Working Under Pressure: Hyperbaric Medicine

Offering a new lease on life

The practice of hyperbaric and diving medicine is fascinating. Many who enter the field do so with the hope of treating injured divers. But injured divers are an infrequent visitor to most hyperbaric facilities – a sign of the sport's safety.

"Overall, divers constitute about 1 to 2 percent of the cases seen by hyperbaric centers," said Nick Bird, CEO and chief medical officer of DAN. The primary focus of healthcare related to divers is on injury prevention. As such, the majority of a hyperbaric center's focus is on nondiving related illnesses and injuries like diabetic wounds, delayed effects of radiation therapy, compromised flaps, burns and certain infections.

"As a diving medicine physician, you treat a wide range of conditions and patients of all ages," Bird said.

For those interested in this field, there are many opportunities available at the technician, nurse or physician levels. In each area, a primary healthcare credential is required.

Physicians entering into this arena commonly come from primary care backgrounds, but many specialties are represented, including surgery, obstetrics and anesthesiology. Subsequent training must include a primary hyperbaric medicine course. To become board certified, a fellowship is now required. For physicians in a fellowship program or those interested in diving medicine, DAN is an excellent resource for additional education.

A hyperbaric team may also include a certified hyperbaric technician (CHT) and a certified hyperbaric registered nurse (CHRN). CHTs come from many fields, usually emergency medical technicians, medical administrators or certified nursing assistants. CHTs fill many roles including chamber operators, maintainers; and attendants and well as ensuring patients are safely prepared for treatment. CHRNs oversee treatment plans and coordinate patient care between the primary and hyperbaric physicians. They are also integral to critical patients and those needing additional medical attention. The hyperbaric physician performs the initial consultation and oversees the treatment and management of the patient's care.

What makes hyperbaric medicine so unique and rewarding? "The field of medicine is divided into two primary disciplines: surgery and clinical medicine," said Bird. "Surgical approaches are geared towards task completion and problem resolution. Clinical medicine, on the other hand, has an instrumental role in disease management. The field of hyperbaric medicine is a fascinating combination of these two perspectives. We treat acute problems that may take from days to months to resolve. As such, our patients become well known to us (the clinical medical model), but the goal is to see patients return to their lives with resolution of the initial injury – an end-point more commonly seen by surgeons. When you save a limb or return a state of function thought lost to them, it gives a new lease on that person's life – that's a very powerful thing."
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