With the rapid growth of non-emergent HBO2 facilities for non-healing wounds, what was not anticipated was the decline of available HBO2 facilities for emergencies. Our concern is that many recreational scuba divers may be unaware of this growing problem and assume incorrectly that local hyperbaric chambers will provide emergent HBO2 for diving-related illnesses. Thus, our intent is to bring attention to the loss of 24/7 emergent HBO2 facilities in the United States, and to bring awareness of the action steps recently taken in effort to reverse this trend.
Scuba divers are trained to know that the primary treatment for decompression sickness and gas embolism is recompression with hyperbaric oxygen. The Divers Alert Network (DAN) presents an excellent overview of several different types of hyperbaric chambers
. There are three primary classifications for chambers:
Class A - multiplace chambers
are large enough to accommodate multiple patients inside the chamber.
Class B - monoplace chambers
treat one patient at a time; they are the most common in the U.S.
Class C - animal chambers
are not used to treat people.
Pre-dive trip planning should include locating the nearest chamber that will provide emergency HBO2 treatment in case of a diving emergency. Additional overview of scuba diving safety, prevention and hyperbaric chambers safety and credentialing can be reviewed at DAN
. The UHMS maintains a list of accredited clinical HBO2 facilities
; DAN maintains a list of hyperbaric treatment facilities that will accept emergency HBO2 patients. Previously, DAN reported that the number of HBO2 facilities available to treat diving-related emergencies 24 hours per day, 7 days a week (24/7) dropped from 37% in 2004 to only 7% in 2016, and this downward trend continues today. Recently, an Open Letter
to the UHMS journal editors stated that each year in the United States there are approximately 70,000 patients for whom emergency HBO2 treatment is indicated – see Table 2. However, fewer than 10% of the approximately 1,300 U.S. hyperbaric facilities will accept emergency HBO2 patients. The number of hyperbaric treatment facilities in the U.S. that offer emergent HBO2 on an intermittent basis is 99 according to the list provided by DAN. The number of hyperbaric treatment facilities in the U.S. that offer full-time access to emergent HBO2 therapy is 78 as of June 2020, with several treatment facilities having just dropped their 24/7 emergent HBO2 availability (Personal communication: Dr. Jim Chimiak – 29 May 2020; personal communication Mr. Dick Clarke – 19 June 2020).