Featured News

The Baromedical Nurses Association (BNA) will celebrate this exciting event at the Annual Hyperbaric Nurses Day on Saturday, April 12, 2025!  All are welcome to join us for great presentations!!

Since the BNA’s inception in 1985, one of our main goals has been to recognize the specialized practice of hyperbaric nursing. Hyperbaric oxygen therapy requires nurses to have heightened patient assessment skills, advanced knowledge of specific disease processes, and technical abilities not elsewhere seen in nursing environments.(The BNA website)

The BNA is committed to offering quality continuing education for nurses working in hyperbaric medicine.  Webinars and online learning opportunities are offered throughout the year.  All education for BNA members is FREE with your membership and at a fee of $15.00 for non-BNA members. (BNA website). 

For further information, you are invited to the BNA website at www.hyperbaricnurses.org. The following are just a few of the items from the website:

The BNA is a professional nursing organization representing Registered Nurses and Licensed Practical/Vocational Nurses engaged or interested in hyperbaric oxygen therapy. This organization meets the needs of the nurse though:

• Education opportunities
• Achieving continuing education goals
• Providing a pathway toward certification
• Networking and connecting with other nurses in the hyperbaric community
• Advancing the practice of hyperbaric nursing

Membership benefits include:

• Discounted cost for the certification exams
• Meet and greet at chapter and international meetings
• Opportunity to serve on committees to advance the BNA & personal professional goals
• Enhance the hyperbaric nursing experience

In 1995, the first BNACB (Baromedical Nurses Association Certifying Board) was elected by the BNA to oversee the hyperbaric certification process of the Certification of Hyperbaric Registered Nurse (CHRN). The BNACB has regular quarterly meetings discussing issues with certification and is governed by its own set of by-laws.

We look forward to everyone attending the 2025 Baromedical Nurses Association - Hyperbaric Nurses Day annual celebration on April 15, 2025, to meet the speakers and enjoy excellent presentations!

The growing presence of soft-sided bag chambers in the marketplace has led to several questions and concerns for many in the hyperbaric community. This article aims to reveal some of the facts and misconceptions surrounding these chambers and identify the hazards associated with their use. It is important to know that soft-sided bag chambers and the facilities in which they operate are subject to the exact safety requirements of any hard-sided chambers. These safety requirements can be found in the following Fire Protection Codes and Engineering Standards:

NFPA 101: Life Safety Code (This code applies to all public and private buildings, including assembly occupancies, business occupancies, daycare facilities, educational occupancies, health care occupancies, residential occupancies, and high-rise buildings).

“8.7.5 Hyperbaric Facilities. All occupancies containing hyperbaric facilities shall comply with NFPA 99 unless otherwise modified by other provisions of this code.”

Annex Note on 8.7.5:

“A.8.7.5 while the scope of NFPA 99 is limited to healthcare occupancies, it is the intent that this requirement to be applied to hyperbaric facilities used in all occupancies.”

NFPA 101 Handbook Note on 8.7.5:

“Hyperbaric facilities can be found in a variety of occupancies in addition to healthcare occupancies. For example, hyperbaric chambers have been installed in amusement centers and physical fitness centers and have been promoted as health-enhancing aids. Paragraph 8.7.5 extends the use of the provisions of NFPA 99, Healthcare Facilities Code, to hyperbaric facilities, regardless of occupancy classification.”

Per NFPA 99 (2024) Section 1.1 Scope:

“1.1.12 Hyperbaric Facilities. Chapter 14 establishes criteria for design and operation of hyperbaric chambers and facilities. Chapter 14 covers electrical, fire, pressure, and gas hazards associated with hyperbaric facilities that are used, or intended to be used, for medical and experimental procedures at gauge pressures from 0 kPa to 690 kPa (0 psi to 100 psi).”

Annex Note on 1.1.12:

“A.1.1.12 Hyperbaric chambers are found in a variety of settings, including but not limited to hospitals, doctor’s offices, private clinics, and business occupancies. Not all hyperbaric facilities are designed or equipped the same.  Hyperbaric treatment and facilities are used for a variety of emergent and non emergent conditions, and the acuity of patients ranges from stable to critical. These variations lead to differences in hyperbaric equipment, ancillary support equipment, and facility location. This chapter is intended to provide minimum safeguards for hyperbaric patients and personnel regardless of the location of the facility.”

NFPA 99 (2024) Chapter 14, section 14.2.2.1 requires that:

“Chambers for human occupancy and their supporting systems shall be designed and fabricated to meet the requirements of ASME PVHO-1, Safety Standard for Pressure Vessels for Human Occupancy, by personnel qualified to fabricate vessels under such codes.”

Per ASME PVHO-1 (2024), Section 1 General Requirements, 1-2 Scope:

1-2.1 Application

“This standard applies to all pressure vessels that enclose a human within their pressure boundary while under internal or external pressure exceeding a differential pressure of 2 psi (15 kPa). PVHOs Include, but are not limited to, submersibles, diving bells, and personnel transfer capsules, as well as decompression, recompression, hypobaric, and hyperbaric PVHOs.”

Many soft-sided chambers on the market are not registered with the FDA, and even those that are do not comply with NFPA 99 (Chapter 14) and are not designed, fabricated, and certified to the ASME PVHO -1 safety standard. In many cases, non-certified devices are being constructed outside the U.S. and enter the country piecemeal to avoid recognition by inspecting governmental entities at the border. They are then assembled after entry. In some cases, purveyors of these bag chambers claim that their product is substantially equivalent to the FDA-cleared Gamow bag. The Gamow bag was designed to deliver only compressed air to the occupant and was never designed to provide hyperbaric oxygen therapy. The Gamow Bag is ONLY intended to treat ACUTE MOUNTAIN SICKNESS at altitude and is not certified for use with any level of supplemental oxygen (Link: FDA Consumer Alert). Notably, the Canadian equivalent of the US Food and Drug Administration (Health Canada) has banned soft-sided bag chambers in their country. (Link: Health Canada Alert)

Do not be fooled. The use of these chambers is not without risk. We know that at least one person, a young man in North Carolina, has died from asphyxia at home when undergoing treatment in a “Mild Hyperbaric Chamber,” which was unattended.  Also, in Great Britain, a diver with decompression illness was treated in a “Mild Hyperbaric Chamber” without resolution. Eventually, this diver was treated at a mainstream certified chamber at adequate doses with good results. The delay in appropriate treatment could have resulted in permanent disability or even death. In India, in September 2024, a soft-sided bag chamber ruptured with the occupant inside. The chamber was not attended. The man sought medical attention but, to our knowledge, did not receive an evaluation by a hyperbaric specialist. The status of his condition is not known.

There are many other reasons to dissuade people from entering or operating these chambers. Among them is the fact that they are not compressed with certified CGA Grade N Medical Air or even modified Grade E (breathing air for use at pressure), as required by NFPA 99, and many are sold with oxygen concentrators, a device not authorized to be used in conjunction with fabric, soft-sided chambers. The quality and purity of the gases breathed is a major concern. The fire risks associated with using concentrated oxygen under pressure are also very real. Many examples of soft-sided bag chamber facilities allow cell phones, tablets, and other electronic devices inside the chambers. In almost all of these devices, there appear to be no static grounding mechanisms present, as required by NFPA 99. While these non-certified devices are very poorly regulated, the training requirements for operators are even less so. This presents another significant risk to the occupant and anyone near the chamber while it is in operation. Please stay away from these devices; if you encounter them, alert your local Fire Marshal.

Andrew Melnyczenko is a Certified Hyperbaric Technologist with 26 years of experience in the Hyperbaric Industry in civilian and Military settings. He has been Chairman of the UHMS Hyperbaric Oxygen Safety Committee since 2018. You may contact Andrew by emailing him atmelnyczenko.andrew@mayo.edu.

POSITION STATEMENTS FROM HYPERBARIC ASSOCIATIONS:

Link to the UHMS Position Statement on Low-Pressure Fabric Hyperbaric Chambers:

https://www.uhms.org/images/Position-Statements/UHMS_Position_Statement_LP_chambers_revised.pdf

SAMJ publication related to soft-sided chambers and the SAHUMA Position Statement:

https://journals.co.za/doi/abs/10.7196/SAMJ.2019.v109i4.13524

https://sauhma.org/blog/2020/04/25/low-pressure-fabric-hyperbaric-chambers

ECHM-EUBS Position Statement on the use of ‘mild hyperbaric therapies’ in humans

https://www.eubs.org/wp-content/uploads/2022/12/ECHM-EUBS-Position-Statement-Mild-Hyperbaric-Therapies-20.12.22.pdf

NBDHMT Monthly Briefings,July 2023, May 2023, August 2022.

REFERENCES:

1. American Medical Association. “Oppose Unsafe Use of “Mild Hyperbaric Therapy” D-270.986. 2022.
2. American Society of Mechanical Engineers. Safety Standard for Pressure Vessels for Human Occupancy, ANSI/ASME PVHO-1-1912. New York: ASME, 2023.
3. Burman, F. (2019). Low-pressure fabric hyperbaric chambers. South African Medical Journal, 109(4): 12574. doi: 10.7196/SAMJ.2019.v109i4.13524. PMID: 31084683.
4. National Fire Protection Association. NFPA 101: Life Safety Code. 2024 edition. Quincy, Mass. NFPA, 2024.
5. National Fire Protection Association. NFPA 99: Health Care Facilities Code. Quincy, Mass. NFPA, 2024.
6. National Board of Diving and Hyperbaric Medical Technology. “Monthly Briefing July 2023”. Accessed October 22, 2024.
7. National Board of Diving and Hyperbaric Medical Technology. “Monthly Briefing May 2023”. Accessed October 22, 2024.
8. National Board of Diving and Hyperbaric Medical Technology. “Monthly Briefing August 2022”. Accessed October 22, 2024.
9. Southern African Undersea and Hyperbaric Medical Association. SAUHMA Position Statement: Low-Pressure Fabric Hyperbaric Chambers. Accessed 10/18/2024.
10. Undersea and Hyperbaric Medical Society. UHMS Position Statement: Low-Pressure Fabric Hyperbaric Chambers. Accessed 10/18/2024.
11. S. Food and Drug Administration. Hyperbaric oxygen therapy: Get the facts. Published July 26, 2021.
12. Health Canada. Unauthorized soft-shelled hyperbaric chambers may pose serious health risks. Published October 25^th, 2019.

Greetings from all of us here at UHMS!

As we embark on a new year, I want to thank each of you for your dedication to the field of undersea and hyperbaric medicine. Our work is critical to advancing patient care, improving clinical outcomes, and ensuring the highest safety standards in hyperbaric facilities worldwide. In this first-quarter update, I would like to highlight several key areas that reinforce our commitment to excellence: certification, facility accreditation, hyperbaric system safety, and the value of being a UHMS member.

The Importance of Certification

Certification is a hallmark of professional experience, competency, and commitment to best practices. Whether you are a physician, nurse, or technician, obtaining and maintaining your certification in hyperbaric medicine demonstrates your expertise and adherence to the highest standards of patient care. UHMS strongly encourages physicians in our field to pursue certification through ABPM/ABEM subspecialty board certification or PATH CAQ and NPPs to achieve PATH CAE; we also promote all nurses who participate in the care hyperbaric patients to become Certified Hyperbaric Registered Nurses (CHRN) program, and technicians to be certified as Certified Hyperbaric Technologists (CHT) or Certified Hyperbaric Specialists (CHS). These credentials not only enhance your professional standing but also elevate the credibility of our specialty within the broader medical community.

Please review our position statement on Certification Matters: UHMS POSITION STATEMENT.

Facility Accreditation: A Commitment to Excellence

In light of the recent tragedy in Troy, Michigan, where a 5-year-old little boy died in a horrific chamber fire while his mother stood by helplessly and watched, I will continue to pound the drum that Hyperbaric Facility Accreditation must become mandatory across the board.

Hyperbaric Facility Accreditation by UHMS remains the gold standard for ensuring safety, quality, and adherence to clinical best practices. Accredited facilities demonstrate their commitment to patient safety, operational excellence, and compliance with industry guidelines. If your facility is not yet accredited, I strongly encourage you to explore the process. Not only does accreditation improve patient trust and regulatory compliance, but it also serves as a proactive approach to risk management and liability reduction.

Maintaining Safety Diligence in Hyperbaric Systems

Safety is the foundation of everything we do in hyperbaric medicine. The risks associated with hyperbaric oxygen therapy (HBO₂) demand unwavering diligence in maintaining equipment, conducting regular safety drills, and ensuring proper staff training. UHMS provides comprehensive guidelines and resources to help facilities uphold the highest safety standards, including routine inspections, emergency preparedness protocols, and compliance with NFPA 99 and ASME PVHO-1 standards. I urge all members to prioritize safety in daily operations and take advantage of UHMS educational offerings on hyperbaric safety.

The Value of UHMS Membership

Your membership in UHMS is more than just an affiliation—it is an investment in your professional growth and the advancement of hyperbaric medicine. As a UHMS member, you gain access to cutting-edge research, clinical practice guidelines, educational opportunities, networking events, and advocacy efforts to shape our specialty's future. Additionally, membership provides exclusive discounts on conferences, workshops, and certification programs that support your career development.

The UHMS tent is wide open, so please come in and join us to make our specialty vibrant and viable for generations to come!

UHMS Finances

I am pleased to report that UHMS's financial position remains strong.

UHMS experienced a great financial year in 2024, and we ended the year with a robust surplus of $285K, compared to a much smaller surplus in 2023.

Our balance sheet remains healthy, with operating, savings, and investment accounts continuing to hover at near-all-time highs.

Member Benefits

As a reminder, UHMS members receive three free CE/CME credits upon joining or renewing. This benefit represents an immediate $40 savings for Associate members and $60 for Regular members annually. 

Associate Member Town Hall

Members are invited to attend the UHMS Associate Council town hall meeting on the second Thursday of every quarter, where invited speakers present on relevant topics that apply to our specialty.

Corporate Partners

If you are a UHMS Corporate Partner, please attend our monthly Corporate Partner Town Hall meeting series. These are held on the 1^st Wednesday of every month at noon and are intended to be an open forum for discussing the challenges and successes your businesses and practices are experiencing and to create momentum and collaboration where appropriate.    

If your organization wants to educate the UHMS membership about the care provided or the goods and services offered, consider joining our Corporate Partnership Program. See https://www.uhms.org/corporate-memberships.html.  

MEDFAQs

The UHMS offers its version of "ask the experts." MEDFAQs can be found at the following URL – https://www.uhms.org/resources/medfaqs-frequently-asked-questions-faq.html, and is a valuable tool for our membership.

If you are familiar with MEDFAQs, check back, as new Q&As are posted regularly.

Research

The UHMS Research Committee continues to be very active. We hope to announce some good news in the new year on the IRB front, where members of our community can come to the UHMS for the Institutional Review Board's needs.

We are soliciting donations from our members for two research initiatives. One is the Continuous Glucose Monitor study (https://www.uhms.org/cgm-hyperbaric-oxygen-study), and the Multicenter Registry for Hyperbaric Oxygen Therapy at Dartmouth (MRHBO₂) continues seeking funds for free hospital membership. The MRHBO2 is funded entirely via grants, not by the registry's participating hospitals - https://www.uhms.org/donate-to-the-multicenter-registry-for-hyperbaric-oxygen-therapy.html.

Remember that donations to the UHMS Funds for Research and Policy Advancement are tax-deductible. For more information, check out the UHMS website –  https://www.uhms.org/funding.html.   

QUARC

To better understand the field's challenges, log in and visit the QUARC page – https://www.uhms.org/resources/quarc.html. Here, you will find impending legislation and other relevant policies on the provision and limitations of HBO₂ coverage and the UHMS's responses and guidance.

The chairs of QUARC are requesting that you please let us know as soon as possible if there are any unusual denials or challenges with physicians gaining access to insurance panels for HBO2 services: jpeters@uhms.org.

UHM

If you are a UHMS member, we are happy to announce a new search feature for previous issues and articles from UHM/UBR - https://www.uhms.org/publications/uhm-journal/download-uhm-journal-pdfs.html. Currently, the feature works with keywords.

Looking Ahead

This year, UHMS remains committed to expanding educational initiatives, strengthening industry partnerships, and advocating for policy advancements that benefit our field. We invite you to engage with us, participate in upcoming events, and contribute to the ongoing dialogue that shapes hyperbaric and undersea medicine.

Thank you for being an integral part of our society. Your expertise, dedication, and continued engagement make a difference in advancing the science and practice of hyperbaric medicine.

If you have a suggestion or comment on how we can better serve you, please email me at jpeters@uhms.org or call at 561-776-6110 extension 100.

Sincerely,
John Peters
Executive Director
Undersea and Hyperbaric Medical Society

Medical skills and devices require competencies.  As a new nurse, I learned core hospital competencies for bedside procedures such as foley catheter insertion, intravenous catheter (IV) insertion, and nasogastric (NG) tube placement.  I never stopped completing competencies as I worked in different units and developed new skills.  When I learned to work in the emergency department, I was required to complete an arrhythmia competency course, demonstrating that I could read and interpret cardiac rhythms.  I had to complete more competencies before I was allowed to work in the emergency department trauma bays.  When I worked in the intensive care unit, I had to complete a myriad of complex competencies for various open heart and cardiothoracic devices before I was allowed to manage those patients.   All these competencies went into my hospital HR and certificate management systems. Hyperbaric oxygen therapy is no different.  Class A and Class B hyperbaric oxygen therapy chambers are medical devices –proper training and competency should be required to operate a chamber with a patient inside.

Historically, in the HBO2 industry, much emphasis has been placed on completing an introductory 40-hour HBO2 training program.  These courses are recognized and approved by various entities in the industry, and each entity applies its curriculum standards and review process for course recognition.  Much debate also occurs around how the course should be staged (in person, virtually, or self-paced).    While the course is critical for teaching hyperbaric history, theory, and clinical practice, no course can teach competency for every conceivable chamber and gas system a student may encounter when returning to their own center.  Students who complete these courses often report having more questions than answers when they return to their own unit after completing an appropriate course.

There are well over one thousand hyperbaric programs in the United States, and within these programs, there are many varieties of chamber make and model. Sechrist, Perry, Pan American, and ETC are just a few companies that have produced hyperbaric chambers over the years. Each of these companies also produced various chamber models, some with additional features such as electronic interfaces. Multiplace systems can also be unique, with specific capabilities developed for the institution in which they operate.

One must also consider the endless complexity of gas systems, as understanding how to monitor and operate the affiliated gas systems is another responsibility of a hyperbaric chamber operator.  Some HBO2 programs are tied directly into the hospital’s bulk oxygen system, while others may have a dedicated (smaller) bulk system for the unit or even a Dewars system.  Medical air may be piped into the chamber from H tanks in the unit, in an adjacent storage area, or even a hospital medical air compressor.  Some chambers can even compress oxygen or air, which adds to the complexity of learning to operate the system in one’s unit.

The need to demonstrate competency doesn’t stop with operating chambers and their affiliated gas systems.  What about hyperbaric-related clinical skill sets such as tympanic membrane inspection, use of TCP02 devices (if the unit has one), or use of hyperbaric unit glucometers?  Clinical competency should be demonstrated on all these items.  Some competencies will only include technical items, while other competencies may include clinical theory and training around unit policies for various patient situations and emergencies.

Multiplace hyperbaric chambers can also be complicated, with even more potential for competency training related to the control panel, staff access, and staff exposure to various pressures.

When designing competencies, there’s much to consider.  Should the competency document be based on a pass/fail system (competent or not competent)?  Or should competency include levels of proficiency such as competent and able to train others (superuser), competent but not able to train others, and not competent?

After designing a competency, staff should also consider what to do with those competencies.  Storing physical/paper competencies for all active hyperbaric staff is always a great idea.  But what about software?  Many hospital programs have portals and human resource software that allow for the uploading of competencies.  Managers in these systems should also consider how and when they’ll audit these competencies for their staff.  Once a competency program is in place, the logic follows that there needs to be enforcement and auditing around that program.

Even after a strong competency document has been designed, one must ask…how long is it good?  Is the competency document recognized indefinitely, or does it expire?  Should a policy be developed that requires competency to be repeated continuously?  If competencies must be repeated annually, who will sign off those with expiring competencies?

Even after competencies have been designed and enforced, program managers should ask themselves whether their staff is spending enough time operating the equipment to stay competent.  Full-time hyperbaric chamber operators will quickly become proficient in daily chamber operations.  But what about casual staff who complete the initial training process but only cross-cover hyperbaric operations every few weeks?  Are they spending enough time with the chambers to remain proficient?  How should a program measure the ongoing competency of staff?  Should a program enforce mandatory “practice” time for staff not operating hyperbaric equipment daily?  If so, how often?

Some hospital programs may have multiple campuses that staff float between. In this case, there may be differences in chamber or gas system type between campuses. Sending staff from one campus to another without proper orientation and training at both locations can also lead to confusion and operational issues. In these situations, program managers may want to consider whether they should develop an ambiguous HBO chamber competency or whether specific competencies (for each make and model of the chamber in their system) should be developed and enforced for traveling staff.

In summary, hyperbaric oxygen therapy is a specialty that deserves adequate training and competency standards as any other. The introductory hyperbaric course should not be viewed as the end of a student’s training but only the beginning. Every hyperbaric oxygen program should have adequate competency training and documentation in addition to completing an introductory course.

The Registry is a database designed to gather consistent measures about the use, outcomes, and safety of hyperbaric oxygen (HBO2) treatments from hyperbaric centers worldwide. The goal is to publish this information for quality improvement, patient care, and research and to document the outcomes from hyperbaric oxygen treatment. The Registry collects data for the 15 UHMS-approved indications for hyperbaric treatments and selected other emerging indications. The data from the participating centers are aggregated to provide information that no single center could collect independently.

Members of the registry meet quarterly via Zoom to discuss treatment experience in individual centers and challenges that may be encountered using the registry system. This allows for regular improvements and adaptations of the data collection protocols.

The standardization of data entry allows for the comparison of outcomes across centers for patients with similar clinical presentations.

The number of participating treatment centers entering data has grown from 25 in 2020 to 30.

The figures below illustrate the range and distribution of patient entries in the registry over the past several years and the specialties referring patients for HBO2. The largest patient population has consistently come from delayed radiation injury. However, there has been a notable increase in referrals for idiopathic sudden sensorineural hearing loss (218 cases in 2024, compared to 172 cases in 2023), a relatively recent addition to the UHMS-approved indication list. This may explain the rise in referrals from Otolaryngology. Additionally, a moderate number of patients enter annually for non-UHMS approved indications. While any one center may be treating those cases in very small numbers, the pooled data can then be examined collectively for a more meaningful assessment of the value of those treatments.

Figure 1. Patient entries by center 2024

Figure 2. Referral reasons 2024

Figure 3. Referral reasons 2023

Figure 4. Referring physician 2024

Figure 5. Referring physician 2023

Figure 6. Non UHMS Approved Indications 2024

Figure 7. Non UHMS Approved indications 2023

Donald Ray Chandler
April 14, 1937 — January 21, 2025

Donald R. Chandler, age 87, of Huntingtown, Maryland passed away Tuesday, January 21, 2025, at his home. Don was born April 14, 1937, in Alton WV, son of the late Ralph and Cozbi Chandler. He is survived by his wife of 63 years, Sandra. In addition to his wife, he is survived by his three children, Mark, Lisa, and Sandee, nine grandchildren, and nine great-grandchildren. He is also survived by siblings, Danny and Kathy and preceded in death by three siblings, Dick, Helen, and Judy.

He was a career Navy veteran, career government employee and a previous Executive Director of the Undersea and Hyperbaric Medical Society. His lifetime passion was his 49 years as a devoted minister.

He had many accomplishments with one being the "Undersea and Hyperbaric Medical Society, 1967 – 2007, A History of 40 Years" to capture our UHMS history. If you've never read it, it's available here: https://lnkd.in/gYmx8yUQ

Dr. John Hallenbeck, UHMS president from 1982-83, passed on 9 Feb. 

 Dr. Hallenbeck was an internationally renowned basic and translational neurologist and an esteemed member of the NINDS family. He was the founder and chief of the Stroke Branch in the NINDS intramural program, where he served for nearly three decades through his outstanding research, mentorship, and leadership. Upon his retirement from civil service in 2018, he was honored with the title of Scientist Emeritus.

A pioneer in the field of neurovascular inflammation and stroke protection mechanisms, Dr. Hallenbeck was among the first to recognize the importance of vascular inflammation and neuroinflammation in stroke, and the potential of ischemic tolerance to prevent cell death. His groundbreaking work significantly advanced the understanding of stroke pathology and highlighted inflammation as a critical area of research in neurodegenerative diseases. 

Dr. Hallenbeck's seminal research on ground squirrels illuminated how the process of hibernation protects the brain by activating SUMOylation, a cellular mechanism crucial for protein function regulation. His further studies demonstrated that SUMOylation also protects the rodent brain from stroke.

Together with the members of his Clinical Investigations Section, Dr. Hallenbeck studied ways to prevent the development of spontaneous brain infarcts in hypertensive, stroke-prone rats. With his team, he explored endogenous neuroprotective mechanisms that induce tolerance to hypoxia and ischemia in brain cells.  His research into E-selectin, a cell adhesion molecule expressed exclusively on endothelial cells, highlighted the potential of immunization through mucosal tolerization as a viable therapeutic approach. He demonstrated that intranasal administration of recombinant E-selectin can suppress both thrombotic and hemorrhagic strokes in spontaneously hypertensive, genetically stroke-prone rats. This strategy holds promise for protecting the brain from ischemic injury, autoimmune encephalitis, vasospasm in subarachnoid hemorrhage, white matter damage, and vascular cognitive impairment. 

Dr. Hallenbeck earned his BS in medicine from the University of South Dakota in 1964 and his medical degree from the University of Pennsylvania in 1966. Following a medical internship and neurology residency at the University of Michigan, he joined the U.S. Navy. At the Naval Medical Research Institute, his research focused on central nervous system decompression sickness and air embolism, and later, on the inflammatory and immune mechanisms in acute brain ischemia. 

In 1983, Dr. Hallenbeck was appointed chief of the Navy’s neurology training program at the National Naval Medical Center. From 1983 to 1991, he served as Professor of Neurology and Physiology at the Uniformed Services University of the Health Sciences, also holding roles as Vice Chairman and Chairman for Research in its Neurology Department. In 1991 he was recruited to lead the newly created Stroke Branch in NINDS Intramural Research, where he served as chief until 2018.

Upon his transition to NINDS, the National Naval Medical Center (now the Walter Reed National Military Medical Center) created the "Hallenbeck Award," annually recognizing an outstanding graduating neurology resident for their dedication and excellence in clinical neurology, research, and professionalism.

Under Dr. Hallenbeck’s leadership, the NINDS Stroke Branch grew into a world class translational stroke research enterprise. He fostered a multidisciplinary research team focused on translating promising innovations into clinical trials, while at the same time creating an atmosphere that encouraged team members to inquire and learn about all aspects of stroke research, including those outside of their primary expertise.

In 1999, with the addition of Dr. Steven Warach to the team, the Stroke Branch developed an acute stroke care program located at Suburban Hospital in Bethesda, MD. Later, the program expanded to Washington Hospital Center in Washington, DC. This A-rated program produced unique research opportunities and has effectively recruited patients to multi-level trials. Additionally, this work established the critical role of imaging biomarkers for managing clinical decisions associated with acute stroke. The program has had an important impact on the quality of stroke care.

Throughout his career, Dr. Hallenbeck received numerous prestigious awards including the American Stroke Association’s highest honor, the Thomas Willis Award. He also received the Stover-Link Award, the Albert Behnke Award, the Mihara Cerebrovascular Disorder Research Prize, as well as several DHHS Special Act or Service Awards and three NIH Director’s Awards. 

In a 2011 interview with Medscape, Dr. Hallenbeck reflected, "Life is always better if you choose to do something that you can do fairly well, rather than to struggle with what you do or just be average at what you do," he said. "The other important thing is to be able to tell the difference. You need to know when you really like to do something and have some promise for that line of work. I'm happy with the choice I made. I'm in a field that is right for me."

John’s legacy endures through his monumental contributions to stroke research, treatment, and prevention, and through the many scientists he worked with, mentored, and inspired.

Dear Esteemed Colleagues,

It is with profound sadness that we extend our deepet condolences to the family of Thomas Cooper, the 5-year-old boy who tragically lost his life in a hyperbaric chamber fireat The Oxford Center in Troy, Michigan, on January 31, 2025. Our thoughts are with his loved ones during this unimaginably difficult time. 

As the investigation into this incident continues, it serves as a stark reminder of the critical importance of adhering to stringent safety protocols in hyperbaric oxygen (HBO2) treatment. The Undersea and Hyperbaric Medical Society (UHMS) Accreditation Program is designed to ensure that facilities meet the highest standards of care and patient safety. Accreditation signifies that a facility has undergone rigorous evaluation, confirming the adequacy of its equipment, staff training, and adherence to established safety procedures. 

The U.S. Food and Drug Administration (FDA) advises patients seeking HBO2 treatment to choose facilities accredited by the UHMS, underscoring the program’s significance in promoting safe and effective treatment environments.

Proper education and training of healthcare professionals involved in HBO2 treatment are paramount. While a 40-hour introductory course in hyperbaric medicine provides foundational knowledge, it is not sufficient for those in leadership roles within hyperbaric centers. The UHMS offers the Program for Advanced Training in Hyperbaric Medicine (PATH), a comprehensive curriculum designed to deepen physicians’ understanding of hyperbaric medicine, its indications, safety, and appropriate treatment protocols. 

Additionally, the UHMS provides specialized training in diving medicine, including a four-day course in Louisiana and a two-week Physician Training in Diving Medicine program at the University of California, San Diego. These programs aim to equip physicians with a well-rounded education, enhancing their ability to make informed decisions in both undersea and hyperbaric medicine with Diving Medical Advisory Committee (DMAC) certifications.

In light of recent events, we urge all facilities offering HBO2 treatment to pursue UHMS accreditation and for healthcare professionals to engage in advanced training programs. By committing to these standards, we can work together to prevent future tragedies and ensure the safety and well-being of all patients under our care.

Sincerely,

Owen J. O’Neill, MD, MPH, FUHM, FACHM
UHMS President

The new regulatory framework following Law No. 24 of March 8, 2017 (the Gelli Law) led to establishing the National Guidelines System (SNLG) through the Ministerial Decree of February 27, 2018. Managed by the Istituto Superiore di Sanità (ISS) via the National Center for Clinical Governance and Care Excellence, this system aims to standardize and improve healthcare practices by providing evidence-based guidelines. This initiative enhances the quality and safety of care and serves as a reference for medical liability assessments.

Developing the methodological and operational manuals for producing guidelines and good clinical practices ensures the scientific rigor and applicability of clinical guidelinesin the Italian healthcare system. The emphasis on transparency, collaboration with scientific societies, and continuous updating of guidelines reflects a broader effort to align medical practices with international standards. Furthermore, the link between guidelines and legal responsibility underscores the dual purpose of the SNLG: improving healthcare quality while also serving as a reference in medico-legal contexts.

The Italian Society of Underwater and Hyperbaric Medicine (SIMSI) is included in the List of Scientific Societies and Technical-Scientific Associations of Healthcare Professions pursuant to the Ministerial Decree of August 2, 2017. https://www.salute.gov.it/imgs/C_17_pagineAree_4834_16_file.pdf

In July 2023, SIMSI in collaboration with Italian Navy's Health Inspectorate, "Ispettorato di Sanità della Marina Militare Italiana," (SIOeChF): The Italian Society of Otorhinolaryngology and Cervico-Facial Surgery, (SIAARTI): The Italian Society of Anesthesia, Analgesia, Resuscitation, and Intensive Care,  (SIAF): The Italian Society of Audiology and Phoniatrics,  (SIMEU): The Italian Society of Emergency-Urgency Medicine,  (ASPaTI): The Association of Patients Treated with Hyperbaric Oxygen Therapy,  (ANCIP): The National Association of Private Hyperbaric Centres, Otosub, submitted a guideline proposal, "Therapies for Idiopathic Sudden Sensorineural Hearing Loss (ISSNHL)" to the National Center for Clinical Governance and Care Excellence, which was evaluated and approved on July 12, 2024. https://www.iss.it/en/-/terapie-ipoacusia-improvvisa-neurosensoriale

Key Points

Recommended Treatments

1. Combination Therapy (Strong Recommendation, High-Quality Evidence)
   • The combined use of systemic and/or intratympanic corticosteroids (CSI) with Hyperbaric Oxygen Therapy (HBOT) is more effective than corticosteroids alone in the initial treatment of ISSNHL.
   • Patients receiving HBOT plus corticosteroids showed greater hearing recovery than those on corticosteroids alone.
2. Timing of Treatment (Conditional Recommendation, Low-Quality Evidence)
   • The best results are achieved if treatment begins within 15 days of onset.
   • If treatment within 15 days is not possible, initiation within one month is still considered beneficial.

Effectiveness & Safety

• HBOT + corticosteroids lead to significant hearing improvement based on clinical trials.
• Side effects of HBOT are minor (e.g., middle ear barotrauma in <4% of patients).

Economic Considerations

• Hearing loss has a major socioeconomic impact, increasing healthcare costs and reducing quality of life.
• The guidelines emphasize early intervention to reduce long-term healthcare burdens and the need for hearing aids.

Conclusion

The SIMSI guidelines support HBOT in combination with corticosteroids as the standard treatment for ISSNHL, reinforcing the importance of early intervention and multidisciplinary management to optimize patient outcomes​.

Dott. Luigi Santarella
SIMSI