Draft Policy On Medical Supervision During HBO Treatments
On behalf of SAUHMA HBO Workshop By Dr W.A. Meintjes & Dr Frans J. Cronje

Hyperbaric oxygen therapy (HBOT) is a well-established, conventional medical treatment. It is not without risks, nor is it invariably beneficial. Appropriate patient selection and medical supervision are therefore critical to ensure its safe, cost-effective and ethical application.

The most obvious risks of HBOT are associated with the physical effects of pressurisation and depressurization, an elevated fire hazard, and the potential for explosion of pressure vessels. Patients undergoing HBOT may also suffer several possible medical complications and side-effects1-6. Of these, middle ear barotrauma is the most common: it affects up to 9.2% of patients). Other effects include changes in visual acuity; hypoglycemia, oxygen toxicity, dizziness, anxiety reactions, dyspnoea and chest pain (in 0.5-1.5% of patients); and pulmonary barotrauma-related complications. Several medical conditions represent relative or absolute contra-indications for HBOT (e.g. current pneumothorax and previous Bleomycin therapy), and should be specifically screened for before therapy is initiated.

In addition to the physical and medical implications, there are also economic ones. HBOT is relatively costly, which is why its use should be based on sound medical- and scientific justification. HBOT is therefore subject to the same statutory and ethical medical principles that govern other aspects of health care – including medical facilities, -devices and pharmaceuticals.

As representative association for the medical application of HBO, SAUHMA considers it a foundational ethical requirement for a medical practitioner (who is trained in the use of HBOT) to (1) select patients for HBOT, and (2) supervise each and every treatment that is provided. By extension, SAUHMA considers unsupervised HBOT treatments to be potentially life-threatening, intrinsically unethical and therefore completely ineligible for reimbursement by either patients or third-party payers.

To clarify the role and function of the medical practitioner responsible for HBOT, however, and to clearly define what the scope and nature of medical supervision should look like in practice, SAUHMA has developed a Policy on Medical Supervision for HBOT. This Policy represents the consensus statements formulated at a SAUHMA HBOT Workshop in February 2016.

DEFINITION OF “MEDICAL SUPERVISION” OF HYPERBARIC TREATMENTS

Upon appropriate assessment and selection of a patient for HBOT (by a suitably trained hyperbaric physician), supervision of each HBO treatment is to include supportive, personally undersigned documentation, clearly indicating that:

• Full professional medical responsibility has been assumed formally by an individual medical practitioner, for the safety of the hyperbaric system for the period of treatment; this may include, but is not limited to:
  • Signing off each hyperbaric treatment session;
  • Signing off on the safety checks of the facility at the beginning of the day;
  • Providing clinical notes on each treatment session for each individual patient, in which there is clearly stated that:
    • Prior to HBOT:
      • Every patient is fit for each HBOT session, and that
      • The indication for HBOT remains appropriate, including identifying and documenting the need for any additional testing, assessment or adjunctive medical-, surgical- or wound care;
    • During HBOT: Any complications and side-effects were managed appropriately;
    • After HBOT:
      • No complications / side-effects occurred; or
      • If complications or side-effects did arise, that these were properly documented, appropriately managed; and that
      • Ongoing HBOT treatments were based on the outcome / progress of the preceding HBOT sessions, with due consideration to the true need / justification for further HBOT, additional testing, and/or for adjunctive medical-, surgical- or wound care.

In order to meet these obligations, the responsible Medical Practitioner may delegate duties to another medical practitioner, who is adequately trained, able and willing to perform them. Irrespective of whether or which duties have been delegated, however, immediate advanced life support and emergency medical care must be available at all times during HBOT.

Also, notwithstanding any of the above, the responsibility for operating a clinical hyperbaric chamber for patient treatments may not be delegated to any person who is not a current, registered healthcare professional. Physical operation of the chamber may be performed by a person not registered with a health professional council on the condition that the responsible health care professional is able to personally and continuously monitor the health and wellbeing of the patients in the chamber.

MINIMUM TEAM SIZES

Monoplace Chamber Operations: The minimum on-site team of staff shall consist of two persons of which at least one is registered with a health professions council. Teams typically consist of a medical practitioner (to supervise the treatment and for emergency assistance - if necessary), and a registered nurse or emergency medical technologist to operate the chamber.Multiplace Chamber Operations: The mimimum on-site team shall consist of (1) two persons who are registered with a health professions council – usually a hyperbaric physician (for supervision of the treatment and for emergency assistance, if necessary) and a medical attendant for taking care of patients inside the chamber (under pressure); and (2) a chamber operator to conduct the hyperbaric treatment from outside; the operator does not need to be a registered healthcare professional.

TRAINING OF MEDICAL PRACTITIONERS

A medical practitioner qualified to provide HBO treatment is one who has undergone specific training in this field of medicine.  Current competence in the management of acute cardiopulmonary emergencies relevant to HBOT (e.g., current ATLS training which includes the placement of intercostal drainage sets) is essential.

Suitable training may include, at a minimum, the following:

• Training, experience and privileges within the health care facility or -institution to manage acute cardiopulmonary emergencies, including advanced cardiac life support, and emergency myringotomy;
• Completion of a recognized hyperbaric medicine training program as established by SAUHMA.  The two programmes currently meet this requirement in South Africa, namely the
  • "Diving and Hyperbaric Medicine Staff Training Course” as accredited with the UHMS, and
  • First two modules of the BScMedScHons (Hyperbaric Medicine) programme of the University of Stellenbosch.
• Other international programmes may be submitted to the SAUHMA Executive Committee to confirm equivalency.
• Continuing medical education in hyperbaric medicine of a minimum of 16 hours every 4 years after initial credentialing.

Certain duties may be delegated by the responsible medical practitioner, to medical practitioners who are not trained in hyperbaric medicine, on the proviso that they have (1) received appropriate in-post training at the facility, and (2) have acknowledged their formal, informed acceptance of the delegated duty based, and (3) are competent to do so.

REFERENCES:

1. Hadanny A, Meir O, Bechor Y, Fishlev G, Bergan J, Efrati S. The safety of hyperbaric oxygen treatment--retrospective analysis in 2,334 patients. Undersea Hyperb Med 2016; 43(2): 113-22.
2. Skeik N, Porten BR, Isaacson E, et al. Hyperbaric oxygen treatment outcome for different indications from a single center. Ann Vasc Surg 2015; 29(2): 206-14.
3.  Camporesi EM. Side effects of hyperbaric oxygen therapy. Undersea Hyperb Med 2014; 41(3): 253-7.
4. Seidel R, Carroll C, Thompson D, et al. Risk factors for oxygen toxicity seizures in hyperbaric oxygen therapy: case reports from multiple institutions. Undersea Hyperb Med 2013; 40(6): 515-9.
5. Biddle C. Oxygen: the two-faced elixir of life. AANA J 2008; 76(1): 61-8.
6. Ambiru S, Furuyama N, Aono M, Otsuka H, Suzuki T, Miyazaki M. Analysis of risk factors associated with complications of hyperbaric oxygen therapy. J Crit Care 2008; 23(3): 295-300.

OBJECTIVES

To reduce bubble size and eliminate gas nuclei. To maximize the diffusion gradient for elimination of inert gas and thereby accelerate gas ‘wash-out’. Hyperoxygenation of hypoxic and/or ischemic tissue. Reduction of oedema. Attenuation of ischemia-reperfusion injury.

DIAGNOSIS

Onset of musculoskeletal pain, cutaneous manifestations, central or peripheral neurological lesions or cardiopulmonary symptoms within 24 hours of completing a dive or series of dives to a depth that exceeds 9 metres sea water. Consider altitude provocation. The ability to differentiate decompression sickness from cerebral arterial gas embolism in the acute treatment phase is no longer considered critical.
Diagnosis to be confirmed by a medical practitioner trained in diving medicine.

CRITERIA FOR HBO THERAPY
 
Symptom onset within 24 hours of completing a dive that involved moderate to high gas loading. Dives to the limit of or exceeding no decompression time frames. Obvious violation of decompression guidelines. Treatment should not be commenced more than 14 days after exposure.

WORK-UP CONSIDERATIONS

1. Continue administration of 100% oxygen via non-rebreather mask, naso- or endo-tracheal tube for up to 16 hours.
2. Complete dive history, including staged decompression and repetitive diving profiles.
3. Past medical history.
4. Physical examination including, but not limited to, a full neurological examination.
5. Special examinations: Exclude pneumothorax before recompression; chest x-ray mandatory if lung overexpansion is suspected. Other special examinations as required.
6. Signed informed consent for HBOT.

TREATMENT

• Fluid resuscitation (IV for severe cases. Avoid dextrose containing solutions.)
• Urine output monitoring. Exclude urinary retention; catheterize if necessary. Maintain at least 1-2 mL/kg/hr.
• Consider oral Tenoxicam or equal NSAID during recompression for musculo-skeletal DCS. DVT prophylaxis critical for paralysed divers. Sedation only if essential.
• Monitor vital signs.
• Prompt HBO with compression to 2.8 ATA:
  • USNTT5 (or equivalent) only for asymptomatic, omitted decompression or pain-only DCS, with complete relief within 10 minutes at 2.8 ATA otherwise treat on USNTT 6.
  • USNTT6 (or equivalent) for all other DCS including neurological or cardiopulmonary manifestations.
  • Consider extensions at 2.8 ATA and/or 1.9 ATA where indicated.
• In case of CNS oxygen toxicity, interrupt oxygen breathing and allow 15 minutes of air breathing after reaction has entirely subsided. Resume treatment schedule at point of interruption.
• Retreat after 6 – 24 hours if residual symptoms remain:
  • Major symptoms: Consider 1 – 2 further USNTT6.
  • Minor symptoms: HBO at 2.0-2.4 ATA for 90 minutes daily.
• Refer patients with residual symptoms for rehabilitation.
• Risk assessment for return to diving, as indicated.
• Consider PFO screening where indicated.

SUGGESTED TREATMENT THRESHOLD

Approximately 75% of cases have complete resolution following the 1st USN TT6.
To be determined in consultation with DANSA. Stop treatment if no functional improvement after 2 consecutive treatments

ICD 10 CODES

T70.3 Caissons disease (decompression sickness).
T70.0 Otitic barotrauma
T70.1 Sinus barotrauma
T70.8 Other effects of air pressure and water pressure. Blast injury syndrome.
T70.9 Effect of air pressure and water pressure, unspecified
T79.7 Traumatic subcutaneous emphysema
S27.0 Traumatic pneumothorax
J98.1 Pulmonary collapse
J98.2 Mediastinal emphysema
I26 Pulmonary oedema
W94 Exposure to high and low air pressure and changes in air pressure

LEVEL OF EVIDENCE

Level C. All authorities consider it unethical to subject this indication to a randomized controlled trial with a non-treatment control group.

CHAMBER CLOTHING
SELECTING SUITABLE CHAMBER CLOTHING MATERIALS A REVIEW OF THE RELEVANT CONSIDERATIONS Francois Burman Pr. Eng. MSc

Much has been written about, speculated on, and even mandated as to what clothing materials are suitable for use in a hyperbaric chamber. This article provides some of the factual and practical considerations when deciding on what materials to select for regular chamber clothing.

All clothing fabrics burn; especially in the presence of elevated concentrations of oxygen. There are also other considerations to take into account, including static-electricity control, comfort, fit, functionality, appearance, soil-resistance, laundering suitability and even control of dedicated clothing within a unit.  However, the overriding consideration remains fire safety and this often affects the final decision.

Traditionally, and as still evident in many hyperbaric standards and guidelines, cotton has been the material of choice.  This is largely based on perceptions that cotton burns slower, does not release especially toxic combustion products, and does not melt onto human skin.  However, this is only partially true. In fact the fire-safety record of cotton needs to be reviewed in more detail.

The main factors that render cotton more or less burnable are the density of the weave, the thickness of the material, the presence of a fluffy or loose pile, and the individual fit on the person.   Being an open-cell or porous material, cotton does not retain oxygen once the environment changes.  Lastly, cotton does not promote a build-up of static electricity, rendering it less likely to serve as a source of ignition energy. In comparing like-for-like materials, in terms of weave, thickness and fit, cotton is not highly-rated in terms of time to actually ignite.

In addition to cotton, there are two alternative, practical options, viz. (1) a ‘suitable’ blend of cotton and synthetic (polyester) material, and (2) the new generation fire-safe materials – such as a blend of viscose* and natural fibre (an example of which is a fabric made of wool and viscose – used to produce children’s nightwear).
* Viscose is a natural polymer made from wood pulp, often referred to as Rayon, and commonly referred to as a semi-synthetic fibre.

Reviewing the intrinsic properties of these materials provides additional, relevant information, such as a comparable measure for determining flame resistance, also called the Limiting Oxygen Index or LOI.  This measure indicates whether material is appropriate for hyperbaric operating conditions, especially as these indices represent the minimum concentration of oxygen required at the ambient environmental pressure to ignite the materials. Once again, it is the relative scale that is important rather than the absolute values.

In essence, the term ‘flame resistance’ – when applied to the use of clothing in hyperbaric facilities – should rather be read as “time to act”; a precious commodity in the event of a chamber fire.

As with most decisions, there are a multitude of factors that influence the final choice.  In determining the most suitable, the safest and the most compliant product, the following decision factors need to be taken into account and prioritized according to actual situational requirements and existing risk factors:

• Permanent flame resistance regardless of how many times the garment is laundered
• Reasonable protection against radiant and convective heat
• Tight weave construction
• Good wear comfort
• Breathable and irritant-free for most patients
• Suitable for dyes and colours to enable regular laundering
• Durable for repeated use
• Control of static electricity
• Soil resistant (should not stain especially easily)
• Acceptable cost

The author has three personal recommendations regarding clothing that do not relate specifically to the material of selection, but do having bearing on clothing with respect to fire.
 

• It is preferable to select clothing that can be removed relatively easily without having to be pulled over a person’s head.  Garments that can be removed easily in the event of a fire will result in less severe burns, or possibly avoid burns completely. It has to be accepted, however, that the various fixtures such as buttons (which tend to get lost) or ties (which tend to result in modesty issues) are not ideal.
• Pockets should not be installed in any chamber clothing. The added control requirement is one more step that can go wrong and too often pockets may be used to carry contra-band into the chamber; usually completely unwittingly.
• The more close-fitting the garments, the lower the flame spread rates tend to be; accordingly, this fit of garment is recommended.  Interestingly, and as a result of analyzing the Florida fire of 2009, the least burned surfaces of both patients were the areas covered by synthetic undergarments. This tends to support this opinion.

So, what about tie-strings versus elasticized waist bands?  In theory, loose pieces of clothing will ignite more easily; yet elasticized materials contain especially hazardous synthetic materials.  The best path to follow is that of full analysis and selection of materials that are most suitable, e.g., a tight-weave draw-string, or an elastic material with natural rubber and fire-resistant fibre.  However, in both cases, as long as these materials are kept away from direct exposure to a source of ignition and are surrounded by other known fire-resistant material, the actual additional risk is not significant.

And what about static electricity? This natural phenomenon results in the discharging of 3000V+ electric sparks - sometimes between unsuspecting personnel or patients and any grounded object (like the chamber). Apart from being a source of surprise, it is a possible ignition source.  In general, natural fibers (cotton) tend not to produce a significant static charge, whereas polyester-containing materials are more inclined to do so. There is an almost direct relationship between the polyester content and the amount of charge.  Therefore, additional controls may be needed where static is a known issue, and these apply to both the inside and the outside of the chamber.  These could include grounding straps (which may be wrist, heel or shoes-based); washing with a suitable fabric softener or spraying materials with a 30:1 dilution of water-to-softener; applying a suitable anti-static spray; or using grounding mats located at key places (especially at the entrance to chambers).

CONCLUSION

It is evident that there is no cookie-cutter answer to the best choice of materials to use in a hyperbaric chamber. This short article has simply attempted to highlight the important considerations and to provide a basis for reaching an appropriate decision.  The latter should only be taken on the basis of sufficient knowledge of what has been selected, and this decision-making process should be recorded in writing, and maintained with the facility’s documented safety program.

No materials are perfect, and none can mitigate general negligence.

RESOURCES

• Library files at American Kynol, Inc., Pleasantville, NY
• Flammability of Textile Products in Canada, Health Canada, 2003 ISBN 0-662-67236-4
• ASTM D 1230-61: Standard Test Method for Flammability of Apparel Textiles, ASTM International, West Conshohocken, PA, 1994.
• Australian Government Articles on Clothing Fabrics.
• Lenzing Fibres Sales and Marketing Library, Germany.
• NFPA 99: Health Care Facilities, Quincy, MA, 2015.
• New Zealand Standard 8777: 1973 Men’s Industrial Overalls for General Purposes.
• Risk Assessment Guide, International Atmo, Inc. San Antonio, Texas, 2015.
• U.S. Consumer Product Safety Commission, Flammable Fabrics Act.

Dr Cecilia Roberts

St Augustine's Hyperbaric Medicine & Wound Care Centre

Mr Francois Burman, discusses hazard identification and risk assessment for chambers. What to do and how to prioritise the findings when there are deviations from the appropriate norms, standards, or recommendations. Francois Burman is a professional graduate and medical engineer. He holds a Master's degree in Baromedical Sciences from the University of Stellenbosch.

 Website: http://www.sauhma.org/home.htm

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We look at the importance of sanitising and cleaning Hyperbaric Chambers and equipment. It is excellent practice to clean the hyperbaric chamber after each patient is treated, in order to keep it in good working order and reduce the danger of infection.

We are shown how to clean a hyperbaric chamber properly and are provided relevant information on recommended cleaning materials. Cleaning your hyperbaric chamber can be done in as little as three minutes.
 The presentation is by Francois Burman, a professional graduate and medical engineer He has a Master's degree in Baromedical Sciences from the University of Stellenbosch.


Website: http://www.sauhma.org/home.htm

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Scuba diving feels uncomplicated when you're drifting over a shallow reef or descending through clear water toward a sandy bottom. On the other hand, diving can be physically demanding, especially when swimming against the current or walking to a dive site with heavy scuba gear. Divers must be physically capable of handling themselves and assisting their dive partners if necessary in certain scenarios.

Dr Lourens De Kock discusses the practical experience in regards to using the Chester step test to determine diver fitness levels as well as how it includes occupational health and fitness.
Dr Lourens de Kock is a medical consultant in the fields of occupational health care, diving, aviation, and shipping medicine.


Website: http://www.sauhma.org/home.htm

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Dr Jack Meintjes discusses how Hyperbaric Oxygen Therapy can be used to treat illnesses such as Covid.

Website: http://www.sauhma.org/home.htm

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Enjoy this lecture by Dr Jack Meintjes, in which he discusses standardisation and the changes made, such as the new standards for office spirometry. in 2019. He is an occupational medicine specialist and diving medicine expert. He has served as the medical director for DAN since 2007. Dr Meintjes has extensive training in hyperbaric medicine and commercial diving.

 Website: http://www.sauhma.org/home.htm 

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In this video presentation by Dr Meintjies, he discusses the cases of skin decompression sickness and their effects. He shows us the differences between skin decompression and other rashes. 
Dr Jack Meintjes is a diving medicine expert and an occupational medicine specialist. He is Divers Alert Network Southern Africa's medical director and has significant training and experience in hyperbaric medicine and commercial diving.

Low-Pressure Fabric Hyperbaric Chambers

Keywords: SAUHMA, UHMS, position, soft chamber, low-pressure chamber, Gamow bag, home chamber

Date created: 25 April 2017
Date revised: 25 April 2020
Date of next revision: 25 April 2023
 
Authorship: SAUHMA Technical Advisor, SAUHMA Executive Committee, UHMS Safety Committee, UHMS Oxygen Therapy Committee.
 
Reviewed and approved by: SAUHMA Committee
 
Overview
 
The low-pressure, fabric hyperbaric chambers (operating at less than 1.4 ATA) marketed for sports and alternative medicine, have a U.S. Food & Drug Administration (FDA) 510(k) clearance for Acute Mountain Sickness only and are designed to be compressed only with air. The FDA prohibits the use of these devices with supplemental oxygen.[1]
 
In South Africa, there is no Medicines Control Council review or cautionary statements, nor concerns raised by the Department of Labour at this stage.
 
The internationally recognized NFPA 101 Life Safety Code and NFPA 99 Health Care Facilities Code describe the requirements for the construction, operation, and maintenance of hyperbaric facilities.[2] [3]
 
The Pressure Equipment Regulations (through SANS 347) classifies a typical Gamow bag (based on volume and maximum operating pressure at less than 1.5 ATA) as Category “Not regulated”.  The low-pressure fabric hyperbaric chamber thus falls outside of any regulated requirements.[4]
 
The Diving Regulations specify that all persons exposed to pressures in excess of 100 millibar above ambient pressure (1.1 ATA) are required to conform to the requirements of these regulations, unless the treatment concerns medical conditions (non-diving) and in this case, the facility providing such treatments is required to be accredited by SAUHMA.
SANS 347 Annex A provides a schedule of health and safety standards approved by the Department of Labour. ASME PVHO-1 is listed as an approved safety standard.[5]
 
The ASME-PVHO-1 standard applies to any pressure vessel that encloses a human within the pressure boundary, with an external or internal pressure exceeding 2 psig above ambient pressure (1.14 atmospheres absolute).
 
SAUHMA’s approved indications require that treatment pressures given be at a minimum of 2 ATA. At this pressure, the pressure vessel is categorized as a Category III vessel, subject to all the design, construction, testing and certification requirements listed in SANS 347.
 
Accordingly, SAUHMA requires that all hyperbaric chamber construction is required to satisfy Category III requirements, as a minimum, and shall meet the relevant ASME-PVHO-1 requirements.
 
The SANS 347 vessel conformity categorization as Not Regulated is not appropriate where human occupancy adds a considerable safety responsibility to any pressure vessel product.
 
As considered by the UHMS, SAUHMA does not endorse the concept of low-pressure therapy at any time.[6]
 
Conclusions and Recommendations

• Hyperbaric oxygen therapy is defined as an intervention in which an individual breathes near 100% oxygen while [wholly enclosed] inside a hyperbaric chamber at a pressure equal to or greater than 1.4 ATA.
• SAUHMA approved indications commence at pressures greater or equal to 2 ATA.
• Low-pressure hyperbaric chambers, at pressures equal to or less than 1.4 ATA approved for acute mountain sickness only.
• Mild hyperbaric exposures with air, deliver no more oxygen to the body than breathing oxygen by mask at sea level pressure.
• Exposure to treatment pressures less than 2.0 ATA while breathing air does not meet the SAUHMA definition of therapeutic hyperbaric oxygen therapy and does not achieve the minimum pressure and oxygen levels required for any SAUHMA approved indication.
• All SAUHMA approved indications require that the patient breathe near 100% oxygen while enclosed in a chamber pressurized to a minimum of 2 ATA.
• SAUHMA does not recommend the use of mild hyperbaric therapy for any medical purpose other than acute mountain sickness.

[1] Food and Drug Administration, CFR _Code of Federal Regulations Title 21
[2] National Fire Protection Association, 101 Life Safety Code 2015 edition
[3] National Fire Protection Association, 99 Health Care Facilities Code, 2015 edition
[4] SANS 347: Categorization and conformity assessment criteria for all pressure equipment, 2nd Ed, 2012
[5] ASME PVHO-1, Safety standard for pressure vessels for human occupancy, 2015.
[6] Undersea and Hyperbaric Medical Society Position Statement on the Conduct of Hyperbaric Oxygen Therapy

As our association's next general meeting is due, this will be held on Saturday 29 September 2018 at 8h30, to coincide with the 2nd Tricontinental Conference on Diving & Hyperbaric Medicine proceedings. www.tricon2018.net 

The scientific meeting has been accepted by the Department of Labour as approved refresher training. We are encouraging all our members to make use of this wonderful international opportunity.

Please see our home page for further details and to RSVP.

Due to the rise in low-pressure, fabric chambers being marketed for sport and alternative medicine and in an attempt to inform and protect the general public as well as medical funders, SAUHMA has issued a position statement on this topic. We will continue to promote safe and effective Hyperbaric Oxygen Therapy (HBOT) whilst combating the off label use of HBOT as well as false marketing to the public regarding the medical benefits of soft chambers.

The TRICON2018 website is now fully functional and accepts registrations and abstracts for the 2nd Tricontinental Scientific Conference on Diving and Hyperbaric Medicine (Durban, SA, 23-29 September 2018). Make use of the favorable early registration rates, available until March 31st! 

Please see the below training  opportunities, available in Canada, for qualification as Clinical Hyperbaric Technologist, Safety Director or Technician .
The CHT course is unique as it offers a complete 2 week programme to train CHT students in a university program.

Click here for more information

The ​DAN Annual Diving Report is now available for download on the DAN website at: https://www.diversalertnetwork.org/medical/report/

The prestigious Wilbur T. Workman Safety Award was awarded to Mr Francois Burman at the recent UHMS Gulf Coast Chapter Annual Scientific Meeting held in Durham, North Carolina, in honor of a lifetime dedicated to improving safety and technology in the field of Underwater and Hyperbaric Medicine. 

Congratulations Francois! Your South African colleagues proudly salute you!

The European Committee for Hyperbaric Medicine recently held their 10th Consensus Conference on Hyperbaric Medicine in Lille, France from 14-16 April 2016.

Highlights were the change in ISSNHL and STRN (proctitis; cystitis) from type 2 to type 1, as well as Femoral Head Necrosis from no recommendation to level 2 recommendations, all supported by improved levels of evidence. The addition of a negative recommendation list is also new. 

See the summary of the new updated ECHM European list of indications for HBOT in our library as well as an explanatory document on the consensus methodology and how to interpret the different types of recommendations and levels of evidence.

​The following webinar was recently hosted by Radiometer with Mr Dick Clarke as the presenter. The various elements around TCOM are covered very well. I am not sure how long it will be available for and the first 10 minutes and last 5 minutes relate to the webinar platform and accreditation which is not of any relevance to us.

http://www.radiometer.com/en/webinars/transcutaneous-oxygen-monitoring-of-hyperbaric-problem-wound-referrals

Several DAN members have contacted us with concerns about the current Ebola epidemic. We therefore provide a summary by Dr Darryl Garth Vine of the  Western Cape Department of Health with additional comments by DAN’s Medical Director – Dr Jack Meintjes.

On August 2nd 2014, Dr Pieter Landsberg passed away. It was with great sadness that I learned this, as I had known this man, the father and doyen of diving medicine in this country, for over 30 years. He was a doctor with a true passion for underwater and hyperbaric medicine and physiology.

I first met Pieter in 1982, when I enrolled for the diving and submarine medicine course held annually at the naval base in Simon’s Town. It was the only recognised diving course available at the time and he was both a lieutenant commander in the navy and a lecturer at the course. He later took my wife and I for an inland dive at Cinderella dam in Benoni. It was a dreadful dive, with very limited visibility and nothing to see aside from weeds and an old sunken rowing boat. But it was the beginning of a lifetime association in diving medicine. At that time, SAUHMA did not exist. There was no relationship of any kind between doctors living in all the different provinces in South Africa and interested in underwater medicine.
​
Together with a few other doctors, notably Dr Frans Cronje and Dr Andy Branfield, Pieter used to meet with us from time to time at the Institute for Aviation Medicine near Pretoria. It was here that the concept of a formal diving medical association arose and SAUHMA was born. At that stage, only Gauteng was represented and Pieter was the first president. He was also fiercely concerned in the training of the fire-fighting unit in Benoni and preparing his MD thesis on the physiology of carbon dioxide in breathhold diving. A few years later SAUHMA expanded to include all diving doctors in all provinces as well as the SA Navy.

We have lost the father of our society and we mourn our loss. 

Dear Members,
 
SAUHMA is pleased to announce the release of our new website, designed with a fresh new look and user-friendly navigation, updated with the latest information about our products and services.
 
The updated video page showcases the presentations of the recent SAUHMA conference. You can now easily find the login link to the new "Diving Fitness Registry", the easy to navigate "Library” and a great “Calendar” to keep you update with all things SAUHMA under the same roof.
 
One of our main goals was to build a user-friendly and simple to navigate site. The new design allows the users to quickly find the contents thanks to its low hierarchical structure.
 
We hope that you will enjoy browsing our new site, finding more options and information each time, and that it will be yet another tool for strengthening our relations.
 
Sincerely,
 
Dr Cecilia Roberts