The Saba Hyperbaric Chamber slideshow for the treatment of diving related accidents in the Caribbean. One of the oldest operational hyperbaric chambers in the region. If you have dive accidents in the region, you can contact the organization 24/7. HBOT involves breathing 100% (pure) oxygen while in a special space called a hyperbaric chamber. The air pressure inside is raised to a level that is higher than normal air pressure. The increased air pressure in the chamber helps the lungs collect more oxygen. Hyperbaric oxygen therapy (HBOT) is well known for treating scuba and deep-sea divers affected by the rapid change in pressure around them. But did you know that HBOT is also used to treat a variety of other health problems, including carbon monoxide poisoning and diabetic foot ulcers? Conditions for which hyperbaric chambers are cleared for marketing by the FDA FDA clearance of a medical device includes a determination that the device has the same intended use as, and is as safe and effective as, another legally U.S.-marketed device of that type. As of July 2021, the FDA has cleared hyperbaric chambers for the following disorders: Air and gas bubbles in blood vessels Anemia (severe anemia when blood transfusions cannot be used) Burns (severe and large burns treated at a specialized burn center) Carbon monoxide poisoning Crush injury Decompression sickness (diving risk) Gas gangrene Hearing loss (complete hearing loss that occurs suddenly and without any known cause) Infection of the skin and bone (severe) Radiation injury Skin graft flap at risk of tissue death Vision loss (when sudden and painless in one eye due to blockage of blood flow) Wounds (non-healing, diabetic foot ulcers) HBOT is being studied for other conditions, including COVID-19. However, at this time, the FDA has not cleared or authorized the use of any HBOT device to treat COVID-19 or any conditions beyond those listed above. The website, clinicaltrials.gov, has more information on HBOT clinical trials for COVID-19 and other conditions. Risks of hyperbaric oxygen therapy When HBOT chambers are used for indications cleared by the FDA, HBOT is generally safe, and serious complications are rare. Because of the increased pressure and increased concentration of the oxygen during HBOT, potential risks include: Ear and sinus pain Middle ear injuries, including tympanic membrane rupture Temporary vision changes Lung collapse (rare) High concentrations of oxygen also pose the risk of fire, which is one reason why the FDA recommends treatment at an accredited facility. Explosions and fires have occurred in HBOT chambers that have not been reviewed by the FDA and are located at unaccredited facilities. Hyperbaric medicine is medical treatment in which an ambient pressure greater than sea level atmospheric pressure is a necessary component. The treatment comprises hyperbaric oxygen therapy (HBOT).

1. Saba Hyperbaric
Chamber Facility
TENDER TRAINING PART I
INTRODUCTION TO TENDER ROLE AND RESPONSIBILITIES

2. Training Objectives
As a result of training a qualified tender will:
 Understand the pre-requirements and paperwork required to function as a tender.
 Understand the role of the tender.
 Engage in effective communication with patient during all phases of the treatment.
 Efficiently follow required safety procedures designed to prevent emergencies and provide a
safe treatment facility.
 Execute on their assigned role and protocols during a normal treatment.
REVISED MAY 2015 2

3. Steps to become
a Tender
Volunteer Release Form
Updated: May 2015 Reviewed: kw
I, _______________________ agree to provide occasional service to the Saba
Hyperbaric Facility in the conduct of hyperbaric recompression treatments. I am
completely aware of the risk involved and potential hazards while conducting
hyperbaric treatments.
I am comfortable to perform the assigned tasks to my best ability. I will not hold the
Saba Hyperbaric Facility and related entities (such as employees, certified assistants,
or affiliated entities) responsible for harm that may be caused to me due to
participation in treatments, as a result of the inherent risks associated with
decompression sickness or as a result of negligence.
The Saba Hyperbaric Facility agrees to assume all liability regarding my efforts on
their behalf relating to any such treatment sessions.
Signature (participant):
Signature
(Saba Hyperbaric Facility):
All intended lawsuits must be under Caribbean Netherlands
Law and tried in Dutch Court.
1. Attend Training
2. Complete Medical exam
3. Complete Liability
Release
4. Commitment to adhere
to treatment policies and
procedures
5. Willingness to be on-call
and adhere to on-call
policies and procedures
REVISED MAY 2015 3

4. Role and Responsibilities of a Tender
ROLE
To provide basic patient
care during the
hyperbaric treatment.
RESPONSIBILITIES
Conduct pre and post dive procedures
Facilitate communications between
patient and outside personnel
Implement safety and emergency
procedures as necessary
Fulfill assigned recordkeeping and
administration requirements
REVISED MAY 2015

5. Tender Dive Considerations
Pre Dive
 Consider your own physiological factors:
 Fatigue
 Dehydration
 Strenuous Exercise
 Drug and alcohol free
 Calculate personal clean time
REVISED MAY 2015 5

6. Tender Dive Considerations (continued)
During the Treatment
 Position compromised blood flow
 Sitting with legs crossed
 Flex joints, move around every 20 -30 minutes
Post Treatment
 Wait a minimum of 30 minutes before leaving facility
 Obtain supervisor approval prior to leaving
 24 hour no-fly
 12 hour surface interval before a no-decompression dive/24 hours for a deco dive
REVISED MAY 2015 6

7. Interacting with Patients
Do:
 Conduct yourself in a professional manner at all times.
 Introduce yourself to the patient by first name only.
 Keep all patient informational (medical and personal) strictly confidential.
 Keep noise level low and all non-essential persons out.
 Be aware that most patients will be nervous before a treatment.
Don’t
 Discuss the patient’s treatment or condition with family members or others that may inquire.
 Don’t mention patient name or show patient records or paperwork with patient identity.
 Don’t speak or act in a manner that will make the patient defensive or embarrassed.
REVISED MAY 2015 7

8. Interacting with Patients
Most frequent patient questions and concerns
REVISED MAY 2015 8

9. Interacting with Patients
1. When can I dive again ?
2. How can I be bent? My computer says I am fine?
3. Where do I pee (vomit)?
4. Will I feel fine after this one treatment?
5. My buddy did the same dive I did, why is he okay?
6. Do you think the 4 shots and 6 beers I had last night had anything to do
with this?
7. How much is this going to cost?
8. I did everything correctly, do you think <insert instructor name> and <insert
dive shop name> are to blame? How could they let this happen to me?
Others?
REVISED MAY 2015 9

10. Treatment Protocol
REVISED MAY 2015 10

11. Communication Procedures
Clear and Concise Messages
Dive Hand Signals
REVISED MAY 2015 11

12. Safety Procedures
Clothing
 Clean Set of 100% cotton scrubs
 Remove jewelry and piercings
 No make-up, lotions, sunscreen or hairspray
 Only cotton underwear
 Shower prior to treatment
REVISED MAY 2015 12

13. Safety Procedures
Items Not Allowed in Chamber
 Paper or tape
 Clothing under scrubs (nylons, slips, bras, etc)
 Electronic Equipment
 Glass bottles or containers
 Alcohol, paint, acetone, finger nail polish
 Items containing mercury including thermometers
 Cigarettes or lighters
REVISED MAY 2015 13

14. Safety Procedures
Items Allowed
 Underwater dive torch (rated for use at min 50m/165 ft)
 Dive Computer
 Metal bedpan
 Water bucket
 Bite piece
 Bed sheet
Treatment Checklist Items
REVISED MAY 2015 14

15. Responding to Patient and Facility
Emergencies
REVISED MAY 2015 15

16. Monitor Patient
 Oxygen Toxicity Symptoms
 Claustrophobia (Anxiety Attack)
 Hyperventilation
 Nausea
 Respiratory Difficulty
 Seizure
 Cardiac Arrest
Immediately inform
Chamber Operator
of Situation
REVISED MAY 2015 16

17. Monitor Patient
Oxygen Toxicity Symptoms
V Tunnel Vision
E Ringing in Ears
N Nausea
T Tingling or numbness
I Irritability
D Dizziness
REVISED MAY 2015 17

18. Monitor Patient
Oxygen Toxicity
Remove patient from O2
If symptoms subside, restart
oxygen breathing after 15
minutes.
If symptoms start again interrupt
O2 breathing for another 15 min.
If problems continue, course of
treatment may be altered or
discontinued.
PATIENT CARE
REVISED MAY 2015 18

19. Monitor Patient
Oxygen Related Policies
Oxygen Toxicity is not life threatening in the
chamber, but can cause harm to patient or
tender.
Tenders do not breathe 100% O2 at
depths greater than 15 m (2.5 ata).
Critical patient should be on oxygen
during compression (descent) if
possible.
If O2 breathing is interrupted due to
CNS toxicity, allow 15 on air after
reaction and resume schedule at
point of interruption.
REVISED MAY 2015 19

20. Monitor Patient
Claustrophobia
(Anxiety Attack)
Hyperventilation
Check for CO2 build up (venting)
Verbal assurance
Chemical Assistance (Attending
Physician)
May have to abort the Treatment
REVISED MAY 2015 20

21. Monitor Patient
Nausea
Chemical Assistance
(Attending Physician)
Secure O2
PATIENT CARE
REVISED MAY 2015 21

22. Monitor Patient
Respiratory
Difficulty
Assess patient and possible
cause.
Suction as needed
(Attending Physician)
Secure O2
PATIENT CARE
REVISED MAY 2015 22

23. Monitor Patient
Seizure
Secure breathing
Protect patient from harm
Administer Valium and/or
Phenobarbital (Attending
Physician)
Abort treatment
PATIENT CARE
REVISED MAY 2015 23

24. Monitor Patient
Cardiac Arrest
Secure airway
Start CPR
Abort treatment
PATIENT CARE
REVISED MAY 2015 24

25. Facility Emergencies
Fire in Chamber
• Tell Chamber Operator fire or smoke location
• Use alternative air source
• Close O2 supply valves
• If time permits switch patient to air
• Use water bucket for small fires
REVISED MAY 2015 25

26. Facility Emergencies
Fire in Building
• Close O2 supply
• Pull fire alarm and call emergency services 416-3737
• Execute immediate ascent of inside attendants and patient
• Use fire extinguisher to contain fire
• Evacuate all personnel and patients ASAP
• Close doors
REVISED MAY 2015 26

27. Facility Emergencies
Contamination Inside Chamber
• Switch to 100% O2 masks
• Chamber operator will begin decompression immediately
• If contamination or odor is in breathing masks:
• Discontinue mask use
• Switch to alternative air source
• Begin decompression
REVISED MAY 2015 27

28. Other Potential Facility Emergencies
Chamber air supply malfunction
Loss of chamber pressure/over-pressurization
Power Failure
• Locate and switch on flashlight
• Use alternative communication
Follow emergency procedures as directed by Chamber Operator
REVISED MAY 2015 28

29. Max Descent Rate: 25 ft/min Max Ascent Rate: 1 ft/min Total Time: 285 min (4 hrs 45 min)
REVISED MAY 2015 29
60 ft

30. Saba Hyperbaric
Chamber Facility
TENDER TRAINING PART II
PRACTICAL AND SCENARIO TRAINING

31. Practical Training
As a result of training, a qualified tender will:
 Identify the parts of the chamber
 Describe how the parts of the chamber function
 Identify the location of appropriate forms and charting systems
 Observe the role and responsibilities of the chamber operator
 Successfully complete a pressure test
 Outline the appropriate action responses to given scenarios
REVISED MAY 2015 31