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Staff Minimum Qualifications and Training for HBOT

Staff Minimum Qualifications and Training for HBOT

Staff Minimum Qualifications and Training for HBOT

INTRODUCTION

Overview

This topic elaborates on the minimum qualifications and training/education for hyperbaric staff, and provides policies that can be adjusted and adopted by hyperbaric programs. For more complete, suggested hyperbaric staff qualifications and training/education, see topic "Staff Qualifications".

Background

Relevance

Determining the make-up of the hyperbaric team is dependent on the purpose and scope of the facility. Nevertheless, regardless of the purpose and scope of the facility, minimum qualifications and training for hyperbaric personnel should be observed, in order to ensure patient/ staff safety and safeguard the program against medical-legal actions. Inadequate knowledge of applicable gas laws, chamber fire safety, potential risks, side effects, and contraindications of hyperbaric medicine, may result in dangerous situations that risk patients' and personnel's well-being. 

Regulatory and accreditation bodies such as the National Fire Protection Association (NFPA), the Undersea and Hyperbaric Medical Society (UHMS) and the National Board of Diving and Hyperbaric Medical Technology (NBDHMT) have an expectation that each hyperbaric medicine facility has appropriately trained personnel qualified to provide care and treatment safely. 

These organizations provide guidance and recommendation(s) in order to ensure compliance with regulatory and industry standards within the hyperbaric facility, as summarized below:

  • The NFPA 99 (2012 Edition: Chapter 14) provides the regulatory requirement(s) and guidelines for Hyperbaric Facilities. Within Chapter 14 of the NFPA 99 are the guidelines that must be established to ensure safe operations of the hyperbaric facility.[1]

MINIMUM QUALIFICATIONS AND TRAINING FOR HBOT 

Training, education, and experience are the fundamentals of qualified staff. Each of these should be considered when determining the make-up of the hyperbaric team.   

In regard to the training of hyperbaric personnel, NFPA 99 (A.14.3.1.3.3) states [1]

  • "It is incumbent upon the governing body to insist that rules and regulations with respect to practices and conduct in hyperbaric facilities, including qualifications and training of hyperbaric personnel, be adopted by the medical or administrative staff of the institution, and that regulations for inspection and maintenance are in use by the administrative, maintenance, and ancillary (and, in the case of a hospital, nursing and other professional) personnel."
  • In addition, Appendix A (A.14.3.1.3.4) states – “It is recommended that training of hyperbaric chamber personnel be closely monitored, following the guidelines and publications of the Undersea & Hyperbaric Medical Society, the Baromedical Nurses Association, and the National Board of Diving and Hyperbaric Medical Technology”. 
  • Note to readers: The NFPA Appendices are important resources, as they provide ‘real-world’ examples of the thoughts behind the codes stated in Chapter 14.


POLICY - MINIMUM QUALIFICATIONS AND TRAINING FOR HBOT

Purpose

To clarify the necessary professional training and qualifications of the physician and full- and part-time staff members who staff the program.


Policy 


The hyperbaric program shall have personnel that meet minimum qualifications and training according to NFPA 99 (A.14.3.1.3.3).[1] 

Procedures

  1. Physicians, Non-physician practitioners, Nurses and Allied Health staff must have current State licensure.
  2. Physicians must have current state DEA and BNDD
  3. Physicians, Non-physician practitioners, Nurses and Allied Health staff:
    1. Must demonstrate successful completion of training approved by the UHMS (Undersea and Hyperbaric Medical Society), the (BNACB) Baromedical Nursing Association Certification Board or the NBDHMT (National Board of Diving and Hyperbaric Medical Technologists), respectively. All team members must demonstrate a fundamental appreciation of hyperbaric medicine with respect to:
      1. Knowledge of the “approved” uses, and the basis for their treatment with hyperbaric oxygen therapy.
      2. Knowledge of applicable gas laws.
      3. Knowledge of chamber fire safety.
      4. Knowledge of potential risks, side effects, and contraindications of hyperbaric medicine, and an ability to explain these issues to patients/ families in terms that they can understand.
      5. Ability to provide hyperbaric treatments and transcutaneous assessments in a safe and effective manner, with minimal discomfort to the patient.
      6. Knowledge of the hyperbaric chamber, associated ventilator, and all ancillary equipment, standard operating procedures, and related emergency procedures.
      7. Ability to recognize side effects and complications (including ear, tooth, and sinus difficulties, pneumothorax, oxygen toxicity, and hypoglycemia) and to follow up with appropriate corrective action.
    2. Must provide documentation of professional and educational credentials in accordance with federal and state requirements and Staff Competency and Compliance policy.
    3. Are encouraged to further their professional education and development. Specific opportunities will be provided in the field of hyperbaric and diving medicine and technology.
    4. Are required to maintain and document competency and compliance.

Additional guidance - staff training, competency and compliance

Hyperbaric Technologists

Technologists candidates should become certified as Certified Hyperbaric Technologist - CHT (must meet NBDHMT eligibility requirements). For more details on duties, education, experience, training and performance expectations see topics "Certified Hyperbaric Technologist" and "Hyperbaric Chamber Operator". 
Certified Hyperbaric Technologist - CHT
The NBDHMT Resource Manual describes the training and competencies needed to become a Certified Hyperbaric Technologists (CHT), as well as the acceptable qualifying pathways.[2] The CHT is not a licensure, but rather an additional certification beyond the individual's qualifying profession.[2]

The acceptable qualifying pathways for CHT certification are: 
  • Respiratory Therapist
  • Physician Assistant
  • Active Duty Military Corpsman
  • EMT/Paramedic
  • Registered Nurse or LPN
  • Nurse Practitioner 
  • Physician 
In addition to the qualifying pathway the NBDHMT provides specific guidelines for training and competency for CHTs beyond the initial Introductory Hyperbaric Medicine Course. Guidelines include [2]: 
  • Be at least 18 years of age with a high school diploma or equivalent.
  • CHT applicants must have completed a National Board of Diving & Hyperbaric Medical Technology (NBDHMT) approved hyperbaric medicine introductory training course within three years of intended CHT test date.
  • As part of the clinical internship, the CHT must complete the Transcutaneous Oxygen Monitoring (TCOM) Module.
  • Upon completion of an approved course, CHT applicants must undergo a clinical work experience of 480 hours in undersea, hyperbaric medicine or aviation medical technology. Forty (40) hours of this requirement must be a supervised direct and physically present clinical internship. The Board must be notified in writing of the name of the preceptor prior to commencing the internship. The preceptor should be either a CHT or a CHRN with a minimum of two years experience.
  • Military personnel must complete 1000 clinical hours in addition to required, approved, training received in the military (unless 480 hours of approved clinical internship can be completed at an NBDHMT approved facility)
  • Maintain a minimum 24 continuing education credits every two years with at least 12 of those specific to undersea, hyperbaric, or aviation medicine

Hyperbaric Clinical Registered Nurse

For details on duties, education, experience, training and performance expectations see topic "Hyperbaric Registered Nurse"

Staff Physician

For details on duties, education, experience, training and performance expectations see topic "Staff Physician"


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NOTE: This is a controlled document. This document is not a substitute for proper training, experience, and exercising of professional judgment. While every effort has been made to ensure the accuracy of the contents, neither the authors nor the Wound Reference, Inc. give any guarantee as to the accuracy of the information contained in them nor accept any liability, with respect to loss, damage, injury or expense arising from any such errors or omissions in the contents of the work.

REFERENCES

  1. . "Hyperbaric Facilities" Chapter 14, NFPA 99 Health Care Facilities, 2012 Edition. National Fire Protection Association, Quincy MA .;.
  2. National Board of Diving and Hyperbaric Medical Technology (NDBHMT). Certified Hyperbaric Technologist Resource Manual . 2019;.
Topic 1380 Version