Hyperbaric Oxygen Therapy - Hyperbaric Chamber Information ...

early as 1995. The guidelines – known as HOTFIG 10 – were developed to provide
industry-wide codes of practice and involved representatives from the Australia and New
Zealand Hyperbaric Medicine Group (ANZHMG), HTNA technicians, HTNA nurses,
and suppliers and operators of hyperbaric chambers.
HOTFIG was envisaged to be a consensus document with industry-wide acceptance and
sought to provide recommendations and requirements for the safe operation of
hyperbaric facilities. To wit: “All of [HOTFIG] will comply with the world’s best
practice.” In August 1999, HTNA released amendments to the original document. The
major sections are discussed below.
Hyperbaric facility
It was recommended that consideration be given to proper access, fire protection,
emergency procedures, and patient support. Issues relating to the treatment chamber
include advice about the pressure vessel, viewports, doors, penetrators, fixtures and
furniture, and other physical structures.
Operational systems and preventive maintenance
Recommendations for monoplace and multiplace chambers are given separately,
although proposals are shared between the two. Various aspects of operation discussed
in the document include air pressurisation encompassing air purity, monitoring and
storage; breathing gas systems including oxygen supply and gas analysis; environmental
conditioning; communications; patient monitoring; and lighting, electrical, and fire
suppression systems.
HOTFIG recommends that established written procedures be in place for regular
preventive maintenance of the hyperbaric system and its ancillary equipment. Emergency
protocols should likewise be established and regularly reviewed. Some emergency
situations identified by HOTFIG include loss of primary pressurising gas, loss of primary
oxygen source, rapid changes in chamber pressures, fire, and patient states including
oxygen toxicity seizures, cardiac arrest, barotrauma, pneumothorax claustrophobia or
acute anxiety and accidental extubation.
Personnel
HOTFIG recommendations for staffing of hyperbaric facilities focus on three aspects:
general concerns, training and qualifications, and minimum staffing levels.
General concerns include recommendations for hazard identification and risk
assessment, and determination of appropriate staffing. The following qualified personnel
be available:
• medical director – a physician with special knowledge in the diagnosis, treatment and
assessment of disorders treated with HBO and having special training or experience
in the management of clinical hyperbaric medical problems;
• consultant hyperbaric physician – a physician with training and experience in
hyperbaric medicine who is able to prescribe HBOT and is medically accountable for
the safety of patients and staff. Minimum requirements are completion of an
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