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Hyberbaric Chamber Safety

The safe handling and storage of compressed gas cylinders in the hyperbaric facility should be done in compliance with the National Fire Protection Association (NFPA), the Occupational Safety and Health Administration (OSHA), the Compressed Gas Association (CGA), and other Federal, State and local regulations provide guidance in maintaining a safe environment. 

Here we provide a checklist of safety guidelines. These can be printed and updated to maintain a safe environment:

Storage of Cylinders

  • All cylinder valve caps must be tightly secured unless the cylinder is connected for use.
  • Valves must be closed on all empty cylinders in storage.
  • All cylinders must be stored in racks, carts or secured into position with chains or safety straps.
  • Separate full and partial/empty cylinders into different containers.
  • Storage racks should be labeled “Full” or “Empty.”
  • Cylinders stored in departments for prompt use should not exceed two working days’ worth of supply.
  • Do not expose cylinders to temperatures exceeding 125°F.
  • Do not store flammable gas cylinders with non-flammable gas or oxide gas cylinders.
  • Store all flammable gas cylinders in a separate one-hour rated structure vented to the outside. This standard also applies to flammable gas cylinders that are empty.
  • Do not use multiple gas cylinder storage areas and distribution stations for the storage of any other materials.
  • No more than 12 oxygen E cylinders can be stored in a smoke compartment. Storing over 12 E cylinders is allowed, but needs to be stored in a one-hour fire rated storage room. 

Color Codes and Identification 

  • Identify all medical gas cylinders as such, and ensure that they have chrome valves. Use proper color-coding identification for industrial gases.
  • Ensure that the contents of cylinders are readily identifiable by the labels attached. Do not deface, alter, or remove the labels.

Cylinder Handling and Transporting

  • Do not drop, drag, or roll the cylinders.
  • Never use valves or valve caps to pick up cylinders.
  • The elimination of all sources of ignition should be the rule, regardless of whether or not the gas being used is flammable or not.
  • Transport cylinders exceeding size "E" on a properly designed cylinder truck or cart. Securely strap or chain the cylinder in place.
  • Do not use oil on cylinders nor handle cylinders with clothes or gloves contaminated with oil.
  • Never attempt to mix gases in cylinders.
  • Never attempt to repair valves, cylinders, or pressure-regulating equipment. Send them back to the manufacturer for repair.
  • Do not remove, alter, or replace safety relief mechanisms, non-interchangeable connectors, and/or other safety features.
  • Do not use multiple gas cylinder storage areas and distribution stations for the storage of any other materials.
  • When transporting E cylinders along with patient beds; place the E cylinder in a designated cart and securely hook the cart on the end of the bed for transportation. Remove the cylinder and cart once on hospital elevators.  For beds that do not have a back rail to attach the E cylinder, pull the E cylinder in the designated cart behind the bed.
  • Transport E cylinders in the designated manufactured cylinder holder in the back of wheelchairs.

Making Cylinder Connections

  • Always use the proper attaching or regulating devices.
  • Be familiar with the pin indexing system and do not force thread connections.
  • While standing to the side and away from other personnel, momentarily open the cylinder valve to eliminate dust and foreign material.
  • Make the connection of apparatus to cylinder valve. Tighten connection securely with the appropriate wrench.
  • Release the low-pressure adjustment screw of the regulator completely.
  • Slowly open the cylinder valve to the fully open position.
  • Slowly turn in the low-pressure adjustment screw on the regulator until the proper working pressure is obtained.
  • Close the cylinder valve and bleed off working pressure when the cylinder is not in use.


The WoundReference Hyperbaric Oxygen Therapy Knowledge Base features guidelines to promote high standards of patient care and operational safety within the hyperbaric program and other important tools. The WoundReference Curbside Consult gives you actionable, specific answers from our multidisciplinary clinical and reimbursement advisory panel in a timely manner. 

For customized safety programs and other wound care and hyperbaric medicine consultation services, visit MidWest Hyperbaric. 


We thank Julie Rhee ScM, for style editing


  1. National Fire Protection Association, Occupational Safety and Health Administration, Compressed Gas Association

About the Authors

With over four decades of healthcare experience, Jeff currently holds the position of Principal Partner at Midwest Hyperbaric LLC and the Co-founder and Chief Clinical Officer of Wound Reference. Jeff has excelled in critical care throughout his career, devoting almost a decade as a Flight Respiratory Therapist/Paramedic for the Spirit of Kansas City Life Flight. In 1993, Jeff transitioned into the field of Hyperbaric Medicine and Wound Care, where he committed 21 years of his career to serving as the Program Director for a 24/7 Level 1 UHMS Accredited facility with Distinction. In this role, he continued to provide patient care while overseeing all administrative, clinical, and daily operations within the Wound Care and Hyperbaric Facility. Jeff is a Registered Respiratory Therapist and a Certified Hyperbaric Technologist (CHT). He has also undergone training as a UHMS Safety Director and a UHMS Facility Accreditation Surveyor. Jeff currently serves as a member of the UHMS Accreditation Council, the UHMS Accreditation Forum Expert Panel, and the UHMS Safety Committee. Additionally, he is an esteemed member of the NFPA 99 Hyperbaric and Hypobaric Facilities Technical Standards Committee. Jeff's dedication to the field has earned him numerous prestigious awards. In 2010, he received the Gurnee Award, which honored his outstanding contributions to undersea and hyperbaric medicine. Three years later, in 2013, he was awarded the Paul C. Baker Award for his commitment to Hyperbaric Oxygen Safety Excellence. Most recently, in 2020, Jeff was honored with "The Associates Distinguished Service Award (UHMSADS)," a recognition reserved for exceptional Associate members of the Society who have demonstrated exceptional professionalism and contributions deserving of the highest accolades.
An Advanced Certified Hyperbaric Registered Nurse and Certified Wound Specialist with expertise in billing, coding and reimbursement specific to hyperbaric medicine and wound care services. UHMS Accreditation Surveyor and Safety Director. Principal partner of Midwest Hyperbaric LLC, a hyperbaric and wound consultative service. Tiffany received her primary and advanced hyperbaric training through National Baromedical Services in Columbia South Carolina. In 2021, Tiffany received the UHMS Associate Distinguished Service Award. "This award is presented to individual Associate member of the Society whose professional activities and standing are deemed to be exceptional and deserving of the highest recognition we can bestow upon them . . . who have demonstrated devotion and significant time and effort to the administrative, clinical, mechanical, physiological, safety, technical practice, and/or advancement of the hyperbaric community while achieving the highest level of expertise in their respective field. . . demonstrating the professionalism and ethical standards embodied in this recognition and in the UHMS mission.”
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