Do you have a HBOT safety officer.
Does your Hyperbaric Oxygen program have a designated Safety Officer? According to the National Fire Protection Association (NFPA-99) and the Undersea and Hyperbaric Medical Society (UHMS) you should have a hyperbaric safety officer designated by the governing body of your facility. Okay then who is that person and what is his job description? The safety officer can be any knowledgeable individual directly involved with the program, preferably from within the department such as a director, nurse, or technologist. The code does not define knowledgeable but actual hyperbaric safety training would be preferable and optimal. I am aware of two programs presently available that will specifically prepare an individual for the hyperbaric safety officer role. These are International ATMO in San Antonio and Oxyheal in Las Vegas. Check their Internet sites for dates since these are only offered at a few times throughout the year. I can say from personal experience that the International ATMO program was excellent and well worth the four days of study. The NFPA code does not specially name who the safety officer must be but it does state that it should not be the medical director. I believe the intent of the code in this instance was to involve numerous staff rather than just one in the decision making process for the development of safe practices. Establishing relationships across the department are important and obtaining many individual perspectives can prove beneficial. The role of the safety officer was first created by the NFPA code in 1968 and has been expanded since then. This individual has responsibility for overall review of the safety procedures and policies for the hyperbaric facility. This includes the examination and analysis of all aspects of the hyperbaric operation and environment with emphasis on the recognition of potential hazards. A sample job description was discussed and offered at the "Technical Aspects of Hyperbaric Chamber Safety" seminar in 1996. Their job description concentrated the core duties of this position into a few general categories. The largest and primary category of responsibility for the safety officer is education. One form of education is the development of information for patients such as chamber safety for new patients. (See previous Focus publication entitled hyperbaric patient education). Another area is the education for new staff and continuing education of existing staff. Staff education will focus on work hazards associated with equipment and operations and the review of patient incident reports. This would include practice of emergency procedures and interventions along with conducting fire drills and mock evacuations. Education must also be provided to anyone working in the area of a chamber, such as the environmental services staff who might decide to clean the chamber with an improper cleanser. Harsh products like alcohol should never be used on an acrylic chamber. The safety officer plays an important role in the quality improvement program for the department and will participate in studies and data collection. Another role identified in this document is referred to as "policing". Policing, or what I call managing, is the assessment of proper and consistent compliance with department safety policies and procedures. The safety officer must also approve any equipment and materials which will be permitted in the chamber. The safety officer must also oversee decompression procedures when diving with 21% air. This is more relevant in multiplace chambers where attendants actually dive" with the patients. Nothing is more embarrassing (or possibly hazardous) than to give your staff the bends. The safety officer must assess the facilities compliance with all applicable federal, state, and local codes and laws regarding hyperbaric oxygen therapy and healthcare facilities in general, (See resources below). The safety officer should serve on hospital safety committee and foster good relationships with local fire and EMS staff. They must ensure documented and timely compliance with all maintenance programs and any modifications to the chamber or support equipment to be used inside or attached to the chamber. The continual performance of a risk assessment analysis for all aspects of the hyperbaric operation is critical to ensure safe practices.
In summary, the hyperbaric safety officer plays an important role in the safe provision of hyperbaric oxygen therapy and they are part of the decision-making team. The safety officer does not have to be an engineer or mechanic or know everything there is to know about the operation of a hyperbaric department but they should bring their own special knowledge base and perspective to the decision-making team. Here is a list of documents and resources that the safety officer of a hyperbaric facility should be familiar with;
* ANSI/ASME/PVHO-1/2: Safety code for Pressure Vessels for Human Occupancy
* NFPA 99 Healthcare Facilities Chapter 20 HBO Hyperbaric Facilities, Chapter 5: Gas and Vacuum Systems, and Chapter 8 Electrical Equipment, include explanatory note in Annex A, B, and C. NFPA 53: Recommended Practice on Materials, Equipment and Systems Used in Oxygen-enriched atmospheres.
* NFPA 77: Recommended Practice on Static Electricity.
* ANSI/CGA G-7.1 (Commodity Specifications for Air), ANSI/CGA P-2 (Characteristics and Safe Handling of Medical Gases), and ANSI/CGA G4.1 (Cleaning of Equipment for Oxygen service)
The Undersea and Hyperbaric Medical Society (UHMS) has guidelines which are especially helpful in tying all this information together and can be found in the Hyperbaric Facility Accreditation Program (you may be able to download this from their website www.UHMS.org). The most prominent textbook in this field of study is "Hyperbaric Facility Safety: A Practical Guide, W.T. Workman; Best Publishing. There is certainly enough information in the above resources to keep you occupied in guideline heaven for quite a while. Although very rare, fatal accidents have occurred in association with high-pressure oxygen rich environments such as hyperbaric chambers so we must always remain vigilant and safety oriented. Implementing safety-minded policies and procedures can help create a safe operation and environment. Conducting frequent safety drills and review of emergency procedures are important for staff preparation in the management of potential hazards. And as most of us know, complacency may be our greatest safety risk.
Ken Capek, RRT, CHT, MPA is Director of Respiratory Care and Hyperbaric Oxygen Therapy at Englewood Medical Center in Englewood, NJ. He can be reached at Ken.Capek@ehmc.com