONLY):
Visual inspection of the fluid levels on the hydraulic lift should be done monthly. Pull out the
hydraulic fluid stick located above the lift circuit board. Should the fluid level read low, replace
with appropriate fluid. Regular or Synthetic transmission fluid should be kept onsite for refilling.
Check Here
Fill
Here
Transmission Fluid
42
Maintenance
Changing HVAC/ECU Filters:
There are 2 types of filters for the hyperbaric chamber. One is a 1” filter for the HVAC unit
located in the control panel area, and the other is a 4’ charcoal filter for the ECU. The ECU filter
can be replaced by removing the four black nuts located on the bottom piece of the ECU. This
filter should be replaced every six months. The HVAC filters should be checked monthly and are
replaced as needed. They can be replaced by opening the overhead compartment in the
closet of the control panel room and sliding out of the grooves.
Figure 1-1 HVAC Filter
HVAC Filter
ECU Filter
Filling the Chiller Fluid:
Visual inspection of the fluid levels on the CHILLER should be done daily. If the fluid levels are
below the half-way point on the site glass, replenish the system. Antifreeze or polypropylene
glycol should be added to prevent overheating. Locate the appropriate fluid on hand and add
fluid to the reservoir.
Reservoir
43
Maintenance
Fire Suppression System Testing
Specifically trained employees are required to test the fire suppression system (FSS).
Those employees should receive proper training on the process of testing the FSS. The
FSS System is tested twice per year. Follow the steps below when conducting a FSS test.
1. Notify all persons in the center and adjacent facilities that a fire suppression test is being
conducted.
2. Check Deluge Tank for proper water level.
3. Bleed off pressure of the Deluge Tank from 190psi to 90 psi.
4. Remove both ¾” FSS nozzles in entry lock, plug with ¾” NPT brass plug, and wrap with
Teflon tape for a proper seal.
5. Inside the main lock, disconnect FSS headers from the bulkhead. Loosen the black
mounting blocks along header inside main lock in order to shift headers away from
bulkhead by approximately 12”. A few mounting blocks may need to be completely
disconnected in order to accommodate necessary clearance. Install two SwageLok
Garden Hose Adapters to the bulkhead assembly.
6. Connect two Garden hoses to the adapter assembly and route to the exterior of the
building for adequate drainage. Take caution with the placement of hose ends. This
prevents the potential for injury as whipping may occur when water is discharged.
7. Remove safety clevis and depress the RED FIRE SUPPRESSION PALM BUTTON on CONTROL
CONSOLE.
8. Verify system actuates within 1 second.
9. Verify alarm is activated both audibly and visually.
10. Once system has been initiated, verify electrical equipment has been de-energized with
the exception of the alarm, communication system, and emergency backup lighting.
11. Allow to continue for approximately 3 seconds.
12. Turn FIRE SUPPRESSION OVERRIDE valve to the override position and verify the system
stops (no flow). Check to make sure the air actuated valve has closed and there is still
water in the tank.
13. Once “No Flow” has been verified, return FIRE SUPPRESSION OVERRIDE valve to normal
operating position.
44
Maintenance
14. Pull the RED FIRE SUPPRESSION PALM BUTTON to the OUT position, replace safety clevis,
and reset electrical control.
15. Repeat steps 7-14 for the following:
MAIN LOCK #1 RED FIRE SUPPRESSION PALM BUTTON.
MAIN LOCK #2 RED FIRE SUPPRESSION PALM BUTTON.
ENTRY LOCK RED FIRE SUPPRESION PALM BUTTON.
16. Drain residual water from all lines.
17. Remove test couplings and hoses.
18. Reconnect the FSS headers inside of main lock at bulkhead. Take caution for proper
alignment of connecting nut as there is a slight offset between bulkhead penetrators
and header mounting blocks. Disconnecting the first inline mounting block completely
will assist with reconnecting header.
19. Check orientation of main lock nozzles and secure all mounting blocks.
20. Remove brass plugs from entry lock headers and replace FSS nozzles. Remove old Teflon
tape and install new tape.
21. Return all valves to operating position
22. Fill Deluge Tank to proper level.
23. Pressurize Deluge Tank to operating pressure. Check for leaks.
24. Connect test gauge to each hand-line at nozzle/hose connection and verify line
pressure is at a minimum of 50 psig above maximum treatment pressure.
25. Remove test gauge from hand-line and replace nozzle.
26. Make available a container of adequate size to receive 5 gallons of water with
activation of Hand-Line.
27. Activate Hand-Line; verify flow and visual and audible alarm activation. Continue flow to
verify at least 5 gallon per minute for four minutes.
28. Fill Hand-Line Tank to the proper level.
29. Pressurize Hand-Line Tank to proper operating pressure. Check for leaks.
30. Verify K-Bottle has adequate volume to return center to normal operating condition.
31. Return FSS to normal operating condition. Notify all personnel the FSS test is complete.
45
Maintenance
Turn On Here
Manual Start-Up of the Generator:
It is a possibility that during a power loss the generator will not start
automatically. In this case it will be necessary to manually start the
generator. The procedure for manually starting the generator varies
depending on what model your facility has. Please check with your
team or Director of Facility Maintenance to familiarize yourself with
the procedure for manually starting your generator.
Draining ECU:
Depending on usage and temperature variations the amount of condensate will vary dictating
frequency of draining. During warmer months this should be done daily at the end each
treatment on ascent. During the winter months
draining is usually unnecessary. To drain the
condensate; manually turn the drain valve so it is
parallel with the brass piping (shown right). The ECU
drain is located on the bottom left hand side of the
unit.
Manually operating the Lift (Braun ONLY):
Locate the manual lift lever (shown below). Insert the lever into opening above lift circuit board
underneath the control panel room and manually pump up the lift to the desired height. To
lower simply turn the lift handle.
46
Troubleshooting
Chamber will not ascend
In the event the chamber will not surface the following steps should be taken.
1. Ensure valves are open completely.
* If not then open valves completely (but do not force open).
2. Ensure there is at least 90 psi in the compressor air
tanks,
*If not, run the compressors until at least 90psi is
achieved. (shown right)
3. Ensure all BIBS vents are in the off position.
*If no, close all vents completely
4. Ensure clamps are properly tightened on the
exterior side of the medical lock.
*If necessary the chamber may be surfaced using
the 1” ball valves. The valves may be gauged to
control the desired ascent rate.
Chamber will not descend
In the event where the chamber will not descend the following steps should be taken:
1. Ensure PICO™ is on and the compressors are indeed running.
*If not, turn on the compressors by following prompts on the PICO™ on the control panel
2. Ensure there is approximately 140-165 psi in the compressor air tanks.
3. Ensure all exhaust valves are closed.
*If not, close all valves completely (but do not force open).
Lift will not raise/lower
In the event where the lift will not raise or lower follow the steps below to troubleshoot the issue:
1. Check Hydraulic Fluid Levels.
*If low, fill with transmission fluid
2. Check to ensure the lift remote is plugged in properly.
* If not, plug in the remote connection completely
3. Inspect the lift for mechanical failure.
ECU is not blowing cool air
In the event where the ECU is not blowing, or not blowing “cool” air, the following steps should be taken:
1. Make sure the ECU handle is in the “OPEN” position.
2. Make sure the CHILLER fluid is “FULL."
3. Inspect for mechanical failure (unusual noises, poor blowing, air temperature).
47
Reporting a Maintenance Concern
Should a maintenance issue arise, it should be immediately documented on the company
INTRANET under the section labeled “Maintenance Log” (shown below). Please be as thorough
as possible when documenting the problem. For any immediate maintenance or equipment
emergency, contact the Director of Facility Maintenance.
Intranet Homepage
Maintenance Log
48
Clinical Equipment
Oxygen is administered by one of two delivery methods, a hood or mask. We will first discuss the
oxygen hood and its accessories.
Oxygen Hood
An oxygen hood is a breathing device used to administer 100% oxygen to patients in a
multiplace hyperbaric chamber. SEALONG’s latex-free is the brand of oxygen hood that MHC
uses. A complete set-up includes, an oxygen hood, a neck-ring, and oxygen tubing.
49
Clinical Equipment
Hood Creation
A new hood will be cut for all new patients on their first day of treatment prior to beginning the
dive. This hood will be used for their entire course of treatments with MHC. Please follow the
steps outlined below to create a hood set for a patient.
1. Ensure headgear is Non-Latex
3. Measure the patient’s neck with the SEALONG measuring tape.
4. Use the SEALONG measuring chart to determine where to cut the neck-ring.
5. When cutting the neck- ring, cut one line smaller than the measured number.
*Note: When cutting a neck-ring try to limit JAGGED edges, it promotes tearing.
6. Next, place the cut neck-ring over the patient’s head to determine proper fit. It might
be necessary to trim an additional ¼” or less to ensure a comfortable fit. Keep in
mind, a “snug” fit is necessary to maintain a proper seal around the patient’s neck.
7. Obtain the remaining supplies to complete the full hood set:
a) Hood
b) “2” Hoses
c) “4” tubing adapters
d) Electrical Tape
e) Hair tie
f) Scissors
8. Next measure “2” 12-13 segment lengths of
oxygen tubing (ie: hose) and cut with scissors.
Mark the tube tip that will be used for oxygen
with green electrical tape
9. After every third segment, connect the tubing
using electrical tape, start three segments
from each end.
10. Using an alcohol prep, place four tubing
adapters on the ends of the oxygen tubing.
11. Finish with rolling up the completed hose and
placing it inside of the hood. Secure the neckring onto the bottom. The hood set is now
complete.
12. Label the hood with the patient’s name on
the silver name label. (AND NECK RING)
*Note: If the patient is on a seizure protocol, label the hood with a red dot to distinguish
he/she from the remaining patients. (shown right). Label the hood with a YELLOW dot
if the patient has a DNR.
50
Clinical Equipment
SEALONG Hood Measuring Chart:
SEALONG Hood Accessories:
51
Clinical Equipment
Frequently Asked Questions/Troubleshooting
Here are some frequently asked questions regarding Sea-Long Medical Systems and its products. If you have
additional questions or comments, please contact Britani Bramble at 517-581-9428.
How do I keep from tearing the neck-ring?
First and foremost: a smooth, non-jagged edge must be obtained. Before stretching the opening over the
patient's head, fold the cut edge under slightly so the stretching occurs at the fold instead of the cut line,
which is now the neck-ring’s weakest point.
What is the best way to cut the neck-ring to size?
Determine the patient’s neck size using a tape measure. The neck-ring should fit tight enough to prevent leaks
but not be uncomfortable. Use the TRIM CHART to determine the rib that most closely matches the neck
measurement. If it is between sizes, choose the next smaller rib to prevent cutting too large. Use sharp scissors
to make one continuous, smooth cut. This will prevent jagged edges and tearing points.
Why is it so difficult to separate the hood from the neck-ring?
Most likely the o-ring needs to be lubricated with an oxygen compatible lubricant. It only takes a very
small amount to make it easier. Too much lubricant will make it difficult to keep the seal in place. Place a pea
size amount onto your finger and rub directly on the o-ring. Equally distribute the lubricant over the entire oring.
What type of lubricant do I need for the neck-ring?
An Oxygen Compatible lubricant is necessary and should be available at your facility.
How does the Trachea Accessory work?
The Trachea Accessory was designed especially for the trachea patient. If the patient has a traditional
'Jackson' or 'Shiley' Trachea, the PN600 fits perfectly over the opening! The swivel action deters pulling on the
often sensitive skin area surrounding the trachea, and the connector piece allows the inhale and exhale
tubing to connect without using the hood. A diagram for proper connection is included.
What flow rate is used with the Trachea Accessory?
This can be tricky and will vary, so consult your patient on what is comfortable. We have surveyed and found
that a flow rate of 15 LPM to 30 LPM has been successful. You must closely monitor blood oxygen levels.
What causes visor fog?
Fogging occurs because of high humidity percentages inside the hood. It can often be eliminated by adjusting
the flow rate.
My patient has a stoma, what can I use?
The "Tape-on Neckdam" is available for patients with a stoma. The Neckdam Sleeve works exclusively with our
Replacaeble Series to make it convenient and cost-effective.
52
Clinical Equipment
SEALONG Trachea Attachment:
VI) For patients with a trachea, please follow the steps below:
1. First remove trachea accessory from bag.
2. Fit tubing on one side of the trachea “T” for the intake and the other side for exhaust.
3. Turn on O2 flow.
4. Attach the Trachea Accessory over the patient’s trachea opening.
5. Continue treatment normally.
6. If the patient exhales a substantial amount through the mouth, then a hood will be
required.
**When setting up for a trachea patient, use what is most comfortable for
the patient.
53
Clinical Equipment
SEALONG Mask Creation:
For any patient or staff that requires a mask for oxygen breathing they must be properly
measured and fitted. Please follow the steps below for mask creation and fitting.
1. Using the SEALONG measuring tape, measure between the patient’s eyebrows to
their chin (shown right) to determine correct mask size.
2. Begin assembly of complete mask set using picture below by using the picture
below as a guide. Be sure to choose appropriate reservoir bag size to prevent
over inflation on exhalation.
54
Ancillary Equipment
It is necessary to obtain patient vital signs during the pre-treatment assessment and possibly
during emergent circumstances. You will be required to become familiar with the use of three
standard pieces of medical equipment; a glucometer, thermometer and sphygmometer. The
individual medical devices are described in more detail below.
Blood Pressure Monitor(Sphygmometer)
A sphygmometer is a device used for measuring blood pressure in the arteries. It is important to
familiarize yourself with the type of sphygmometer your center carries as models differ. As a
technician you will be required to obtain a patient’s blood pressure daily with either a manual
or mechanical sphygmometer.
Thermometer
A thermometer is a device used to measure a
patient’s internal body temperature. It is important
you familiarize yourself with the type of thermometer
your center carries as models do differ. As a technician you will be
required to obtain a patient’s temperature daily.
Glucometer
A glucometer is a medical device used for determining the
approximate concentration of glucose in the blood. MHC typically uses a hospital issued
glucometer to obtain a pre and post treatment blood glucose level (BGL) on all diabetic
patients. It is also mandatory to obtain a pre and post BGL on a patient’s first day of treatment.
In the event where a technician needs to obtain a BGL inside the hyperbaric chamber a onetouch glucometer is used, more specifically the ACCU-CHECK ADVANTAGE(shown below).
*Note: Please remember to disinfect the glucometer after every use.*
One-touch
Glucometer
Hospital glucometer
55
Resupply
There are two different processes for ordering clinical supplies. Hyperbaric treatment supplies
are ordered by MHC using the corporate supply order form shown below. All other clinical
supplies are ordered through the center’s hospital supply warehouse. Be sure to familiarize
yourself with your center’s resupply process and your responsibilities as a technician.
MHC Resupply Process
Please follow the steps below when placing an order for specific hyperbaric supplies such as
hoods, masks, oxygen hose, alcohol disinfectant, etc.
1. Fill out the proper MHC Purchase Order Form. This can be found on the MHC Intranet
under Forms > Expense Forms and Purchase Order > Purchase Orders
2. Add desired supplies by filling out the top portion and having your center director sign
and date the bottom.
3. Fax Attn: Mary Miller at 216-674-8233
*Note: Corporate orders are placed every Wednesday, please allow approx: 2 buisness
days for all SEALONG orders.
*Note For anything not listed on the standard order form. Please complete a special
purchase order form. This can be found on the employee intranet under Forms >
Expense Forms and Purchase Order > Purchase Orders.
56
Typical Center Schedule
The typical hyperbaric center schedule consists of three treatments or “dives” per day Monday
through Friday. On Saturday two treatment times are typically available. A sample center
schedule is shown below. Patients are expected to arrive approximately 30 minutes prior to their
scheduled treatment time. This allows ample time for the pre-treatment assessment and any
possible discussions with the hyperbaric physician. Please familiarize yourself with your centers’
schedule.
57
Daily Treatment Flow
HBOT Daily Timeline
Mobile Hyperbaric Centers, Inc.
Group1
7:00 AM
7:15 AM
7:30 AM
7:45 AM
8:00 AM
8:15 AM
8:30 AM
8:45 AM
9:00 AM
9:15 AM
9:30 AM
9:45 AM
10:00 AM
10:15 AM
10:30 AM
10:45 AM
11:00 AM
11:15 AM
11:30 AM
11:45 AM
12:00 PM
12:15 PM
12:30 PM
12:45 PM
1:00 PM
1:15 PM
1:30 PM
1:45 PM
2:00 PM
2:15 PM
2:30 PM
2:45 PM
3:00 PM
Group2
Group3
Group4
H&P TIME
Assessment
Transport
Begin
H&P 8:30 am
HBOT
End
Transport
Assessment
Transport
Begin
H&P 11:00 am
HBOT
Assessment
End
Transport
Transport
Begin
H&P 1:30 pm
HBOT
End
Transport
58
Daily Patient Flow
Patient arrives for HBOT no
more than 1/2 hour prior to
treatment time
Patient registers with hospital
for billing/insurance and
Practice Manager
Patients should arrive in scrubs
Store any valuables. And
continue to triage area
Patient undergoes
pre-treatment assessment
Patient has abnormal vitals,
CP, SOB, or other complaints
Patient has no complaints noted on
Assessment Form (form signed by
physician before treatment)
Patient MUST be evaluated by
HBO MD on duty
Patient transported into the
HBO chamber with hoods,
blankets and drinks.
Patient is cleared for HBOT by
HBO MD on duty
HBOT STARTS
HBOT ENDS
Patient transported back to MHC waiting area.
Hoods are cleaned and stored by Technicians
Patient sent directly to
ED or referred to PCP
for evaluation
No further HBOT until
clearance from Pt.'s
PCP has been
received
Patient changes into street
clothes, scrubs and blankets
put into lockers or laundry.
59
Daily Logs
Daily Startup/Shutdown logs are required to be completed by the end of every working day.
These logs verify that all locations are operating within the safety parameters defined by MHC.
Both the startup and shutdown log can be found on the Intranet. To fill out the log follow the
steps below:
1. Go to the MHC Intranet at www.mhcenters.com/forum
2. Select the appropriate log on the left side of the Home Screen (shown below).
3. Select “New Log Entry” and fill out all required fields.
60
Input of Patient Vitals
The third technician or “off tech” is responsible for entering vitals for that respective treatment. It is
necessary to enter patient vital signs as part of the documentation process.
1. Click on “S” Jelly Bean
2. Double click “Patient” name
3. Next, scroll down and select the “Vitals” section
(Figure 2). (NOTE: do NOT enter vitals for PHOTO)
4. Input vitals in yellow highlghted field (Figure 3).
5. When finished check the “Vitals Taken” box and
close.
Figure 1
Figure 2
Figure 3
61
Merging a Template
The third technician or “off tech” is responsible for entering the data for that respective treatment. It is
necessary to “merge a template” as part of the documentation process. Merging a prefilled template
minimizes repetitive data entry and creates a more efficient work flow. Follow the steps below to merge a
template for each patient.
1. Select the “Templates” button on the button of the screen.
2.
Select a generic template unique to your center or a patient specific template from a
previous dive that coincides with the current dive time. Be sure to only select visits labeled
“DIV” (shown below).
2
3
4
3. Next, click “Merge Template” on the bottom of the window (shown above).
4. When the merge is complete click “Close” in the bottom right hand corner of the window.
5. Review merged content for accuracy and fill in all blank fields (ie: technician, dive duration,
dive depth, air break times).
6. When finished, return to the main schedule by selecting “Resource Schedule” on the top left
side of the screen.
62
Checking out a Patient
The third technician or “off tech” is responsible for entering the data for that respective treatment. It is
necessary to “check out” a patient as part of the documentation process. Every patient on the schedule
must be checked out by the end of the working day. When checking out a patient you will choose from
the listed criteria to acknowledge the patient’s visit status for that day. Follow the steps below for
checking out a patient.
1. Double click on the desired patient’s name.
2. Note any global alerts in the pop up window (ie: Falls Risk, Linking of Referral, HIPAA).
3. Verify your facility is selected.
4. Select the drop down tab and select appropriate label (usually “Check Out”).
3
4
63
Linking a Referral
The third technician or “off tech” is responsible for entering the data for the respective treatment. It might
be necessary to “link a referral” daily, as part of the documentation process for certain patients. Note: a
referral does NOT need to be linked for “ABHO”, and “Non-Billable” treatments. Follow the steps below to
link a referral.
1. Double click on the desired patient.
2. Acknowledge the global alert prompt that appears, and verify if referral linking is required.
3.
Next select the “Referrals” tab located on the top of the appointments window.
4. In the new window
3
select the appropriate
referral by single clicking
the desired line and then
selecting “update” and
then “close.”
4
*Note: email the patient
care coordinator at least
5 days before the
expiration of the auth
64
5. Next in the center of the referral window select “Visit Details” (shown below).
6. Single click the first available BLANK line.
7. Choose the arrow to display the drop
down menu and select correlating date
(shown below).
5
6
8. If two dates are available, select the
appropriate “treatment” authorization.
The duplicate date should be identified
with a “P” indicating it should only be
used for linking a “photo” exam.
9. When done select “OK.”
*Note: If done correctly BLUE lettering will be
displayed on appointment window (shown
below)
7, 8
65
Changing the Time of a Scheduled Visit
It is possible a patient will want to change which dive they would like to attend. If so, you could be asked
to change the patient’s scheduled visit to another time. Please follow the steps below to change a visit.
1. Double click on the patient you wish to switch.
2. Change the “Start Time”, “End Time”, and “Visit Type” (shown below).
3. Click “Ok.”
Cancelling a Patient
Visit
Ideally we would like all of our patients to attend HBOT every day. In the event that a patient must cancel
their visit, you could be asked to document the cancellation on the schedule. Patient cancellations are
only completed if the patient has communicated with the center as to why they are unable to attend
treatment (only cancel after you have attempted contact). Depending on your center’s routine, you
could also be required to place a telephone encounter to document the cancellation in greater detail.
Follow the steps below to simply cancel a patient from the daily treatment schedule.
1. Double click on the patient you wish
to cancel.
2. Select the “Visit Status” dropdown.
3. Select “Cancelled.”
4. Next, in the “General Notes” section,
briefly describe the reason for the
patient is cancelling, when they plan
to return, and your initials.
3
4
5. Select “OK.”
66
Pre-Treatment Assessment
Patients will begin to arrive approximately a half hour before their scheduled treatment time. This allows
ample time to complete the pre-treatment assessment and allows the HBO physician to complete any
photo exams. During treatment, it is the responsibility of the third or “off” technician to complete the pretreatment assessment for the upcoming patients. The pre-treatment assessment is completed in the
designated triage area.
Please use the Daily Treatment Assessment Form (shown below) to complete a thorough and accurate
assessment. Any abnormal vital signs or complaints must be noted on the assessment form and
communicated to the HBO physician before the patient can begin treatment. Abnormal vital signs are
outlined below. When all assessments are complete, the completed assessment forms are then given to
the HBO physician for review. Once the HBO physician has signed all of the assessment forms the
treatment may begin. As a reminder, all new patients will have their BGL taken before and after their first
treatment regardless of referring diagnoses.
*Abnormal Vital Signs*
BP >150/90 or <100/60
BGL 75-150 Non-dia (>120 or <200 for diabetics)
Pulse >110 or <60
Resp >20 or <12
Temp >100F
*Note: All questions must be asked, and all fields must be completed*
67
Transporting Patients
Safely transporting our patients to or from the hyperbaric chamber is a priority for all technicians. This
includes ambulatory and non-ambulatory patients. Please pay careful attention to patients who are at
an increased risk for falls. These patients should be identified by a
red wristband. There are two methods of accessing the
hyperbaric chamber, direct entry (i.e. stairs, level) or the hydraulic
lift. Depending on your facility, the type of access you may have
will vary. To minimize workplace injury, always use at least two
technicians when lifting or moving a patient. For further
clarification on lifting or moving a patient please refer to the
Safety and Operations Manual.
Transporting using the Hydraulic Lift
1. Position patient evenly on lift.
2. If in a wheelchair, lock brakes on both sides of the
wheelchair (shown right).
3. Inform patient of impending raise or lowering of
the platform.
4. Secure gate where applicable.
5. Raise or lower the patient using the lift remote.
Note: After the patient is secure, please use the yellow warning strap before it is lowered.
Prepare Treatment Essentials
It is also the responsibility of the third “off” technician to prepare all of the items necessary for
the upcoming treatment. This includes but is not limited to; patient hoods, patient drinks,
blankets, and pillows. Ideally all of these items, along
with all patient assessments, should be completed
before the previous dive reaches the surface.
Drink Tray
68
Treatment Responsibilities
During a Treatment
During a treatment each of the three technicians on duty will assume one of the following roles:
1. Chamber Operator
2. Chamber Attendant
3. Third “Off” Technician
Below are the responsibilities of each of the above positions. Please familiarize yourself with each role as
you will be required to perform all duties independently.
Training Note: Tech should be switching out operator role at least every 30 minutes.
Chamber Operator:
The Chamber Operator is responsible for the safe operation of the hyperbaric chamber during a
treatment. The Operator must never leave the treatment controls unattended. If a break is
necessary, you may ask a fellow technician or physician to switch you positions. Responsibilities
include but not limited to the following:
1. Monitors chamber pressure, and adjust accordingly to maintain 2.4 ATA at all times.
2. Monitors chamber oxygen level maintaining below <23.5% at all times.
3. Accurately documents all dive times in the treatment log book and notes any
abnormal events that occur during the treatment.
4. Measures the passage of time during treatment by the use of digital timers on the
control panel.
5. Maintains constant verbal communication with chamber attendant and advises
he/she of all changes in pressure.
6. Maintains constant attentiveness of patients and chamber attendant at all times.
7. Visually inspects control panel for any abnormalities or fault lights prior to, and
throughout the duration of the treatment.
8. Minimizes distractions and
stays focused on
observing treatment by
the viewing monitors.
Distractions include
(books, cell phones,
laptops, personnel).
9. Aware of any unique
patient circumstances
affecting normal
treatment regimen (i.e.
seizure protocols, new
patients, illness).
69
Treatment Responsibilities
Chamber Attendant:
The Chamber Attendant is responsible for the safety of the patients during a hyperbaric
treatment. The Attendant must remain seated near the door and maintain an unobstructed
forward view of all patients. The Attendant must also breath oxygen the last 20 minutes of the
treatment, responsibilities include but not limited to the following:
1. Accompany and observe the patients inside the hyperbaric chamber for the duration of
the treatment.
2. Verify there are NO prohibited items in the hyperbaric chamber prior to beginning
treatment (see pg 30).
3. Verify all necessary items have been placed in hyperbaric chamber prior to beginning
treatment (ie: hoods, drinks, blankets)
4. Prepare patient seating areas and ensure patients are comfortable
5. Set up patient breathing devices (ie: hoods, masks)
6. Coaches patients on proper ear clearing techniques
7. Places and removes hoods between oxygen breathing periods and air breaks (Note, think
about “flushing” O2 from hood by switching to air)
8. Minimizes oxygen leaks by ensuring proper fit and assembly of oxygen breathing devices
9. Responsible for cleanliness of hyperbaric chamber at the conclusion of the treatment. This
includes:
a) Removal of all trash
b) Replacement of stools in a secure location to minimize tripping.
c) Restoration of all arm rests to the upright position.
Third “Off” Technician:
The Third Technician acts in a supporting role during a hyperbaric treatment. Responsibilities
include but not limited to the following:
1. Accurately completes all electronic charting in ECW for the ongoing treatment
(ie: vitals, linking referral, checking out patient, post glucose)
2. Perform pre-treatment duties for the upcoming treatment (ie: patient assessment, drink
preparation, etc)
3. Perform History and Physical (H&P) orientation and tour (i.e. Technician Checklist)
4. Upload daily assessment form to patient file in eCW
70
Treatment Routine
The steps below will outline the typical treatment routine followed by the Chamber
Operator and Chamber Attendant for a dive to the depth of 2.4 ATA
Depth
Chamber Operator
Chamber Attendant
Depth
1.0 ATA
Perform Safety Check
Fill out Dive Log
1.0 ATA
>1.0 ATA
Opens press valve, begin decent
Choose DVD, put on booties/crocs
Verify all Hoods are inside chamber
Verify no prohibited items "10sec time-out"
Signal operator when ready, put on gloves
1.5 ATA
2.0 ATA
2.4ATA
Dim lights 1, 2
Dim lights 3, 4, 5
Close press valve, verbalize "On 02"
Start Timer(s) for 45min and begin movie
>1.0 ATA
Begin placement of oxygen neckrings back to front
Begin placement of oxygen hoods back to front
Turn on each supply valve to "oxygen"
Adjust flow meter between 20-30 lpm
1.5 ATA
2.0 ATA
2.4ATA
Oxygen 20 Minutes
Verbalize "Patient Check" Command
Ask patients how they are feeling?
Oxygen 25 Minutes
Verbalize "Air Break" command
Start 5 min. Timer
Turn on each supply valve to "off"
Air Break, Remove all patients' hoods back to front
Oxygen 20 Minutes
Verbalize "Patient Check" Command
Ask patients how they are feeling?
Oxygen 20 Minutes
2.4ATA
1.7 ATA
1.6 ATA
<1.3 ATA
1.0 ATA
Technician breathes O2 (mask or hood)
Verbalize warning, with one minute remaining
Put on gloves, remove oxygen
Begin removing patient hoods, back to front
Turn all lights on, open primary or secondary
exhaust valve
Remove remaining headgear
Open primary or secondary exhaust valve
Close primary and secondary exhaust valves
Verbalize "Deco Stop"
Start Timer for 3 minutes
At end of the "Deco" open all exhaust valves
Open Exhaust Ball Valve
(primary, secondary, ball valve in entry lock)
Door will open at Surface, Close Valves
2.4ATA
1.7 ATA
1.6 ATA
<1.3 ATA
1.0 ATA
71
Post-Treatment Duties
Post Treatment Vitals
It is necessary to obtain a post treatment BGL on all diabetic patients (shown below). Patients
must have a post BGL of >100 mg/dl before they can be cleared to leave the facility. Notify the
HBO physician if any patient is below the threshold listed above.
ECW Sign-off by MD
Vitals are checked before treatment
After all patient vitals have been entered into ECW and the
patient has been checked out, the HBO physician can then
“sign” all the records for the day.
Hand Off Forms
Hand off forms are required for patients being returned to a
skilled care facility, nursing home or rehabilitation
center. The form can be found on the company Intranet. This
form should be completed, signed by the physician, and
subsequently copied and filed in the patient’s chart.
Hood Cleaning
At the end of the day all the patient hoods that were used should be cleaned for the upcoming
day. Dirty hoods should be kept separate from clean hoods whenever possible. Dirty hoods can
be identified by placing them on the shelf with the neckring
facing outward. This easily distinguishes them as “dirty”
(see right). Hood should be cleaned with ALCOHOL ONLY! This
prevents premature breakdown of the neckring. Hoods are
cleaned by separating the hood from neckring and cleaned
individually. When hoods have dried they can be reassembled
and placed upright on the shelf with the name label facing
outward. Ideally, hoods should be cleaned in between
treatments if timed permits
Dirty Hoods
72
Infection Control
Health care employees can take steps to prevent the spread of infectious diseases. These steps
are part of infection control. Proper hand washing is the most effective way to prevent the
spread of infections in hospitals. Other steps health care employees can take include
1. Covering coughs and sneezes.
2. Staying up-to-date with immunizations.
3. Using gloves, masks and protective clothing.
4. Making tissues and hand cleaners available.
5. Following hospital guidelines when dealing with blood or contaminated items.
6. Proper washing of patient garments including scrubs, pillow cases, blankets.
7. Minimizing cross contamination of patient specific garments.
8. Thorough weekly cleaning of all patient care areas including hyperbaric chamber and
triage area.
Weekly Chamber Cleaning
The hyperbaric chamber should be tidy and well-kept at all times. A daily cleaning of the
hyperbaric chamber should be completed by the end of every working day. In addition, a
thorough cleaning of the main and entry lock chambers, control panel area, and triage area
should all be completed on a weekly basis. Follow the steps below when thoroughly cleaning
the hyperbaric chamber.
1. Only use MHC approved hyperbaric cleaning agent called “BETCO”
2. First, vacuum the entire hyperbaric chamber including the floor, behind seats, and in the
entry lock.
3. Next, spray down walls and begin to wipe down with washcloths from ceiling to floor
*Note: Remove stools when wiping down walls.
4. Replace stools and proceed to clean the floor of the hyperbaric chamber either with a
mop or by hand with a washcloth.
5. Let the chamber ventilate for at least an hour before resuming treatments
73
Education
It is the goal of Mobile Hyperbaric Centers to offer continued education in the field of
hyperbaric medicine. Initially all new full time technicians will be eventually scheduled for an
Introductory Course in Hyperbaric Medicine. The technician will attend the soonest available
Introductory Course in Hyperbaric Medicine at Nix Memorial Hospital in San Antonio, Texas. The
course is designed to strengthen the knowledge and foundation of the new employee in the
field of Hyperbaric Medicine. The Introductory Course in Hyperbaric Medicine is just the first step
toward gaining future licensure as a Certified Hyperbaric Technologist (CHT). See the flow chart
below to see the steps for certification as a CHT.
New Employee is
cleared to work
independently by
Trainer
Upon successful
completion of 40hr
Internship, employee
will then be scheduled
to take NBDHMT CHT
Exam within 6 months.
After 440 clinical hours
have been completed,
Chief Training Officer
will be contacted to
schedule 40hr
Supervised Internship
with Employee.
employee is
scheduled for
available 40hr
Introductory Course
to Hyperbaric
Medicine.
Hyperbaric Technician
CHT Certification
Process
Upon successful
completion of 40hr
ICHM, employee will
then complete 440
hours of clinical work
experience with MHC.
*Approx. 3 months
74
Education (Re-certification)
After CHT certification has been obtained it is necessary to complete 12 continuing education
units (CEU) within a two year time frame to be eligible for renewal. In addition to the 12 CEU’s
the CHT must also work a minimum of 100 clinical hours in a hyperbaric department. Currently
MHC offers 12 Category “A” CEU credits which can be found on the company Intranet under
Education. Please contact the Chief Training Officer for more questions regarding
recertification.
75
Incentive
In order to be eligible for a bonus, the Center must always maintain a safe and quality program.
Therefore the Center must meet these criteria:
1. All items related to safety and particularly the items related to the: Daily Logs, Fire Suppression
System Logs, Safety Director Logs, Generator Logs, Emergency Drill Logs, Fire Drill Logs, and
Annual Competencies must be 100% complete and up-to-date.
2. Patient Show Rate must exceed 70% average for the month.
3. Weekly follow-up exams and letters sent to referring physicians must exceed 90% for active
patients and cannot be missing for more than two weeks for any active patient.
76

Technician Training Manual - Mobile Hyperbaric Centers

Transcription

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