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Monthly Briefing Archive

Current Monthly Briefing

August 2014

A note to follow-up on last month’s Briefing.

The Board has heard from some several CMA/CNA CHT's expressing discontent. This was certainly to be expected. The Board also heard from an equal number who recognized the rationale behind the change. They indicated that they will seek to advance their professional standing in order to maintain CHT status and ultimately become more 'marketable' within the health care delivery system’s medical community with the higher level of training. They were grateful that the Board had elected to provide financial support, by way of an individual stipend of $150.00, to all those affected who agree to enroll in classes to maintain eligibility. There are 190 CHT's with such eligibility pathway issues and the Board felt that the offer of stipends to all of them was entirely consistent with its stated mission, which is to 'Ensure that the practice of diving medicine and hyperbaric oxygen therapy is supported by appropriately qualified technologists and nurses, through respective board certification pathways'.

The president of the National Association of CMA's also contacted the Board as he had been lobbied by one or more of those so affected. He was provided with additional insights. He wrote again to see if grandfathering was a possibility. With an explanation as to why this could not be possible and would make no sense at all he appeared to accept the Board's.

Dick Clarke, President
National Board of Diving & Hyperbaric Medical Technology

July 2014

The NBDHMT has become increasingly concerned that CNA and CMA CHT's are being placed into clinically responsible positions that exceed their respective scope of practice. The Board considers this to have important patient safety and operational practice implications.

CNA’s are trained to assist with activities of daily living, while CMA’s  are trained to assist with clerical work and physician procedures within a medical office setting.

The Board’s earlier decision to include CNA’s and CMA’s as qualifying pathways was thought to represent a means whereby unlicensed personnel could obtain added competency in support of, but not replace, licensed staff. Conferring CHT status was never intended to represent a process whereby CNA's and CMA's would, for example, be employed as lead or principal operators of monoplace hyperbaric chambers. Yet this is what has transpired and to an ever increasing degree. This situation does, therefore, warrant corrective action by the Board.

Accordingly, there will be a transition over the next 18 months to an eventual elimination of these two health care categories as eligible for CHT status. The Board understands that this may be somewhat disruptive and concerning to you, however, the Board also knows that it is the right thing to do. The attached document provides a detailed summary of the process whereby this decision was reached. It also suggests an eligibility pathway alternative for CNA's and CMA’s currently certified as CHT's in order to maintain their status with the Board.

Designation Qualifying Pathway for CHT (PDF)

Dick Clarke, President
National Board of Diving & Hyperbaric Medical Technology

June 2014

It is not uncommon that diver medics struggle to obtain the necessary hours of DMT instructor-based continuing education required for recertification. Available resources are clearly very limited. In order to improve this situation the Board has introduced a web-based continuing education center. It can be accessed on the Board’s website (www.nbdhmt.org) as a direct left column link, or via the ‘Diver Medics’ link and item #11. At the present time there are seven lectures representing a total of 7.5 hours of credit. To obtain credits diver medics are required to review lectures and complete lecture-specific tests. There is presently no cost for this service. Lecture content and available credits will be increased as suitable material becomes available.

Although the DMT Education Center only went live last week the Board has already received requests from CHT’s for awarding of credits following their viewing of this material. The current topics are very much diver medic related and are not considered to represent suitable Category A ‘hyperbaric’ CEU materials. However, as they do represent an ‘indirect’ knowledge extension they can be used for CHRN/CHT/CHT-Vet Category B recertification credits.

In due course the Board will introduce a similar CEU process for hyperbaric team members.

Dick Clarke, President
National Board of Diving & Hyperbaric Medical Technology

May 2014

It is with great pleasure that the NBDHMT welcomes its newest Board member, Bryan Miers. We are delighted with his addition, one that will increase our scope and expertise as we address new education and certification opportunities. Below is his brief biographical sketch.

Captain Bryan Miers is a twenty-two plus veteran of the Henrico County Division of Fire. He also has over 17 years of service as a Nationally Registered Paramedic. In addition to his paramedic, he is a certified Diver Medical Technician (DMT), American Heart certified Advanced Cardiac Life Support (ACLS) and CPR instructor. He is currently the Station Captain of fire station 2. In addition to his suppression responsibilities he is Captain of the Henrico Search Rescue Dive Team. He has been a member of the Dive team for over 10 years. He was placed as team leader in 2011 after his appointment to Captain. Captain Miers has been diving since 1990 and is currently a SDI Instructor. As for public safety diving, he is currently Emergency Response Diver International (ERDI) Instructor and holds multiple certifications from Dive Rescue International. He also holds many specialty instructor certifications including deep diver, dry suit, full face, nitrox, and boat diving. In addition to his scuba diving experience, Captain Miers is a Planning Section Chief (PSC) for a Type 3 Incident Management Team (IMT) team, which oversees emergency response to large incidents throughout the Central Virginia Area. He has also received specialized training in swift water rescue from Rescue 3 and Marine Patrol functions from the US Coast Guard. Captain Miers has worked with the Virginia Port Authority and numerous dive teams throughout the state of Virginia to increase the safety of Public Safety Divers. He was instrumental in the development of the Richmond Metro ‘Dive Accident Management Manual’, a unique and valuable document that effectively guides both the medical first responder and the areas public safety dive team members when faced with a diving accident or injury. Captain Miers will bring his knowledge and skills to the development, introduction and oversight of the Board are new diving medicine certification courses for shore-base medical first responders.

Dick Clarke, President
National Board of Diving & Hyperbaric Medical Technology

April 2014

As we close in on the 25th anniversary of the certified hyperbaric technologist program it was thought useful to provide a brief summary of its beginnings, evolution and present status.

Deliberations by the National Association of Diver Medic Technicians represented the genesis for this category of allied health professional. Constituted in 1985, the NADMT served as the oversight organization for the medically and geographically remote diver medic. Within its leadership were several representing the operational and clinical practice of hospital-based hyperbaric medicine and all too aware of a lack of formalized training standards and certification for those who operated hyperbaric delivery systems. Arguably, hyperbaric medicine represented the last therapeutic service without such standards.

Over an 18 month period working groups were tasked with the development of eligibility criteria, training modules, instructor approval standards, an examination question bank, a study guide and additional program resource materials.

Once these components had been assembled the CHT program was launched. Initial certification testing took place in San Diego, California, in conjunction with the Undersea and Hyperbaric Medical Society’s 1991 Annual Scientific Meeting. At this time the NADMT became the National Board of Diving & Hyperbaric Medical Technology, a non-profit certification organization. First headquartered in New Orleans, LA, the Board’s administrative home was relocated to Columbia, SC in 2009.

In 1995 the NBDHMT had assumed responsibility for the hyperbaric nursing certification testing process, on behalf of the Baromedical Nurses Association and its Certification Board. A certification program in veterinary hyperbaric technology followed in 2011.

Consistent with other medical technology certification standards, CHT’s are required to maintain competency and commit to ongoing education. They do so through recertification requirements based upon confirmation of skills maintenance and accumulation of hyperbaric-specific education credits. To facilitate ongoing professional development, the NBDHMT accredits numerous online enduring material programs, and likewise credits various meetings and conferences.

The NBDHMT assumes a leadership stance on all things hyperbaric safety and related operational practice, which includes ongoing generation of Position Statements. (www.nbdhmt.org)

Practicing CHT’s are encouraged by the fact that their certification Board is comprised largely of their hyperbaric technology peers, peers who represent an enormous amount of experience and expertise. They are joined on the Board by others widely acknowledged as undersea and hyperbaric medicine subject matter experts. Board members offer their time and expertise freely and without expectation. They receive nothing in return but the satisfaction that hyperbaric treatment facilities and their patients are that much better off because of the existence of an exacting certification in hyperbaric technology.

Over the past 23 years 3,797 individuals have achieved hyperbaric certification status, 126 (5%) doing so ‘With Distinction’. Unfortunately first time failure rates have steadily increased over the past decade. From a rate as low as 8-10% in the 1990’s, they have reached 25% in recent years. Retake failure rates are likewise significant for a steady increase. Analyses of respective qualifying pathways indicate that rates are highest among certified nursing aides and certified medical assistant categories, where they approach 60%. This is in stark contrast to registered nurses who choose to take the CHT examination, where pass rates consistently exceed 98%. Because of this growing problem with CNA’s and CMA’s, the Board is currently undertaking a reassessment of its earlier decision to open up certification testing for these nursing support categories. This is high on the Board’s agenda as an increasing number of hospitals are using them in an all too frequent unsupervised hyperbaric chamber operator role. All of those who initially fail are advised of their weakness, encouraged to commit further study and scheduled for retesting upon request and following a minimum of six months from their first attempt.

Those who fail a second time must attend a second NBDHMT-approved hyperbaric training course before becoming eligible to sit the CHT examination for a third and final time.

In conclusion, the practice of hyperbaric medicine is supported by a long-standing and reputable hyperbaric technology certification process. This not-for-profit program’s leadership is comprised largely of CHT peers and representing an enormous amount of experience across the continuum of undersea medicine and hyperbaric oxygen therapy. The essential ‘center of gravity’ of the Board’s mission is to ensure that the practice of hyperbaric medicine has ready access to chamber support personnel who have achieved certification and commit to ongoing skills maintenance and knowledge expansion.

Dick Clarke, President
National Board of Diving & Hyperbaric Medical Technology

March 2014

An eligibility update for those wishing to take the Certified Hyperbaric Registered Nurse (CHRN) examination has been introduced. Effective January 1 of this year, applicants must apply within five years of completing their NBDHMT approved hyperbaric medicine training course. Dispensation is available to those who exceed this five year rule if proof of at least 60 hours of hyperbaric medicine (Category A) educational credits can be provided. Nursing School transcripts would not be considered acceptable in this regard.  

Dick Clarke, President
National Board of Diving & Hyperbaric Medical Technology

February 2014

For the first time one of Medicare's national contractors has incorporated into its Local Coverage Determination a requirement that staff members operating chambers be trained and certified in hyperbaric medicine. Each Medicare Contractor produces an essential interpretation, or clarification, of national CMS/Medicare reimbursement policy. This is contained within each respective Contractor's LCD. All of those health care facilities and professionals practicing within a Contractors region of jurisdiction are required to maintain compliance with the dictates of their governing LCD.

Novitas Solutions is the Contractor in question. Their new LCD is presently in draft form. Open hearings have been completed, with the NBDHMT represented and presenting at one venue. The Board expressed its approval and encouragement of the training and certification standards and made several content and language recommendations. A final LCD is expected in March.

Dick Clarke, President
National Board of Diving & Hyperbaric Medical Technology

January 2014

The Board is pleased to advise that a new certification program is currently under development. It involves training in diving medicine and is directed at the shore-based first responder.

This program is considered necessary as there is presently no other formalized certificate training in this unique area of medical first responder practice. Not infrequently, EMT/paramedic units are called to inland bodies of water and coastal zones to evaluate and transport injured divers. Commonly, these first responders are not familiar with the etiologies resulting in decompression illness or other diving-related injuries. Consequently, there may be some delay as until clinical picture is better clarified, appropriate immediate management instituted and destination protocols determined.

In recent years a number of these first responders and public safety personnel have undergone Board approved diver medic (DMT) training. While the Board certainly appreciates this degree of interest, the Board also recognizes that the current DMT program offers little in relevance to the practice patterns expected of shore-based personnel. The DMT program’s genesis and current basis is the training of medically and geographically remote commercial/professional dive team members, and those who directly support these teams. The DMT is trained to practice in and around the diving chamber as the eyes, ears and hands of a distant medical control physician. This is a far cry from shore-based medical first responders, whose remit is to function within the immediate pre-hospital setting; where hand-off to a physician is usually minutes rather than hours away. Injured professional divers may find themselves many hundreds of miles from a hospital, with several days of decompression required before they can even begin their medical evacuation journey.

Not surprisingly, shore-based first responders who have undergone the current diver medic training program have had difficulty with its unique concepts, operational settings and practice expectations of the remote duty DMT.

The Board is in the process of developing a suitable core curriculum, training course outline, related time frames and an instructor approval process. It is hoped that this process will be completed by May 1 of this year. Please stay tuned for additional updates.  

Dick Clarke, President
National Board of Diving & Hyperbaric Medical Technology

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December 2013

2013 has been another busy year for the Board. A record 66 locations were scheduled for CHT, CHRN and CHT-Vet certification testing. The second DMT refresher training course was held in New Orleans, and included attendance by Board-approved DMT instructors, who were preparing to teach consistent with the Board’s DMT certification examination. Effective 2014, DMT certification will require standardized testing, as per CHT/CHRN/CHT-Vet testing, and no longer based upon each instructor’s individualized post-course test.

Since its availability in April of this year, some 250 copies of ‘Daugherty’s Field Guide for the Diver Medic’ have been purchased. This third edition was completely revamped, updated and expanded, resulting in a doubling of its previous page count.

Best wishes from Board headquarters for the holiday season and the coming year.  

Dick Clarke, President
National Board of Diving & Hyperbaric Medical Technology

November 2013

An update was recently made to the CHT Resource Manual. It related to the process whereby those who have failed to recertify can regain CHT status. The change applies to those whose certification has lapsed for more than two years. In order to recertify, it is now necessary to begin the application process from scratch. This means that applicants must have a current qualifying pathway and should have completed a Board approved hyperbaric training course within two years of their re-application date.

Questions occasionally arise as to the definition of categories of continuing education credits. Two such categories exist. One is termed Category A. To acquire Category A credits one must be exposed to topics/subject matter that is directly related to undersea medicine or hyperbaric oxygen therapy. Examples include chamber fire safety, patient chamber complications, hyperbaric operational issues and emergency procedures, and updates on indications for HBO therapy. Category B credits relate to topics/subject matter indirectly related to undersea medicine and hyperbaric oxygen therapy. Examples here would include CPR, HIPAA compliance issues and wound management updates.

Dick Clarke, President
National Board of Diving & Hyperbaric Medical Technology

October 2013

There is occasional confusion regarding the training course approval processes of the Undersea and Hyperbaric Medical Society and the NBDHMT. Each organization is a separate entity and directs their course approvals to very different groups. The UHMS approves hyperbaric medicine and other courses for physicians, through its relationship with the American College of Continuing Medical Education. This course approval process represents the pathway for physicians to become eligible for hospital credentialing in undersea and hyperbaric medicine.

The National Board, on the other hand, approves courses that represent the pathway for certification in hyperbaric technology (CHT) and hyperbaric nursing (CHRN). These two organizational approvals are independent and exclusive of one another. A nurse or technician would not be eligible to sit their respective hyperbaric certification exam by attending a UHMS approved course, unless that course was also approved by the National Board. Many courses are approved by both organizations, some are not.

Likewise, a physician would not be eligible for education credits and probably not be eligible for hospital credentialing if he/she attended a National Board approved course that was not concurrently approved by the UHMS.

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A reminder to diver medics that our third annual DMT refresher training course is scheduled for February 10-11, 2014, in New Orleans. Registration details are available at http://www.nbdhmt.org/forms/DMT_Refresher_Training_2014_Application.pdf. The Board will provide each registrant with a copy of the 2013 Daugherty’s Field Guide for the Diver Medic as a function of their registration fee.

Dick Clarke, President
National Board of Diving & Hyperbaric Medical Technology

September 2013

Long silent on the issue of off-label HBO therapy, the Federal Drug Administration has finally spoken up. In the first of two recent publications consumers are cautioned as to the likelihood of being misled by promoters of off-label hyperbaric ‘treatments’. This ‘Consumer Update’ lists some 23 conditions being touted as likely to benefit, with the FDA noting that all lack supportive clinical evidence.

As medical science has invariably failed to find therapeutic answers for these conditions it is perhaps not too surprising that many desperate patients and their equally desperate families will grasp at any proverbial straw. Sadly, there are always those who see these patients as an easy source of revenue. This publication makes reference to a growing number of disgruntled patients and frustrated health care professionals who have formally complained to the FDA.

In a second off-label related issue, the FDA has issued warning letters to Healing Dives, Inc. (Woodland Hills, CA), Hyperbaric Options (Troy, Michigan), Oxyhealth, LLC (Santa Fe Springs, CA) and Pressure Tech, Inc. (Freeport, NY). These four companies manufacture/market products to those who have been led to believe, or would like to believe, that breathing 4 psig air inside an inflatable chamber is somehow therapeutic. The FDA accuses these companies of adulteration and/or misbranding of their respective 510 (k) status.

The two links below will allow you to read these publications in full.

http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm364687.htm

http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/2013/ucm20035841.htm?Page=1

Hopefully, the FDA will continue to use its authority to enforce standards that serve protect consumers and guide the appropriate application of HBO therapy.

Dick Clarke, President
National Board of Diving & Hyperbaric Medical Technology

August 2013

One other issue addressed during the June BOD meeting was the high CHT examination failure rates amongst CNA's and CMA's. These rates frequently exceed 50% and it is common for those who do not pass to fail subsequent attempts. Board members considered whether there were problems with preparation to take the examination, aptitude shortcomings, inadequate preceptorship, poor internship oversight, some other issue(s), or a combination of these factors. As essentially all other qualifying pathways enjoy quite a high overall examination success rate, it was felt by many on the Board that the CNA and CMA level of medical training might just be inadequate for assumption of a CHT role. It was pointed out that there is probably nowhere else in hospital and hospital-affiliated settings where these two categories of allied health employees are able to practice at such an advanced and somewhat independent level as that of a hyperbaric chamber, with related and someone independent patient care.

In fact, the CMS/Medicare web site specifically states that the CNA is not a professional, per se, and does not have a scope of practice. CNA's are certified not licensed and are employed to assist nurses. It is the nurse's license that the CNA works under. CNA's are to perform only those tasks that state laws and regulations delegate to them. These tasks are usually limited to personal hygiene and activities of daily living for patients.

The result of these discussions is that it was elected to maintain CNA's and CMA's as qualifying pathways for the time being and to continue to closely monitor respective certification examination results. However, it was decided that effective immediately these pathways will now require at least 12 months of active employment as a CNA or CMA before becoming eligible to sit for the CHT examination. In the meantime a task force will be constituted by the Board to evaluate the greater national regulatory and compliance issues of these allied health designations with respect to the practice of HBO therapy.

Dick Clarke, President
National Board of Diving & Hyperbaric Medical Technology

July 2013

We have found it necessary to edit the April 2010 Position Statement, one entitled ‘Physician Attendance and Supervision of Hyperbaric Oxygen Therapy’. This statement refers to the importance of physician presence in order to affect the safe and effective application of HBO therapy. The Board considered that the language was self-evident, namely, that physician ‘presence’, is required, which we considered as clearly implied in the title ‘Attendance’. However, the language of the statement has been argued in one instance as not to actually require that a physician is present and readily available. Rather, our Statement was considered to imply that being ‘readily available’ by phone would meet intent. Of course, this is far from our intent and completely inconsistent with safe practice standards. So, and in order to avoid any possible future misinterpretation, the statement has been revised, effective July 2013. It is provided below and has already been posted on the Board’s Home Page.

Dick Clarke, President
National Board of Diving & Hyperbaric Medical Technology

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Physician Attendance and Supervision of Hyperbaric Oxygen Therapy: (2010-01) April 2010 (Rev. July 2013)

It is the position of the National Board of Diving & Hyperbaric Medical Technology that provision of hyperbaric oxygen therapy must be directly supervised by a physician (or nurse practitioner/physician assistant where permitted by prevailing credentialing and regulatory standards) who is formally (UHMS or other authoritative body) trained in hyperbaric medicine, involving a face to face classroom vs. online setting. Such supervision should extend to:

  • Assessment of suitability for HBO therapy
  • Determination of risk-benefit profile
  • Interpretation of any related diagnostic testing
  • Generation of a therapeutic dosing profile
  • Evaluation of subsequent clinical course, and
  • Management of any related side effects and complications

Further, the hyperbaric physician must be on the premises and immediately available to the chamber facility at all times that the chamber(s) is occupied. Immediately available would meet the intent of this Position Statement if the physician could arrive at the chamber facility within five minutes of being summoned and in doing so, would not place in jeopardy any other patient presently under their care.

It is the duty of hyperbaric nursing and technical personnel to safely implement ordered therapy and closely monitor patients during their treatments. Should a patient voice complaints or manifest signs suggesting an unanticipated change in status, considered to be hyperbaric related or otherwise, the hyperbaric physician should be immediately notified. Importantly, hyperbaric nursing and technical personnel do not assume any of the physician responsibilities noted above and cannot initiate hyperbaric treatment without patient-specific hyperbaric physician signed medical orders.

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June 2013

The Board of Directors held their annual meeting in Orlando earlier this month. The agenda was packed with reports, items and issues in need of discussion and reconciliation. Several of them are listed as bullet points, below:

  • A record 62 testing sites were scheduled for CHT/CHRN/CHT-V testing over the past 12 months, involving 205 examinees.
  • In the first month of its availability 107 DMT Field Guides were purchased.
  • The financial health of the Board remains strong and will allow continued support of mission-related projects identified by, or requested of, the Board. In the past 12 months the Board has invested some $50,000.00 in such projects.
  • Given the consistently high CHT examination failure rates associated with licensed practical nurses and certified nursing aides, the Board discussed whether these eligibility pathways should be revoked. It was eventually decided to allow their continued access to CHT testing. However, they are required to have first accrued a minimum of one year's employment experience in the traditional role of an LPN or CNA before employment in hyperbaric medicine, related training and the 480 hour preceptorship period.  The Board thought it reasonable to require this one year of experience standard to all CHT eligibility pathways.
  • The Board will again sponsor a DMT instructor refresher training opportunity. Earlier this year 11 instructors were finally supported to attend such an update. They joined a number of DMT's as they underwent update training, in New Orleans. The Board will offer these same opportunities in conjunction with the January 2014 ADCI program, again in New Orleans.

Additional Board meeting update material will be provided in next month's briefing.

Dick Clarke, President
National Board of Diving & Hyperbaric Medical Technology

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May 2013

The NBDHMT is very pleased to introduce you to a new member of its Board of Directors. Dr. Sean Hardy was elected several weeks ago. Sean is board certified in emergency, undersea and hyperbaric medicine. He was first a paramedic then attended medical school at the University of Texas Southwestern Medical School at Dallas. He interned at Louisiana State University/Charity Hospital, in New Orleans, and remained there to complete residency training in emergency medicine. This was followed by undersea and hyperbaric medicine fellowship training, also at LSU.

Sean has completed both the National Oceanic and Atmospheric Administration’s diving medical office training course and the Undersea and Hyperbaric Medical Society’s diving medical examiner course. He practices with long-standing Board member Dr. Keith Van Meter’s team, in New Orleans. His related interests are evident from additional training and certifications, which include FEMA incident command systems training and advanced SWAT team-Department of Homeland Security training and certification.

Sean lectured during the January 2013 NBDHMT sponsored DMT instructor refresher and DMT update training course, in New Orleans. This is where he caught our eye. He has since updated, very effectively, the invasive skills chapter in the new (Third Edition) of Daugherty’s DMT Field Guide (available this week!).

The Board is delighted to have on board someone of the caliber of Dr. Sean Hardy. He is a knowledgeable, personable and enthusiastic physician, a great advocate of the diver medic training and certification program, and an experienced DMT medical control physician.

Dick Clarke, President
National Board of Diving & Hyperbaric Medical Technology

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April 2013

It has been a particularly busy time at the Board headquarters as the new edition of the DMT field guide underwent final editing. We were beginning to think that there is no such thing as a 'final' where editing is concerned! The text is now at the printers and we expect to begin shipping copies before the end of this month.

Many of you who are working in the hyperbaric medicine setting may be aware of the sudden controversy regarding the use of HBO therapy for diabetic foot ulcers. A recent paper in the journal "Diabetes Care" (Margolis DJ, et al. February 19, 2013) reported HBO's failure to heal wounds and prevent amputations, following a retrospective review of over 6,000 cases. This data is in marked contrast to results from higher quality data (retrospective studies being less regarded than randomized, controlled trails). One seemingly apparent reason for this contrast in outcomes is a failure to incorporate transcutaneous oxygen (TCOM) testing during the evaluation and case management of these patients. The NBDHMT has long recognized the importance of this screening tool, having mandated its training as a part of the eligibility criteria for CHT status over a decade ago. Encouragingly, two equally recent papers have found HBO to be clinically valuable in this same condition. One was a randomized and controlled trial (high evidence level) where TCOM screening was employed and where HBO patients clearly did better than those allocated to "controls" (Ma L, et al. Ostomy Wound Management, March 2013). The second paper is an analysis of all previously published randomized and controlled trails. The authors conclude that "…HBO improved rate of healing and reduced risk of major amputations…in selected patients…" (Liu R, et al. Mayo Clinic Proceedings February 2013). It does appear that TCOM screening should be incorporated if diabetic foot ulcer patients are to be best managed.

Dick Clarke, President
National Board of Diving & Hyperbaric Medical Technology

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March 2013

The third edition of the DMT field guide will go to the printers later this month. Twenty subject matter experts have reviewed, edited, updated and in some cases completely re-written the chapters that made up the second edition (vintage 1992). Others have produced entirely new chapters and appendixes. All of them have freely given of their time and expertise without expectation, although they will get a free copy! We expect that the guide will be available by late April so the Board is now accepting orders. See the link below for pricing and ordering information.  

http://nbdhmt.org/forms/Field_Guide_Order_Form.pdf

Dick Clarke, President
National Board of Diving & Hyperbaric Medical Technology

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February 2013

Last month's combined DMT instructor updating/practicing DMT refresher training and skills updating course was a great success. All of the speakers were excellent. They brought the highest possible knowledge and practical experience to an eager audience.

The DMT instructors were sponsored by the NBDHMT in order to prepare them for teaching students based upon the national DMT certification examination that goes into effect in the coming months. Instructors were updated as to current standards for evaluation and immediate management of diving accidents and injuries. Each lecture incorporated sample questions from the certification exam. The DMT’s were likewise updated and enjoyed the opportunity to practice various invasive skills, kindly coordinated by Safety Management Systems.

Elsewhere, the editing and revising of the third edition of the DMT field guide gains momentum. We expect to have it completed by the middle of this month. Layout and editing should be finalized by late March. This will put us on track for its publication and availability in May. You can preview the front cover and the original photograph at http://nbdhmt.org/dmt_cover.asp.

Dick Clarke, President
National Board of Diving & Hyperbaric Medical Technology

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January 2013

The CHT Code of Conduct is a set of principals, values, standards and responsibilities required of all hyperbaric technologists who are certified by the National Board of Diving & Hyperbaric Medical Technology. Among other things, the Code of Conduct serves to ensure that patients are treated safely and operational practices are in compliance with prevailing codes and standards.

In recent months, the Board has found it necessary to discipline two CHT's, both of whom had violated several aspects of their Code of Conduct. In administering respective sanctions the Board recognized that in each instance the CHT's management had, in effect, placed their employee in direct conflict with the Code of Conduct. They had done so by permitting the hyperbaric facility to operate in the presence of serious compliance and safety violations. Given that employees have little to minimal influence over a facility's operational and safety policies, the Board considered it necessary to inform the employer of some of the circumstances that led to disciplinary procedures being implemented against their employee. Facility management was urged to rectify such violations in order to improve patient safety and not place other staff members in violation of their Code of Conduct.

The Board takes its safety and compliance leadership responsibility very seriously. The introduction of the CHT Code of Conduct and expectations of compliance is one tangible example.

Happy New Year!

Dick Clarke, President
National Board of Diving & Hyperbaric Medical Technology

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December 2012

Season's greetings from Board Headquarters! We hope that you and your families will have a safe and enjoyable holiday season.

This past year has been a particularly busy one. A record 49 testing sites were scheduled and 2013 is shaping up to be equally busy. This has resulted in a particularly large number of certifications to process but our administrative team is up to the task. Since the Board's relocation to South Carolina we have strived to fully automate all related activities. From the 40 plus filing cabinets previously, we have just two now. The Board is operating on a foundation of 2012 hardware and software standards and capabilities. Hopefully, you have sensed some of this with our particularly prompt turn-arounds for certification and recertification applications. The ability to electronically confirm certification has also been well received by potential employers and others.

One final reminder regarding the upcoming DMT refresher course, January 16/17, in New Orleans. Registration information and a course outline are available at http://nbdhmt.org/forms/DMT_Refresher_Training_2013.pdf.

Dick Clarke, President
National Board of Diving & Hyperbaric Medical Technology

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November 2012

A reminder that the second annual DMT refresher training course is coming up in January. As with the previous course, it will be held in New Orleans in conjunction with the Association of Diving Contractors International ‘Underwater Intervention’ conference. The location is the Morial Convention Center and the dates are January 16-17. Updates on the evaluation and management of the injured diver will be followed by a series of clinical skills refresher sessions using a variety of teaching manikins. For additional details and registration information please go to http://nbdhmt.org/forms/DMT_Refresher_Training_2013.pdf.  

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The editing of ‘Daugherty’s Field Guide for the Diver Medic’ is about to get underway. This will represent the first revision and upgrading of this very popular text in over 20 years. New sections will be added and the evaluation and management aspects will be brought completely up to date. This process is expected to take several months, as all of those involved have ‘day jobs’, so are volunteering their respective personal time. As in the past, the Guide will be printed on waterproof and tear proof synthetic paper. I will keep you updated via subsequent Monthly Briefings as to an anticipated publishing date. If any of you who have a current version of the Guide would like to see information included that is not presently available then email the Board (www.nbdhmt.org) with your suggestions. We welcome them!                  

Dick Clarke, President
National Board of Diving & Hyperbaric Medical Technology

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October 2012

The Board has recently clarified and defined its CHT recertification process. This was prompted by one or two lapsed CHT's seeking to get their certification back, in one case involving over a decade of inactive status. Listed below is the recertification process and options available to those who fail to recertify within the initial required time frame.

Certification in hyperbaric technology is awarded for a two year period. Recertification applications should be received at Board headquarters no later than the final date noted on the CHT wallet card. If you have lost it then go to www.nbdhmt.org and the 'Confirm Certification' link. Enter your name in to the Confirm CHT Certification and this will display your CHT expiration date. In those who fail to recertify by this date a one year grace period is extended, and a $100.00 late application penalty assessed. Upon expiration of the one year grace period, one final option remains for those laggards still wishing to recertify. This option only applies to those who have maintained active certification or licensure in a qualifying pathway. In this instance, the applicant is required to retake the CHT certification examination. Upon successful testing these applicants would be reinstalled as CHT's. All others, including those who did not maintain active certification or licensure in a qualifying pathway following expiration of the grace period, must begin the process of regaining CHT status via an entirely new application.

While the Board will make an effort to alert CHT's that their recertification date is approaching, the final responsibility is that of each individual. Military personnel deployed in the Middle East are contacting Board headquarters to ensure that their CHT status doesn't lapse, for goodness sake. If they can do that with everything else that they have to deal with in their lives, it is difficult to be sympathetic with those who enjoy the daily comfort and safety of their own workplace and home, largely on the strength of those who are deployed overseas.

A CHT is one who continues to maintain required training and educational standards and continues to maintain a minimum level of hyperbaric-specific employment. The sum of this is that their skill set is likely maintained, if not elevated, and patients can expect (as they should and as they deserve) to be treated in a safe and effective manner. Failing to maintain CHT status beyond the scope of the above referenced recertification periods and expecting to have it immediately returned after a period of several to many years brings into question a hyperbaric technologist's current competency level and longer term commitment to this discipline.   

Dick Clarke, President
National Board of Diving & Hyperbaric Medical Technology

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September 2012

The Board is delighted to announce that it has acquired the rights to Dr. Gordon Daugherty's 'Field Guide for the Diver Medic'. This vital resource was first published in the 1980's and revised in 1992. It became an essential part of the 'tool kit' for a great many DMT's, selling more than 6,000 copies in over 30 countries during the ensuing 25 years.

Author Gordon Daugherty taught DMT training courses on behalf of Houston, Texas-based 'The Ocean Corporation' at the time that he wrote the guide. He also served on the Board of the NBDHMT during this same period. Dr. Daugherty has long since retired and resides in Austin, Texas. He was delighted to learn that his work will live on and readily agreed to sell his ownership rights.

As the material is now 20 years old it is in need of a great deal of revision and updating. Plans are underway to have this accomplished and we anticipate that the new edition will be printed early in the New Year.

Dick Clarke, President
National Board of Diving & Hyperbaric Medical Technology

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August 2012

This month’s Briefing will continue with updates on key aspects of the June Board of Directors annual meeting. In last month’s Briefing two important mission-related initiatives were described.

It was felt necessary to generate a new Position Statement, the first for 2012. This one urged that all those who work within clinical hyperbaric chambers, and others who might be called upon to do so, be medically cleared as fit for employment in this unique environmental setting. While many hyperbaric medicine programs already incorporate such screening not every program does. The Board felt it important to take this position as a means of enhancing the safety and well-being of those above mentioned personnel. (See Position Statement 2012-01; July 2012).

One other initiative was to formalize the curriculum and improve availability of training for those who wish to certify as hyperbaric veterinary technologists. As in the past, Board Member Dr. Dennis Geiser and his committee members have been working to complete various veterinary-related certification components. In the meantime it is considered necessary to provide training opportunities in conjunction with Board approved human hyperbaric courses. The plan is to have the first three days scheduled as a common track. The next two days will be split into human and animal tracks. Two veterinary specialists will travel to respective locations in order to provide the animal course content. The Board is currently making the necessary arrangements for this combined course to be offered twice annually until the full animal-only course achieves Board approval.

On a final note I want to advise you that Paul Baker has resigned his position on the Board, effective July of this year. Many of you will be familiar with Paul’s many accomplishments over almost five decades of military and civilian hyperbaric operations. For 15 years Paul was at the helm of the NBDHMT. That position was passed over to me in 2009 while Paul continued to serve your interests as the Board’s at-large member. Very many thanks, Paul, for your long-standing and unselfish commitment to NBDHMT mission.

Dick Clarke, President
National Board of Diving & Hyperbaric Medical Technology

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July 2012

This year's Board of Directors meeting was lengthy (some four hours) and productive. The agenda was packed with important items which collectively served to consolidate existing Board certification processes and both advance and broaden our training and safety responsibilities. Over the next several ‘Briefings' I will provide detailed updates on some of the more significant decisions that were agreed upon, and will start out with two this month.

The Board's financial position is healthy enough that additional resources are to be directed at further improving mission-related educational activities. Accordingly, we are going to develop and introduce a series of on-line lecture presentations that will also serve as NBDHMT Category ‘A' educational credits. They will be accessible through the Board's website and be free of charge. Subsequent to this initiative, those who seek to recertify will be required to submit evidence (by way of printable certificates) of completion of a select number of these presentations, which will be continually expanded upon. This process is designed to update diver and hyperbaric medicine personnel to key operational, safety, compliance and technical advances. It will also improve access to the necessary Category A CEU's required for recertification, something that has proven problematic for a number of you over the years.  

A second related initiative is a plan to convene a conference for all of the Board's approved DMT instructors. The objective here is to bring instructors up to date with regard to the duties and responsibilities of the DMT, as they relate to the evaluation of the injured diver, communication with the diving medical officer and optimizing medical management, all from a 2012 perspective. This conference will also serve to better prepare instructors to address and upgrade course content in order to become complaint with the standardized DMT certification examination. The Board intends to underwrite the conference registration fee, hotel accommodations, and offset a significant portion, if not all, of related air travel costs, so that instructors will not be out of pocket. It is anticipated that this conference will also be open to DMT's for refresher training, on a first come-first served basis.

Dick Clarke, CHT, President
National Board of Diving and Hyperbaric Medical Technology

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June 2012

I'm compelled to share with you a recent and disturbing event. A hyperbaric team member in Florida contacted a national resource for guidance. His question related to the issue of air breaks, and I have to assume that he was referring to the monoplace hyperbaric delivery system. He related that two physicians in his center would not allow this simple, inexpensive and valuable safety technology to be incorporated unless 'it was the law'. Absolutely fascinating! Patients would not be afforded this largely standardized approach to hyperbaric operations unless the respective hands of these physicians were forced by some form of 'legal' precedent (as if law-makers dealt with such things in the first place).

As informed readers you will no doubt grasp the absurdity of this situation. Why on earth would these physicians not consider this well established safety tool, one costing a mere several hundred dollars? Surely, they were not going to have to pay to have it installed. The caller was eventually referred to our Position Statement on air breaks (August 2009). This particular Statement points out that every hyperbaric chamber should be equipped with an air breathing capability. The caller was also provided with pertinent literature citations. Introducing air breaks should surely not be something the hyperbaric physician is forced to do, something based upon rules and regulations. It should be something that they should see fit to do in the interests of enhanced patient safety. Hopefully, the hyperbaric safety director was able to prevail.

Dick Clarke, CHT, President
National Board of Diving and Hyperbaric Medical Technology

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May 2012

The May 1, 2009 Florida monoplace hyperbaric chamber fire and double fatality has resulted in criminal charges being filed. The hyperbaric medical director and the hyperbaric safety director have been arrested on charges of aggravated manslaughter and manslaughter. A review of the Probable Cause Affidavit reveals an astounding and unbelievable litany of safety and practice standard failures and violations. It was almost a primer in how not to practice.

Some examples include the presence of only one hyperbaric technician, one trainee technician and no nurse in the presence of 12 monoplace chambers; the absence of the technician at the time of the fire; the failure of the trainee to comprehend how to emergently decompress the chamber, resulting in a delay that may well have contributed to non-survivable burn injuries; the chamber in question having long been operationally deficient and should have previously been removed from service; a faked inspection processes; failure to ground the chamber’s occupants, and on and on.

The threat of a catastrophic hyperbaric chamber fire is ever present, as this tragedy attests. It is mitigated to the greatest extent possible by the incorporation of a comprehensive safety plan and an inherent safety culture throughout the entire hyperbaric team. Chambers and related equipment need to be designed, constructed and certified in accordance with prevailing codes and standards. Once operational, they should likewise be maintained and serviced consistent with prevailing codes, standards and authoritative guidelines. Personnel must be appropriately trained and apply their training in every instance to optimize the safe operation of the hyperbaric delivery system. This includes careful record-keeping and the immediate withdrawal of chambers or ancillary equipment from service if problems or concerns are identified. Such equipment should only be returned to use following approval by relevant authorities.

Consistent with the position of the National Board of Diving and Hyperbaric Medical Technology, clinical hyperbaric facilities should undergo a UHMS accreditation survey at the earliest possible opportunity. It is this form of authoritative external review that is best able to confirm, or otherwise, that facilities are operating within expected levels of clinical practice and operational safety.

One cannot emphasize enough the importance of a culture of safety within the hyperbaric medicine environment. That the vast majority of hyperbaric treatments are provided in an uneventful manner can and has lead to complacency. This problem may compound itself if events lead to a lowering of operational practice standards via the introduction of lesser trained individuals, understaffing for economic gain, and failure of an ongoing commitment to continuing education and skills maintenance. The NBDHMT’s mission is, in large part, to provide every opportunity to facilitate high quality, efficacious and safe hyperbaric operations.

Dick Clarke, CHT, President
National Board of Diving and Hyperbaric Medical Technology

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April 2012

The annual NBDHMT Board of Directors meeting is scheduled for June 21. As in the past, it will coincide with the scientific meeting of the Undersea and Hyperbaric Medical Society. This year's venue is Phoenix, Arizona. Continuing another tradition, we will host a 'Breakfast with the Board' the following morning, Friday June 22. This represents a great opportunity for those of you planning to attend the UHMS meeting to say hello to the directors and hear firsthand what initiatives are contemplated, underway and recently completed.  

Highmark Medical Services, one of Medicare's Contractors, has amended its Local Coverage Determination so that NBDHMT certified CHT's and CHRN's are now able to conduct transcutaneous oxygen assessments, from a reimbursement compliance standpoint. For many years, it was only certified vascular technologists or those working in a certified vascular laboratory that met Medicare reimbursements compliance criteria. We were able to convince several contractors that it made good sense to extend authorization to hyperbaric team members. Over the ensuing 15 years several key Contractors have agreed. On January 12, 2012, Highmark became the latest. It was this evolution within the Medicare system that had prompted the NBDHMT to formalize training and certification standards related to transcutaneous tissue oxygen tension measurements. To determine if your region's Medicare Contractor permits hospitals under its jurisdiction to file claims for transcutaneous oxygen testing by those in the hyperbaric medicine facility check with your prevailing Local Coverage Determination for Non-invasive Peripheral Vascular Studies Lower Extremity Arterial Testing. 

Dick Clarke, President
National Board of Diving & Hyperbaric Medical Technology

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March 2012

The Board was saddened to learn of a recent (February 10) hyperbaric chamber accident with resultant loss of life. The preliminary police report notes that a lone horse was being treated. It was still shod and was not wearing protective shoe covers. Some 20 minutes into the treatment the horse began to act up. It kicked away the protective cover exposing the chamber's steel hull. The horse continued to kick the hull with its metal shoes, eventually causing a large spark. A fire was observed soon thereafter. As the chamber operator began to decompress the chamber a survivor described hearing a small explosion followed by a much larger one that caused catastrophic structural failure. The larger explosion was apparently heard 30 miles away. The horse did not survive nor did the chamber operator and survivor was air-lifted to the University of Florida Shands Hospital trauma center. The Board's condolences are extended to the family of Erica Marshall and we wish Sorcha Moneley a speedy recovery.

While oxygen is not combustible, per se, it readily supports combustion. So, when the spark was generated, then would need for a fuel to ignite and burn. We do not know the composition of the protective covering but, regardless, it is well known that flatulence from horses and other herbivores contains methane and hydrogen gases. These are two very flammable substances. The chamber was presumably compressed on oxygen; it is difficult to affect oxygen delivery via individualized systems for these animals in an air-filled chamber. If the chamber was not operating on a continual flush of oxygen basis then these gasses could accumulate. Why the resulting pressure increase would not have been controlled by the chamber's over-pressure relief valve(s) cannot yet be reconciled.

The Board is hopeful that the events surrounding this dreadful event will be fully investigated such that any necessary future chamber design, operating policies and operator training will be optimized.

Dick Clarke, President
National Board of Diving & Hyperbaric Medical Technology

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February 2012

January saw the successful completion of the first NBDHMT sponsored diver medic refresher training course. It was held in conjunction with the Association of Diving Contractors International 'Underwater Intervention 2012', in New Orleans. Speakers were a veritable 'who's who' of the Gulf of Mexico diving medicine scene. Dr.'s Van Meter, Sirio, Bourgeois, Alleman, Murphy-Lavoie, LeGros and Buford joined Cal-Dive Int.'s Health and Safety Director (and NBDHMT Executive Committee Member) Terry Overland, Safety Management Systems Chris Peppler, and this writer. Two full days were packed with reviews and updates on decompression illness, barotraumas, marine life injuries, case management scenarios and 'lessons learned' from past accidents. A series of interactive case presentations and several hands-on clinical skills stations rounded out the course.

All of the speakers willingly gave of their time and expertise and did so without expectation. They freely interacted with attendees during didactic and practical sessions. The quality of the speakers and their material was not lost on the attendees. Early and enthusiastic feedback was sufficient to warrant this course becoming an annual event.

On Friday, January 27, the first Beta testing of the new DMT certification was undertaken. A total of 22 recently graduated diver medics from courses in Key Largo, Florida (The Aquarius Seabed Laboratory) and Denver, Colorado, agreed to take part in this process. Several other DMT training programs will join assist in this manner over the next several months. Results are being fed back to DMT teaching teams so that they can fine tune respective course content in order to address any perceived weaknesses. The Board's goal is to introduce this standardized examination by the end of 2012.

Dick Clarke, President
National Board of Diving & Hyperbaric Medical Technology

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January 2012

The year 2011 was both eventful and encouraging. It was eventful in that the Board successfully introduced a new certification program in hyperbaric veterinary technology. It was encouraging in that despite these difficult economic times the Board’s finances are in better shape than at any other time. This improvement has placed Board in a position where it is able to provide financial support to independent mission-related safety and training initiatives. Earlier in the year a grant was provided to a group that is developing a hyperbaric materials safety testing program. Funds have also been made available to sponsor a DMT refresher training program (scheduled for January 25/26, in New Orleans).

Other notable events include, sadly, the passing of long-standing Board member Bill Hamilton and the recruitment of three new Board members.

This year kicks off with Beta testing of the DMT certification examination. As previously mentioned, the goal of this process is to bring DMT certification in line with that of the CHT, CHT-V, and CHRN programs; namely, that a standardized exam be used. At present, a DMT student becomes automatically eligible for DMT certification upon successful completion of a DMT training course. There is currently no direct oversight by the Board and places some strain on this program’s credibility. Soon, a standardized examination will be independently administered and proctored, as is the case with the three other certification programs. Later this month, Beta testing will take place following DMT training courses in Florida and Colorado. Additional testing will occur at several other sites throughout the first half of the year. From that point on it is anticipated that all subsequent applicants for DMT certification will be required to take the standardized exam. Below is a link to a summary of the various sections that comprise the exam and the degree to which each section constitutes to its overall 120 questions. As with our other certification examinations there are several exams variants, each drawn from the question database.

DMT_Examination_Guideline.pdf

Happy New Year!

Dick Clarke, President
National Board of Diving & Hyperbaric Medical Technology

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December 2011

I am pleased to welcome three new members to our Board of Directors. They are Michael Powers, CHT; Debra Gonzalez, RN, ACHRN, CHT and Valerie Short, RN, ACHRN. Each brings a skill set, knowledge base and extensive experience in areas complementary to the mission and objectives of the Board. To learn more about our new members go to the ‘Who We Are’ link on our website. Brief biographical sketches have been posted.

A final reminder for all of you diver medics is that a DMT Refresher Training Course has been scheduled in January. It will coincide with the annual meeting of the Association of Diving Contractors International, in New Orleans. Course dates are January 25/26. Several undersea medicine experts have kindly agreed to donate their time. Safety Management Systems has been equally generous in their offer to provide an extensive invasive skills updating session during much of the second day. To learn more about this opportunity and to register please go to http://nbdhmt.org/dmt.asp.

Dick Clarke, President
National Board of Diving & Hyperbaric Medical Technology

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November 2011

A reminder to all DMT’s that we have scheduled a refresher training opportunity early in the new year. It will take place in New Orleans on January 25/26 at the Ernest N. Morial Convention Center during Underwater Intervention 2012. I am pleased to report that this training opportunity will definitely take place as we already have sufficient registrants. An excellent line up of experienced diving medical specialists has been assembled. There will be didactic sessions and several invasive skill workshops with expert instructors and state-of-the-art manikins, both kindly provided by Safety Management Systems. Space is limited so register now at http://nbdhmt.org/dmt.asp if you plan to attend.

Dick Clarke, President
National Board of Diving & Hyperbaric Medical Technology

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October 2011

As you will have noted on our home page, we have lost a member of the board. R.W. ‘Bill’ Hamilton passed away in September after a brief illness. Bill served the interests of diver medics, hyperbaric technologists and hyperbaric nurses effectively, passionately and without expectation for over 15 years. But Bill’s ‘shadow’ extended far beyond his role with the NBDHMT.

Following service in the US Air Force as a fighter pilot during the Korean War and in Viet Nam (where he earned the Distinguished Flying Cross) he turned his attention from aerospace to the undersea. Throughout the next four decades Bill evolved into one of the world’s leading environmental and high pressure physiologists. His professional footprints are to be found through much of deep diving’s operational advancements and decompression processes. Upon joining Union Carbide Corporation he pioneered the initial laboratory ‘dives’ that led to the first manned saturation exposures on the continental shelf, exposures in excess of 600 fsw. He also pioneered the study of neon as a possible substitute for helium for dives in the 250-600 fsw range. It was during these research dives, in 1972, that I first met Bill. I was also one of the experimental subjects and we were compressed together to some 500 fsw. My task was to exercise on an ergometer while I was monitored and assessed for various biomedical and performance parameters. Being a fitness addict I sought to break the record for speed and distance on the ergometer bicycle. I did manage to but it came at great expense. During the subsequent decompression I suffered cerebral decompression sickness. It did not help that while passing 120 fsw the chamber operator inadvertently flushed the chamber with pure helium, not the intended helium-oxygen mixture. Bill likewise suffered decompression sickness in an extremity. I came out of it with permanent (right) hearing loss. Bill rushed home after a brief treatment as it was his anniversary and he had missed last year’s anniversary as he was likewise decompressing from a deep research dive.

Bill continued to pioneer decompression procedures, and contributed greatly to deep recreational technical and mixed gas diving. His decompression computer algorithms were acquired by numerous international navies and research laboratories.

Bill served in leadership and consulting capacities within the Undersea and Hyperbaric Medicine Society, the Divers Alert Network, the National Oceanographic and Atmospheric Agency, the National Fire Protection Association and the National Aeronautics and Space Administrations (NASA).

He was the recipient of awards too numerous to mention and leaves behind an enormous legacy. All of those who enter into, and work within, the ocean and other deep bodies of water are that much better off because of Bill. To say he will be missed somehow seems quite inadequate.

Dick Clarke, President National Board of Diving & Hyperbaric Medical Technology

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September 2011

This final report on the business conducted during the 2011 meeting of the Board of Directors relates to CHRN’s and CHT-V’s.

On the nursing front there are currently 377 CHRN’s, 80 ACHRN’s and 6 CHRN-C’s. In 2010 75 RN’s sat the nursing certification examination and 71 (95%) passed. Three of those who passed did so ‘With Distinction’, which meant they scored 90% or higher. During this same year 18 RN’s elected to sit the CHT rather than CHRN exam, with an overall success rate of 94%.

The veterinary hyperbaric technology certification program was discussed at length. All necessary program infrastructure is in place. At the present time, certification edibility will include attendance at a regular (CHT/CHRN) NBDHMT approved hyperbaric training course. It may well be that subsequent training courses will be created specific to vet techs, or veterinary technology components added to some of the existing hyperbaric training courses. Those members of the CHT-V certification committee who meet eligibility requirements will take the first test offered by the Board in the coming weeks.

Dick Clarke, President
National Board of Diving & Hyperbaric Medical Technology

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August 2011

In the July 'Briefing' I provided an update on Board of Directors Annual Meeting activity that was specific to the DMT program. This month I will do the same regarding the CHT program.

There are presently 1,377 active CHT’s. In 2010 the Board convened an impressive 51 testing sites for a total of 265 examinees. Of these, 75% passed (3% With Distinction). When reviewing the answers of those who did not pass there was a clear trend in incorrect responses. It appeared that little effort was made to review the relevant NFPA standards as they relate to overall hyperbaric operational and fire safety standards. Knowledge was also consistently lacking with regard to such fundamentals as air decompression procedures, pressure conversions and gas laws. Those who serve as preceptors for CHT interns are encouraged to direct interns to these areas so as to promote additional study emphasis. There is also a sense that those seeking CHT status are rushing to sit the certification examination before they have accrued sufficient operational experience to complement initial training and their 480 hours of preceptorship.

On another topic, the Board of Directors has posted a new Position Statement (July 2011; 2011-02). It relates to the not uncommon practice of having a pediatric patient accompanied in a monoplace chamber. The decision to require a staff or family member to join such patients is entirely that of the treating hyperbaric physician and presumably a decision based upon a risk-benefit assessment. It is not the intent of this latest Position Statement to argue the relative merits of this practice. Rather, the Board wants to ensure that should dual occupancy occur it does so with relevant safety standards considered.

Dick Clarke, President
National Board of Diving & Hyperbaric Medical Technology

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July 2011

The Board of Directors held its annual meeting in Fort Worth, Texas, on June 16. As has been common in the past, our Meeting coincided with the annual scientific meeting of the Undersea and Hyperbaric Medical Society. Here is an update on the Board’s discussions, as they related to the diver medic program.

There are presently 555 certified diver medics. Conversion to mandatory invasive skills training has been completed. ‘In-house’ certification testing will soon commence. Throughout the history of the DMT program diver medics who passed their post-DMT training course test were eligible for certification. The Board has long felt that insufficient oversight of the testing process was a flaw in the certification process. To bring the DMT program in line with the CHT and CHRN certification programs, the Board will soon assume responsibility for the testing of newly trained diver medics. Step one in this process will be to conduct a ‘sample’ testing at each of the Board approved training facilities. It will be a onetime process and results will not be applied to each student. Rather, their standard, post-course, test will be used for certification purposes. Once the Board’s sample test results have been compiled, each respective instructor/facility will be advised of any topics that require addition emphasis during future training courses. From this point forward, the Board’s examination will be in force for all subsequent DMT certification eligibility. The Board’s examination guidelines can be viewed at the ‘Diver Medics’ link on the website, and listed as item #7. Here you will see that the structure of the exam is broken down into seven categories. A description of each category’s content is included, as well as the relative percentage of topics and questions that each category contributes to the overall examination.

DMT training standards were also discussed, particularly in light of the new certification examination. The Board remains keen to ensure that everything possible is done to produce a high value DMT resource. To that end we will be again be meeting with physicians, supervisors and safety officers in New Orleans at the time of the Association of Diving Contractors International conference next January. In subsequent ‘Briefings’ I will update each of the other certification programs.

Dick Clarke, President
National Board of Diving & Hyperbaric Medical Technology

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June 2011

You may recall the report earlier this year of a devastating horse barn fire at a Texas training facility. The fire claimed the lives of 25 of the 32 horses stabled there. One highly regarded horse, 'Keep On Smoking', suffered second and third degree burns. He was transferred to an equine sports medicine and surgery facility, in Weatherford, Texas. This facility includes 24/7 critical care and hyperbaric oxygen therapy. 'Keep On Smoking' underwent 12 hyperbaric oxygen treatments as part of his burn wound management. He Tolerated them well and is expected to be fit to race again this coming September. And, no, the owners do not plan to change his name!

All of this has relevance to us now that the Board has added veterinary technology to its certification programs. Veterinary hyperbaric medicine is becoming increasingly common, involving both large and small animals. While most often rendered in a sub-acute setting, the above example indicates that urgent access to hyperbaric medicine is also necessary and as equally valuable as it is in humans.

CHVT testing begins this month, with the first examination scheduled to coincide with the UHMS Annual Scientific Meeting, in Fort Worth.

A reminder to those attending this meeting that we will again host a 'Breakfast with the Board' at 7:00 Friday, June 17. Drop by and meet the Board's members.

Dick Clarke, President
National Board of Diving & Hyperbaric Medical Technology

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May 2011

You may have already noticed that a new link has been added to our website. It relates to certification in veterinary hyperbaric technology. Use of hyperbaric chambers to treat a number of different animal species has grown markedly over the past decade. In the US alone it is estimated that there are currently 30 such facilities. Those individuals who meet eligibility standards are now be able to become Certified Hyperbaric Veterinary Technologists (CHVT). As with the CHT and CHRN programs, it is anticipated that CHVT's will serve to enhance safety and quality of delivered care. This new program should also go a long way in raising the stature and professionalism of veterinary hyperbaric medicine.

The annual meeting of the NBDHMT Board of Directors is just around the corner. It is scheduled for June 16 and will coincide, as in the past, with the annual scientific meeting of the Undersea and Hyperbaric Medical Society, in Fort Worth Texas. For those planning to attend the UHMS meeting please join us for ‘Breakfast with the NBDHMT'. This popular annual event (and not just because it's free!) is scheduled for Friday June 17 at 7:00 am. It represents an excellent opportunity to meet with members of the Board and hear firsthand what initiatives the Board is currently involved in and others that are planned. In order to expedite and streamline Board meetings they will no longer be open to non-Board members. However, the following morning's breakfast will serve as an excellent opportunity for you to get updated, have your questions addressed and your comments heard.

Dick Clarke, President
National Board of Diving & Hyperbaric Medical Technology

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April 2011

Evolution from Basic or Advanced DMT training and certification to only the equivalent of advanced status is complete. All those who certify and recertify as diver medics will process the necessary skill set required to comprehensively support the injured during recompression therapy. This has already done much to improve quality of delivered care. The treating physicians no longer have to worry about on-site inability to manage the airway, provide fluids and medications through appropriate invasive options, and cathertize the bladder.

The final component of two years of DMT training and certification enhancement is the centralization of the certification examination process. The electronic question bank is complete.

Dick Clarke, President
National Board of Diving & Hyperbaric Medical Technology

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March 2011

The big news this month is that the certification program for veterinary hyperbaric technology is essentially complete. For the past two years a committee has worked diligently and without compensation to generate the training standards, certification eligibility requirements and examination question bank, for those who provide hyperbaric oxygen therapy to a wide animal species. This form of hyperbaric oxygen therapy has grown enormously over the past decade, in the US and elsewhere. It has not been incident free. There have been several fires with resultant loss of life.

It makes sense, therefore, that those who operate animal hyperbaric should be trained and certified to the same level that is expected of human operations. The Board expects to begin certification testing for CHT-Vet status in the summer. Leading the veterinary hyperbaric certification process was Dr. Dennis Geiser, who also chaired the certification development committee. In recognition of his unselfish and energetic commitment to this new program and to ensure representative balance, Dr. Geiser has been elected to the NBDHMT Board.

Dr. Geiser serves as Assistant Dean for Organizational Development and Outreach, and Interim Department Head - Large Animal Clinical Sciences, at the University of Tennessee, Knoxville. Dr. Geiser is highly regarded within the field of veterinary medicine. He has co-edited two textbooks, authored six textbook chapters, and has many other publications to his credit. The Board is honored and delighted to have longer term access to Dr. Geiser's wisdom and insight.

Dick Clarke, President
National Board of Diving & Hyperbaric Medical Technology

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February 2011

As is our standard practice, we have scheduled our 2011 meeting of the Board's directors to coincide with the Undersea and Hyperbaric Medical Society's annual meeting.  This year it will be held in Ft. Worth Texas, June 15-18.  If you plan to attend please be sure to join us on Friday June 16, for another 'Breakfast with the Board'.  This get- together offers an excellent opportunity to meet our directors and learn firsthand of initiatives we have planned or currently underway.

A big thank-you is in order to Laura Josefsen. Laura has served on the NBDHMT as a member of the Board's Executive Committee for many years and has been a helpful resource. She recently became the nurse-elect to the Board of Directors of the Undersea and Hyperbaric Medical Society. To best devote her time to the needs of this new position she has resigned from the Board's directors. We wish her well. Replacing Laura on the Board's Executive Committee is Terry Overland. Terry has likewise been a long-standing member of the Board. He is our eyes and ears on all things commercial diving and the diver medic.

Dick Clarke, CHT, President
National Board of Diving & Hyperbaric Medicine

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January 2011

I want to take this opportunity to advise you of a new and important hyperbaric chamber fire safety initiative.  This initiative has been born from the increasing number of patients undergoing clinical hyperbaric oxygen therapy.  These patients present with an ever expanding number of supportive biomedical devices, both implanted and otherwise. They present with an array of wound dressings and wound products.  Many of these dressing contain active ingredients aimed at stimulating wound repair. 

Little is known about the majority of these products and agents as they relate to hyperbaric chamber compatibility and risk of fire.  To address this issue the Undersea and Hyperbaric Medical Society formed a  'Material Testing Advisory Committee'.  This Ad Hoc committee, chaired by NBDHMT Board member Richard Barry, has selected Wendell Hull & Associates (www.wendellhull.com) to develop standardized testing capabilities for evaluation of material compatibility for use within hyperbaric oxygen environments.  The MTAC will work closely with Wendell Hull as they develop the testing process.  The immediate goal of this initiative is to produce a set of established guidelines, recognized by an authoritative code writing body, for determining compatibility of an item before permitting its use within the hyperbaric medicine environment.

What is needed is a fund, estimated at $50,000.00, in order to complete this project and develop the necessary testing standards.  The UHMS strongly endorses the project and will be responsible for its administration.  However, because of its charter it is not authorized to solicit funding.

Institutions that provide hyperbaric oxygen therapy and organizations that work in support of the provision of undersea and hyperbaric medicine are encouraged to donate to this important hyperbaric safety cause.  You will be pleased to learn that the NBDHMT, on behalf of its certified personnel, have made the first financial contribution.

Donations should be marked 'Hyperbaric Materials Testing” and sent to:

Wendall Hull and Associates
Attn:  Gwenael Chiffoleau
5605 Dana Ana Road
Las Cruces,  NM  88007

Dick Clark CHT, President
National Board of Diving & Hyperbaric Medical Technology

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December 2010

We are just wrapping up our first year of mandated preceptorship of CHT internships.  It is appropriate, therefore, for the Board to express its appreciation to all of the CHT's and CHRN's who have volunteered their time in this regard.  Those 40 hours of direct oversight go a long way to enhancing the experience and capabilities of each new certified hyperbaric technologist.For those of you, who have not offered your services but would like to do so, please notify Board headquarters.  We are in great need of additional preceptors and you will be helping a great cause.  Your compensation would not be financial, but something much more rewarding.  You would be directly contributing to the quality of patient care within the unique discipline of hyperbaric oxygen therapy.

A reminder to, re-read the Boards Position Statements from time to time.  They are, in the opinion of the NBDHMT, vital to the safe and effective provision of undersea and hyperbaric medicine.  The Board welcomes any comments you may have relating to these positions.

Best wishes to you all for the coming holiday season.  May your 2011 be safe, healthy and professionally rewarding.

Dick Clarke, CHT, President
National Board of Diving & Hyperbaric Medical Technology

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November 2010

On October 11, 2010 the American College of Hyperbaric Medicine circulated a press release regarding the National Board of Diving & Hyperbaric Medical Technology.  It implied that the NBDHMT had only recently joined the ranks of those who have adopted on-line continuing education.  The release went on to market one of their meetings, suggesting that CHT's and CHRN's could receive their recertification CEU's by on-line or physical presence.  The Board advised the ACHM that contrary to their assertions, the NBDHMT had actually pioneered on-line hyperbaric and undersea medicine education a decade ago, and as they had not applied for CEU's for the meeting in question their indication the CHT'S and CHRN's could gain necessary credits was likewise incorrect.  We asked the ACHM to post a corrective follow-up release generated by the NBDHMT.  The ACHM failed to do so as the Board requested, so we have done so ourselves, a copy of which in reproduced below. 

 NBDHMT Requested Release:
In follow-up to our recent memo regarding the NBDHMT, on-line education and the Board's provision of educational credits, we heard from Mr. Clarke, Board president. He pointed out that contrary to our assertion that the Board had recently recognized and adopted on-line education; the NBDHMT had actually pioneered this process as it relates to the discipline of undersea medicine and hyperbaric oxygen therapy. This continuing education opportunity, Mr. Clarke noted, has been in place for much of the past decade. Mr. Clarke added that he was instrumental in getting the Undersea and Hyperbaric Medical Society to adopt enduring materials with on-line continuing educational credits in the early part of the past decade. Mr. Clarke also wanted the ACHM to emphasize in its various communication tools that the NBDHMT does not approve on-line introductory hyperbaric training courses as a method of entry level training and as a pathway for certification as a CHT or a CHRN. Consistent with the UHMS, the Board requires entry level training in hyperbaric medicine to be conducted in a face to face setting at its approved training facilities.

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October 2010

The Board continues to heighten the quality of its certification products.  Position statements posted on our web site make very clear the Board's intent as it relates to specific safety and practice quality expectations and areas of potential controversy.  As these statements frequently involve the larger discipline of undersea and hyperbaric medicine we are pleased to see that they have been reproduced or referenced by other professional organizations.  The Board invites you to forward any questions or comments you might have about our various positions.  Your feedback may well result in the publication of additional such statements.

The recently introduced, Code of Conduct has been broadly and positively embraced.  We have received just one complaint from all 1221 certified hyperbaric technologists.  Employers are expected to gain a measure of assurance that licensing and certification practice standards common across the health care delivery system are now inclusive of the hyperbaric technologist.  Every applicant for CHT status is required to sign the Code of Conduct as a component of their examination eligibility criteria.  All existing CHT's will likewise be required to do so as they apply for recertification.

Effective August 1, 2010, nurses applying to sit the CHRN certification examination are now required to undergo a criminal background check.  Background checks were initially limited to CHT's as state licensing boards traditionally included nursing background checks.  This is no longer the case in some states so the Baromedical Nurses Association Certification Board has directed the NBDHMT to institute this process as of the above date.

The chief beneficiary of these program enhancements, of course, is the patient, who deserves nothing less.  Their collective impact, however, can be expected to extend to our professional colleagues, as well as the broader health care industry.  And that is a good thing too!

Dick Clarke, CHT, President
National Board of Diving & Hyperbaric Medical Technology

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September 2010

To all of you who have already returned your signed CHT Code of Conduct, many thanks! The Board is very encouraged by the sheer number of responses given that the Code of Conduct declaration is not actually required until your recertification application. We take this as an indication of your respective commitment to ethical conduct, integrity and honesty

For those CHT and CHRN's unable to attend meetings and conferences that award educational credits it can be difficult to meet the necessary continuing education requirements for recertification. It might be helpful to learn, therefore, of several on-line programs that are approved by the NBDHMT for both Category A (directly related to undersea and hyperbaric medicine) and Category B (indirectly related; topics such as ACLS and BLS, infection control, HIPAA issues, hospital competencies are examples) credits. They can be accessed at:

http://www.woundeducationpartners.com/
http://www.mededonline.org/
http://www.wendellhull.com

On a final note I would like to express my appreciation to Jeannie McLamb. Jeannie was instrumental in the seamless relocation of NBDHMT headquarters from New Orleans to Columbia in May of last year. Many of you will have communicated with Jeannie in her capacity as Board Administrator over the ensuing 17 months. Jeannie and her family will be relocating to Dallas, Texas in the early part of this month. I would like to thank her for her efforts to enhance the quality of the Board's functions and on your behalf I wish her well.

Dick Clarke, CHT, President
National Board of Diving & Hyperbaric Medical Technology

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August 2010

Effective August 1 of this year a CHT Code of Conduct has been introduced. This development reflects a growing broader acknowledgement that professional activities cannot be regulated by legislation alone. Codes of Conduct are now to be found within federal and state governments, the finance industry (and not before time!), commerce, academia, and various nonprofit organizations. By committing to a specific code of conduct, individuals agree to the incorporation of moral and ethical standards into their professional behavior.

From this point forward, all new applicants for CHT status and those applying for renewal will be required to sign the NBDHMT CHT Code of Conduct. The Code is reproduced below.

As a NBDHMT Certified Hyperbaric Technologist I, the undersigned, acknowledge and agree to honor my obligations to observe the highest standards of ethical conduct, integrity and honestly. Further, I agree that in the performance of my duties:

  1. I will conduct myself in a manner that reflects positively on the NBDHMT and the hyperbaric medicine discipline in general
  2. I will refrain from behavior that harms the public and professional perception of the NBDHMT and the hyperbaric medicine discipline in general
  3. I will conduct my employment consistent with all applicable rules, regulations and laws to which health care providers in general and hyperbaric medicine personnel in particular are subject
  4. I have read all of the NBDHMT published 'Position Statements', understand their intent, and commit to remaining current as new 'Position Statements' are promulgated
  5. I will promote adherence to all relevant facility and patient safety aspects described within the NBDHMT's 'Position Statements'

The Board is confident that the introduction of this moral and ethical commitment will enhance the standing of the CHT program and its certifying organization. It should also serve to improve the quality of care delivered to our respective patient populations.

Dick Clarke, CHT, President
National Board of Diving & Hyperbaric Medical Technology

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July 2010

The NBDHMT Board of Directors held its annual meeting in St. Petersburg, Florida on June 2, 2010. As in common, it coincided with the Undersea and Hyperbaric Medical Society's annual scientific meeting.

Several immediate items arising from the meeting that would be of interest are listed below.

  1. Despite the unusually high costs associated with the relocation of the Board's headquarters from New Orleans to Columbia, SC, the associated upgrading of office technologies and conversion to a largely paperless process our financial health remains very good.
  2. The term "qualifying vocation" has been changed to "qualifying pathway". This is largely semantics but does more accurately reflect the process by which each CHT applicants professional eligibility is considered.
  3. A DMT is not a qualifying vocation/pathway for CHT. To qualify as a CHT one must have completed an NBDHMT approved hyperbaric medicine training course. Certification as a DMT is based upon completion of a diver-medic training course. These two training processes address very different goals and objectives.
  4. A Board administered DMT certification examination remains on track for early 2011. Board approved DMT instructors will be kept updated as this initiative nears completion.
  5. A record 45 CHT and CHRN testing sites were convened over the past 12 months.
  6. A CHT certification program in veterinary technology continues to evolve. This initiative is headed up by Dennis Geiser, a veterinary surgeon based in Knoxville, TN. He attended the meeting and updated his committee's progress. We are aiming for the first examination in 2011.

A number of other decisions were made and a series of "Action Items" established. I will continue to update you on these and other events by way of  these Monthly Briefings.


Pauline PolettiOn a final and particularly sad note, I want to advise you that Pauline Poletti passed away recently. Pauline had suffered cancer for a little more than a year and had done so bravely. As many of you will appreciate, Pauline was a huge part of the Board's administrative activities for almost two decades. She was fiercely loyal and had absolute "ownership" of her responsibilities and duties. She was uniformly considered helpful and supportive by all those who interacted with her on certification and related matters. The Department of Defense did fly her son home from the Middle East to be by her side in her final days. The Board of Directors extends its deepest and heartfelt sympathies to Pauline's family during this difficult period.


Dick Clarke, CHT, President
National Board of Diving & Hyperbaric Medical Technology

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June 2010

The Board is increasingly concerned with what appears to be the practice of hyperbaric oxygen therapy without appropriate physician oversight. It is particularly disturbing to learn that, in some cases, it is the CHT's who is operating a hyperbaric treatment facility in the absence of a physician. Disturbing, given that the process of preparing for and taking the hyperbaric certification exam offers ample evidence of wide - ranging complications and side effects that may complicate patient care. Such problems clearly require physician directed diagnosis, interpretation and management.

Please take a moment to read, or re-read, the Board's Position Statement number 2010-01, posted in April of this year. You can locate it on the Board's Home Page. This statement makes The Board's expectations regarding the operational practice of hyperbaric medicine very clear. Our patients deserve nothing less.

Dick Clarke, CHT, President
National Board of Diving & Hyperbaric Medical Technology

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May 2010

As the pace of the Board's activities continues to accelerate we want to improve the way we communicate important developments. The "Monthly Briefing" does receive some 440 visits every month. This is encouraging. However, a larger number of our diver medics, technologists and nurses do not access and benefit from this content, given that we have 4,000 of them!

To better spread the word then, we plan a monthly email blast. It will contain the current month's briefing, along with anything else deemed informative. Examples of which will include the latest Position Statement, any significant changes to the certification and recertification processes and introduction of any new programs – the veterinary hyperbaric technologist certification is working its way to fruition.

You will have likely received our first blast, sent out during the last week of April. If not, we do not have your email address on file so send it in. The blast carried the Board's most recent Position Statement (Physician Attendance and Supervision of Hyperbaric Oxygen Therapy). This statement was prompted by what appeared to be reports of CHT's independently ordering and delivering hyperbaric oxygen therapy; ie, in the absence of a physician. To most of us this would be readily recognized as practicing medicine without appropriate licensure. It would further represent an obvious violation of several legal and regulatory standards and codes. However, the Board wishes to make this point very clear to its DMT, CHT and CHRN constituents.

Dick Clarke, President
National Board of Diving & Hyperbaric Medical Technology

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April 2010

I have some very good news to report regarding our diver medic colleagues serving in the U.S. Navy. In July of last year, at the invitation of Chief Petty Officer Blair Dell HMS, Special Operations Independent Duty Corpsman at the Naval Diving & Salvage Training Center and Diving Medicine for Medical Personnel lead instructor, I visited his program in Panama City. It was impressive, as was he. The diver medic training these guys undergo is both extensive and unparalleled. During my visit I was invited to speak to a DMT class about to graduate and another just getting underway. My topic was the history of the civilian DMT program and the role of today's diver medic in the commercial diving industry.

This presentation started the wheels turning. Chief Dell and his colleagues began to research a pathway whereby naval personnel who complete DMT training could apply to the NBDHMT for civilian certification and be financially sponsored by the government. Step one was for us to review the USN DMT training course curriculum. As noted above, it was quite superb and greatly exceeded our minimum requirements. With course approval in place, these motivated individuals formally applied to the Department of the Navy for a civilian credentialing opportunity. This has recently been approved and I must say that the NBDHMT is honored to be able to certify graduates of their DMT program.

The annual meeting of the NBDHMT Board of Directors is on the horizon. As in the past, it will coincide with the annual scientific meeting of the Undersea and Hyperbaric Medical Society, in St. Pete, Florida (June 3-5). A reminder that if you are planning to be there, then don't miss 'Breakfast with the Board'. This year's breakfast will be at 7:00am on Friday, June 4, 2010. Try to make it. You will have the opportunity to meet personally with the Board and learn what we have planned for the coming year. At this year's meeting we will also have an exhibitor booth so please drop by and say hello.

Dick Clarke, President
National Board of Diving & Hyperbaric Medical Technology

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March 2010

Our efforts to provide advance notification of recertification deadlines by regular mail are frequently thwarted by incorrect postal addresses we have on file. It would be preferable, of course, to have everyone's email contact. It is more likely to be up-to-date and avoids postal costs. We are in pretty good shape with all of you who have certified in the last several years. However, our records are less impressive for many who have been around a lot longer. Please ensure that the corporate office (nbdhmt@aol.com) has your email address when you have a moment.

Look our for us at the Undersea and Hyperbaric Medical Society Annual Scientific Meeting, June 3-5, in St. Petersburg, Florida, and Hyperbaric Medicine 2010, Columbia, South Carolina. We will have exhibitor booths at both of these meetings. Stop by and meet our administrative staff and Board Members. At the UHMS meeting we will again host a 'Breakfast with the Board'. The Board's certification activities will be updated as you enjoy a complimentary breakfast. This proved very popular last year, with some 70 in attendance. This is another good opportunity to get your questions addressed and represents a useful forum for comments and discussion.

Recent visitors to the Board's website will have recognized a new logo. Nurses now have clear representation on the Home Page via very nicely designed imagery. With the development of a CHRN specific logo we have been able to introduce merchandise specific to the certified hyperbaric nurse. Check out these and several other additions to the Online Store link using the link provided on the Home Page.

Dick Clarke, President
National Board of Diving & Hyperbaric Medical Technology

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February 2010

With the elimination of the Basic level DMT. There exists a need to access invasive skills training. A survey of DMT instructors indicates that such opportunities do exist. The following facilities/instructors have indicated interest in a 'bridging' course that will provide the necessary training to permit Basic DMT's to re-certify.

Hyperbaric Training Associates/Ron Ellerman
rellerman@wi.rr.com

Oxyheal Health Group/Kevan Corson
kcorson@oxyheal.com

Divers Alert Network/USC Catalina Hyperbaric Chambers
huggins@usc.edu

National Polytechnic College of Science
jspelich@natpoly.edu

Contact those instructors if you need additional information. Effective January 1 of this year invasive skills are a mandatory component of the DMT certification training curriculum.

The Board recently decided to eliminate two of the long established CHT Qualifying Vocations. One was 'Researcher'. This was rather a vague term. It had very rarely been employed during certification requests and it did represent a potential for abuse of the spirit and intent of the Qualifying Vocation. The second was 'Medical Services Specialist'. This is a title and position specific to military personnel. Again it has very rarely been employed. Should medical services specialist wish to apply for CHT status, alternative Qualifying Vocation pathways exist (EMT or application to the 'Others' subsequently appeal to the Board).

A reminder that the 480 hours of preceptorship that follows hyperbaric training must include 40 hours of direct oversight. Established CHT's and CHRN's are expected to serve in this capacity. Specific preceptor guidelines will appear in the March Briefing. Hyperbaric physicians would represent an alternative, should there be a program lacking experienced technologist and nurses. If difficulties persist please contact Board headquarters.

Dick Clarke, President
National Board of Diving & Hyperbaric Medical Technology

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January 2010

Adding to NBDHMT recognition by the Health on the Net Foundation as promoting useful and reliable information, the NBDHMT is now a proud member of the Institute of Credentialing Excellence. Formerly the National Organization for Competency Assurance, ICE is dedicated to providing education, networking and advocacy resources for the credentialing community. We will be submitting applications for our DMT®, CHT® and CHRN® credentialing programs to ICE's accrediting body, the National Commission for Certifying Agencies, in the coming months.

We are going to delay the restructuring of the DMT® certification examination. You may recall that the Board had intended to align DMT® certification testing with its CHT® and CHRN® processes. This was to have occurred on January 1 of this year. Unanticipated delays in the reconfiguring of the exam question bank have necessitated this change in plan. All of the Board's approve DMT® instructors and DMT® training facilities have been advised to maintain their current testing procedures until further advised.
Progress continues with the development of a certification examination in veterinary hyperbaric technology. Under the able leadership of Dr. Dennis Geiser, DVM, University of Tennessee, College of Veterinary Medicine, a committee is fine-tuning the process where those seeking such certification will be trained, tested and credentialed. It is anticipated that Board approved training will commence before the end of this year.

As the Board enters it 25th year I am reminded of its formative period. Having first attempted, unsuccessfully, to align certification of diver medics with the National Registry of Emergency Medical Technicians, the Board was formed in 1985. We were advised by some at that time that an upstart organization such as ours would fail to gain necessary credibility and respect. Time has proven otherwise.  And all of those who have benefited therapeutically from your care, be they the commercial oilfield saturation diver off Brasil's Atlantic coast, the teenage female scuba diver in the Florida Keys, the carbon monoxide poisoned warehouse worker in Salt Lake City or the retiree in Philadelphia who avoided losing her radiation damaged bladder, represent the ultimate validation of a certification body dedicated to the safe and effective application of undersea medicine and hyperbaric oxygen therapy.

Dick Clarke, President
National Board of Diving & Hyperbaric Medical Technology

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December 2009

Take a moment to check out the Board's all new Online Store. It was completely revamped and upgraded in November. Merchandise is of the highest quality and the store's payment process has finally entered the modern era -- credit cards are accepted! Consider these items as a great way of displaying and promoting your certification status as a Diver Medic or Hyperbaric Technologist. Hyperbaric Nurse merchandise will be offered once a suitable logo has been designed and approved by the Baromedical Nurses Association Certification Board. Let us know if there are other items you would like to see offered. Sweat shirts and ball caps are in the works.

A new NBDHMT Position Statement was posted on the website home page several weeks ago. It relates to the disturbing practice of hyperbaric oxygen chambers and related supportive infrastructure being sold to the lay public and used in the in-home setting. To the informed, this practice will immediately raise several red flags. Given the Board's leadership position on all things hyperbaric safety, it would be remiss if we did not offer public comment against this practice.

This month's 'Briefing' represents a full calendar year of what we hope have been helpful insights. We will continue to use this communication vehicle to keep you apprised of what we have in the planning stages and what is being contemplated. Those of you who have written to us about the Monthly Briefings have been uniformly pleased. We hope this sentiment extends more broadly.

Some reminders: The decompression table's examination questions on both the CHT and CHRN examinations will change effective January 1. From this point, these questions will be based upon the most recent version of the U.S. Navy Diving Manual (Revision 6). All DMT training must incorporate invasive skills training in the new year. Fees will increase for CHRN certification on January 1st, 2010.

DMT certificates will be issued only at the time of the initial certification. A new card will be issued upon re-certification. In the past, certificates were issued for both certification and re-certification. We have updated the certificates so they no longer have an expiration date. Therefore, your certificate will always show your original certification date.

On a final note, Board Administrators Jeannie McLamb and Nancy Martinich join me and the entire Board of Directors in wishing you and your families an enjoyable and safe holiday season.

Dick Clarke, President
National Board of Diving & Hyperbaric Medical Technology

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November 2009

Many of you will have noticed the HON icon that now features prominently on the Board’s website.  The Health on the Net Foundation (HON) promotes and guides the deployment of useful and reliable health information. Created in 1995, HON is a non-profit, non-governmental organization. It is accredited to the Economic and Social Council of the United Nations.

The NBDHMT received HON certification in October of this year. This important distinction was the result of a HON review committee determination that the information contained within the NBDHMT website meets HON’s eight ethical principals. HON will regularly monitor the website to ensure ongoing compliance. Visitors to the site are assured of the quality and trustworthiness of its medical and health content.

You may also have noticed improved navigation within the DMT, CHT and CHRN linked sections. The ability to locate and download certification application materials has been enhanced. Please don’t hesitate to contact Board headquarters if you feel that we can further enhance the value of our website content.

As noted in previous ‘Monthly Briefings’, the Board has been researching the possibility of incorporating national testing centers into the certification examination process. Having completed the review process it is apparent that we will not be able to offer testing center examination options. Principally, it came down to cost. Clearly, these testing centers commonly deal with larger organizations than the NBDHMT. Unfortunately, there is no way that the Board can absorb associated annual costs (as high as $60,000 in two instances) nor realistically pass on these costs to those who sit the certification examinations. We will continue to coordinate on-site proctorship testing opportunities, to the widest geographic scope possible. A quick review of the current testing locations will indicate just how wide spread and how frequent the Board is able to schedule testing sites. For 2009 alone, some 30 locations will have been used by the end of the year.

On a final note, a new CHT certification level has been introduced. It serves to recognize those who have advanced professionally from their technical and clinical duties to management and administrative responsibilities. Until now, these individuals have frequently been unable to complete the necessary technical and clinical hours to meet CHT recertification requirements. By applying for CHT-Admin, they will now be able to maintain their CHT ‘identity’ and continue to be recognized as a hyperbaric professional.

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October 2009

‘Primary Source Verification’ is now live on our website for all categories of certification. Prospective employers can now directly search our CHRN, CHT and DMT databases. Upon entering an individual’s last name in the appropriate box, via the ‘Confirm Certification’ link on the Home Page, one will see that individual’s full name, certification number (for CHRN’s and CHT’s) and expiration date, if they are indeed certified. Each of the three databases is updated weekly. If the name of a particular individual does not appear, those searching are prompted to a link to the Board headquarters email address to request a more updated search.

Animal chambers have long been a part of hyperbaric medicine’s research efforts. More recently, animal chambers have been employed in a clinical/treatment setting. This practice is growing considerable, and on an international scale. Some of the conditions suffered by our hyperbaric patients are also suffered by animals. One would expect, therefore, that these animals would derive benefits similar to those our patients enjoy. Already, however, there have been several fatal equine hyperbaric chamber fires. In order to enhance the practice safety and clinical effectiveness of these animal chambers, the NBDHMT is in the process of developing a hyperbaric certification standard for veterinary technologists. A working group made up of NBDHMT Board members and veterinary specialists has been formed.  Their remit is to create a training course and certification examination that will result in the awarding of a Certification in Hyperbaric Veterinary Technology (CHVT). It is intended that this new NBDHMT certification will be available in the latter part of 2010.

On a final note, certification and recertification fees for CHRN’s will increase on January 1, 2010. The Board will accept payment at the current rates for 2010 certifications if payments are received by December 31 of this year. For those of you due to recertify in the early part of 2010, payment in December will represent a saving of approximately 20% on next year’s fees.

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September 2009

Certification examination schedules are at an all time high. From January through July of this year, testing was scheduled at 12 different locations, involving 105 nurses and technologists. For the remainder of the current year 16 additional examinations are scheduled, with 111 CHT/CHRN applicants registered to date.  Independent of these impressive numbers is a steady volume of diver medics being certified.

Given the above, I thought that you might be interested to learn of the total number of those who have been certified since the inception of the NBDHMT. These numbers will provide some idea of the growing interest in the practice of undersea and hyperbaric medicine.  The first CHT examination was offered in San Diego, in 1991.  From that point, through 2005, 687 became certified. From 2006 to August 2009 another 702 have certified.  The last four years, therefore, has seen more certification activity than in the previous fifteen years.  On the nursing side, the CHRN exam was first offered in 1995. Through 2005, 292 nurses became certified. From 2006, an additional 326 have certified. Again, the last several years has produced more CHRN’s than the previous 11 years. The DMT certification program is equally impressive. While DMT training began in 1975, it was not until 1989 that formal certification was introduced. From 1989, through 2005, the Board certified 774 diver medics. In the last 3 ½ years another 839 have been added to the rolls.

I think that we can take comfort in this growth, and the increasing professional recognition and credibility that formal certification offers.

Work continues to restructure the DMT certification program into a single standard. As noted in previous briefings, the DMT testing process will be brought in-house in the coming year. The ‘Module 16’ training curriculum is being fine-tuned and the question bank finalized. The same applies to the adoption of national testing centers for three certification programs, which we hope to introduce in the not too distant future.

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August 2009

The annual Board of Directors meeting was held in Las Vegas, in June, in conjunction with the 2009 annual scientific meeting of the Undersea and Hyperbaric Medical Society. An extensive agenda was tackled, much of it designed to enhance the operations and quality of the Board’s various certification processes.

Sub-committees were formed in order to upgrade the DMT training course outline (commonly referred to as Module 16) and to create the DMT examination database. As noted in early ‘Briefings’, the DMT certification examination process will be undertaken by the NBDHMT, in the same manner as the CHT and CHRN programs, beginning in 2010. Invasive skills training will become a standard component of all DMT training at that time.

Another important update is the decision to conduct all future certification examinations through a national chain of testing centers. This is now commonplace for medical, legal, accounting and other professions. The use of testing centers will make it much easier for individuals to schedule their exams, by not having to wait for the required minimum number of applicants before a test date can be scheduled in a specific area. It will also serve to enhance the security and confidentiality of the examination process. We expect to have this process in place by early 2010.

The Board has been approached by members of the veterinary medicine community. They are interested in the development of a training and certification standard for those who operate equine and other animal hyperbaric chambers. An initial approach occurred two years ago; interest is now renewed. I met with a representative of this group in July and the Board will look closely at this possible extension of its certification activities in the coming months.

The Board wishes to emphasize that, going forward, the 480 hours of preceptorship necessary to complete eligibility prior to taking the CHT examination must occur following formal Board approved hyperbaric training. Work experience that has been accumulated prior to the formal training is not considered part of the 480 hours of preceptorship. Preceptorships are expected to be undertaken via an experienced CHT or CHRN wherever possible. If you are thinking of becoming certified in hyperbaric technology, please have your preceptor contact the Board for a guidance document.

On another topic, the Board wishes to clarify the procedure for those who fail their certification examination. They may re-take the examination following a six month waiting/study period. If an examinee fails a second time, they are then required to repeat formal NBDHMT approved hyperbaric training, at which point they become eligible to take the examination a third and final time. Those who fail their third attempt (and this has not occurred to date) would not be eligible to make any further attempts.

One final point is to remind those who apply for certification as CHT’s and CHRN’s that they must submit evidence of completion of three transcutaneous oxygen studies, which represents completion of the TCM Module training process. This evidence can be in the form of a statement within the letter that confirms completion of the preceptorship process.

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July 2009

The new Board headquarters team continues to get a good grasp on the day-to-day aspects of the various certification processes. This has been enhanced by improved office automation capabilities and access to upgraded information technology. Your patience during the past several months has been greatly appreciated. We are now in a much better position to serve you more efficiently.

Both the upgraded CHT and CHRN examinations have literally been put to the test. It appears that our efforts to improve the respective testing banks have been successful. This observation is based upon the very few comments received with completed tests, which typically raise concerns regarding question clarity, appropriateness or intent. We will continue to monitor test results closely and make adjustments as they appear necessary.

If you are a certified DMT, CHT or CHRN and have not done so already, please take a moment to email the Board with your date of birth. We are in urgent need of this in order to introduce Primary Source Verification (see May 2009 Monthly Briefing).

A reminder that those DMT’s certified as ‘Basic” will need to provide evidence of invasive skills training upon application for re-certification on or after January 2010. In the coming months the Board will provide information on where such invasive skills training is being offered.

The NBDHMT Board of Directors held their annual meeting in Las Vegas, on June 24. This meeting coincided with the annual scientific meeting of the Undersea and Hyperbaric Medical Society. I will provide a summary of the Board meeting in the next edition of Monthly Briefing.

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June 2009

Many of you will be aware of the fatal hyperbaric chamber fire that occurred in a free-standing facility in South Florida, on May 1st.

The fire appeared to involve an early model Vickers monoplace. While details of the resulting investigation have not yet been made public, early indications suggest that this facility’s normal course of operations involved marked violations from what would be considered standard hyperbaric safety. This tragic event has prompted the NBDHMT to move forward its planned publication of a series of Position Statements. The first two such Statements are now published on the Board’s Home Page. More will follow and any comments you may have are welcomed.

The Board’s headquarters are now operating from their new location, in Columbia, South Carolina. Please be patient as our team comes to grips with a huge amount of documentation. Note the new Board contact details at the foot of each page of the website. On a particularly sad note, I also want to let you know that the Board’s long serving office manager, Pauline Poletti, is seriously ill and unable to continue her employment. Pauline has a tough time ahead of her, yet she remains in good spirits. Not the least of her difficulties is mounting and uncovered health care costs. A fund has been established by her co-workers, family and friends to help offset these costs. If you would like to make a contribution to Pauline’s financial burden please send it to:

The Pauline Poletti Donation Account,
# 207 81 1600 8 at Capital One Bank.

Payments can be made directly to any Capital One Bank or sent to the attention of Mandy Wise, 1816 Industrial Blvd. Harvey, LA 70058-2314. I know that Pauline, who served the Board and all those who certified for almost 20 years, will be very grateful.

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May 2009

Plans are underway to introduce ‘Primary Source Verification’ to the Board’s website. This is an increasingly common verification aspect of modern healthcare. It is now mandated by the Joint Commission on Accreditation of Healthcare Organizations for all clinical staff required by an employing organization, or the state, to have licensure, registration or certification. The purpose of this verification is to ensure that a person’s qualifications are consistent with their job responsibilities. In the past, such verification was a somewhat lengthy, convoluted and not always successful process. It commonly entailed hard copy communication with numerous related entities. Today the process can be greatly enhanced via access to information links within single website sources.

We plan to get the CHT verification process up and running first. Those seeking to confirm that a staff member or potential employee is currently certified in hyperbaric technology through the NBDHMT will be able to access the ‘Primary Source Verification’ link on the Board’s Home Page. By entering an individual’s name and date of birth, current certification status can be confirmed. We plan to have CHT verification in place by July of this year. Verification will be extended to DMTs and CHRNs in due course.

Another important news item is that the Board’s headquarters is being relocated to Columbia, South Carolina in the coming weeks. We anticipate a seamless transition and no interruption in certification and related support services. Look out for new contact details on the website. On behalf of the Board, I would like to extend my sincere thanks and deep appreciation to Dr. Keith Van Meter. He has generously provided an administrative home for the NBDHMT in his company’s offices in New Orleans for almost 20 years.

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April 2009

An important milestone was reached during March of this year. The first major revision of the CHT examination in the 20 years since it was first introduced was completed. Questions have been added and deleted during this period. However, the exam was in need of a top to bottom overhaul and upgrading. What we have now better reflects today’s operational, technical and safety practice standards. The examination more effectively tests each prospective hyperbaric technologist’s core knowledge. Gone are the questions most relevant to nursing practice and hyperbaric physician decision-making. The examination has also been carefully weighted between key subject categories, in order to further improve balance specific to the roles and responsibilities of the hyperbaric technologist.

All subsequent CHT examinations will use this new question bank. We have elected to maintain the decompression tables’ questions based on the 1999 version of the U.S. Navy Manual’s Standard Air Decompression Tables for the time being. Many of you will be aware that these tables underwent a significant change in 2008. Theses new tables are now incorporated as Revision 6 of the U.S. Navy Diving Manual. We have elected to maintain the 1999 version as not all training centers have switched their teaching materials. We anticipate that the CHT examination will incorporate the 2008 decompression tables for all examinations that are scheduled after January 1, 2010. The principles of table computation remain the same. However, time frames have changed to reflect more conservative exposures and depths are now broken down into 5 instead of 10 fsw increments.

The Baromedical Nurses Association Certification Board is likewise undertaking a updating of the CHRN examination question bank. We expect that their new questions will be incorporated within the coming weeks and be reflected in all scheduled CHRN examinations after June 1, 2009.

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March 2009

A recent visit to Board headquarters in February allowed me to reacquaint myself with Pauline and meet for the first time with Melissa. These two individuals are truly dedicated to the success of the Board’s mission and all those who certify. I also spent time with past president Paul Baker and executive committee member Dr. Keith Van Meter during my time at the office. We discussed a number of initiatives, one of which involves modernizing all of the present office technology. Another will see the Board being able to finally accept credit card payments.

I have a meeting scheduled with the diving medical officers and safety directors from the Gulf of Mexico’s commercial diving industry, in the early part of this month. The purpose of this meeting is to determine from these important ‘end users’ of the DMT certification program if we are continuing to meet their needs. Much has transpired in both the diving industry and the provision of emergency medical care since the inception of the DMT program, in 1975. The Board is presently undertaking a comprehensive review of the DMT certification program. We must ensure that it remains current, pertinent and responsive to the needs of the industry and its injured divers.

I am in communication with all of the current DMT training programs. They have provided valuable service over the years and we want to ensure that they have the necessary tools and guidance to continue to effectively address this important aspect of diving safety. Some changes are likely. The basis for any change will be enhanced education and training and the optimizing of care rendered on behalf of the injured diver.

Dick Clarke, President
National Board of Diving & Hyperbaric Medical Technology

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February 2009

From its independent beginnings, almost three decades ago, the NBDHMT has carved an indelible nitch within the mainstream of undersea and hyperbaric medicine's safety and patient care consciousness. Early attempts to affiliate with existing certification bodies proved unsuccessful. The principal stumbling block was the operational, geographic and medical remoteness of the DMT. These diving first responders were, at times, far beyond the conventional time frames of traditional land-based EMT's/Paramedics in terms of reaching medical facilities and transferring direct care to a physician. This perceived risk was considered too great a hurdle for pre-hospital certifying agencies to assume responsibility for the DMT.

Lacking any alternative and with a firm desire to standardize and enhance the DMT program, an independent non-profit organization was formed. Critic's charged that such an organization would not gain the necessary credibility and acceptance. The board persisted. Time and events have proven our critics wrong. Today, the NBDHMT is an increasingly measured standard, in the U.S. and elsewhere. Oil and gas production companies, oil field diving support companies, hospitals, health insurance companies, training agencies, geographically remote recompression facilities and accreditation programs recognize and promote the personnel and standards that are a product of Board's certification processes.

One recent and particularly important validation of the NBDHMT's credibility and good standing in medical practice comes from Medicare, the U.S. government’s health insurance giant. Several of Medicare's regional intermediaries are now mandating certification in hyperbaric technology or hyperbaric nursing in order to conduct reimbursable transcutaneous oxygen assessments outside of traditional vascular diagnostic setting. One such intermediary, Trailblazer's Health Enterprises *, in a 2008 update, noted:

'Additionally, transcutaneous oxygen measurements may be performed by persons possessing the following credential's obtained by the National Board of Diving and Hyperbaric Medical Technology (NBDHMT):

Certified Hyperbaric Technologist (CHT) or,
Certified Hyperbaric Registered Nurse (CHRN)

* Trailblazer's Health Enterprises, LLC
LCD Non-Invasive Peripheral Arterial Studies U-17B-R6; 10/01/2008

The board intends to build on all of this momentum. Stay tuned to the Monthly Briefing column to find out more specifically where we are heading.

Dick Clarke, President
National Board of Diving & Hyperbaric Medical Technology

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January 2009

A note to say how pleased I am to return to the Board as its president and to advise you of some of the initiatives planned for the coming year.

It has been 13 years since I handed over the leadership reins to Paul Baker. Since then, and ably assisted by his fellow Board members, Paul has undertaken his duties and responsibilities to good effect. Now comes a well earned retirement – well, not entirely. I intend to appoint him to a Director-at-Large position. This will ensure continuity, as well as maintain the availability of a valuable resource.

Through a series of ‘Monthly Briefings’ posted on the website, I will keep you, the DMT, CHT and CHRN, in touch with the Board’s activities, initiatives and progress. In addition, you are invited to contact me at any time should there be other issues you would like to raise, or questions you may have. This first briefing will lay out what I have I mind as a starting point for my tenure.

I intend to initiate a detailed review of the DMT program. It has been in place for some 30 years and its graduates have played an important role, sometimes life-saving and often central nervous system sparing, in the practice diving medicine. This has particularly been the case in the medical and geographic remoteness of the commercial offshore diving industry. At this point in time I feel it important to ensure that the training and certification aspects envisioned and applied back in 1976 remain consistent with the evolving needs of the diving/undersea medicine communities.

To this end I plan to meet with safety officers and managers of the various commercial diving companies and diver treatment facilities in order to get their perspectives on the DMT program. It may also be preferable that we evolve to a ‘national’ DMT certification examination, as we have in place for the CHT program. Feedback from those who employ DMT’s will allow us to refine and upgrade related training standards and the certification process.

A second initiative will be to evaluate the potential ‘globalization’ of the Board’s certification activities through the teaming with similar organizations elsewhere in the world. Several opportunities already exist and others may be out there. Given our extensive certification experience, the Board is in a position to assume a leadership role as it relates to international diving and hyperbaric medicine safety, technology and practice excellence.

I will stay in touch with you through regular briefings that will be posted on the Board’s website. Best wishes for 2009!

Dick Clarke, President
National Board of Diving & Hyperbaric Medical Technology

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