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Centre for Hyperbaric Oxygen Therapy Military Hospital Queen Astrid - Brussels Dr Peter Germonpr Lieutenant-Colonel, MD Medical Director

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Overview History of the centre Staff and equipment Medical environment Activities : medical Activities : research Activities : expertise

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History of HBO in Belgium 1968: Naval hyperbaric chamber in use1968: Naval hyperbaric chamber in use 1966 - 1968: Ministry of Health decides t1966 - 1968: Ministry of Health decides to make HBO available to all citizens

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HBO in Belgium : "the early years" Accepted indications :Accepted indications : Decompression sicknessDecompression sickness CO intoxicationCO intoxication Gas gangreneGas gangrene Choice of monoplace HBO chambers :Choice of monoplace HBO chambers : CostCost SimplicitySimplicity Safer than multiplace HBO chambersSafer than multiplace HBO chambers Acquisition and distribution of 11 HBO chambers (Drger 1000)Acquisition and distribution of 11 HBO chambers (Drger 1000) 1968-1970: 5 chambers1968-1970: 5 chambers 1970-1972: 2 chambers1970-1972: 2 chambers 1972-1974: 4 chambers1972-1974: 4 chambers

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HBO therapy in Belgium : Military Hospital Brussels 1991 Multiplace Comex 1500 HBO chamberMultiplace Comex 1500 HBO chamber Full ICU capacity (treatment & monitoring)Full ICU capacity (treatment & monitoring) Annual number of treatments :Annual number of treatments : 253 (1991) 520 (1992) 1100 (1993) 2630 (1998) On average : 250 ICU HBO sessions / yrOn average : 250 ICU HBO sessions / yr Integrated in Critical Care Department (ICU, EMS, BU)Integrated in Critical Care Department (ICU, EMS, BU)

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Hyperbaric Centre Brussels First multiplace hospital-based HBO chamber in Belgium 1 Med, 4 CHT Adapted multiplace chamber

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Statistiques

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2000 : New hyperbaric chamber Necessity of new HBO chamber & renovation of HBO centre expressed from 1996 Larger treatment capacity Safer treatment of ICU cases Saving on personnel costs New location and offices needed New hyperbaric chamber acquired in 2000 (arrival: October, 1st treatment :24 Dec 2000)

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September 2000

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Equipment and staff New offices and consultation rooms New hyperbaric chamber 16 seat multiplace Custom design & functionality 4 (max) ICU stations Computer controlled Fully redundant (gases, electricity, steering)

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Dimensions : 2.8m diameter, 8m length

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Ambulatory treatments : 16 seats

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Intensive Care treatments : up to 4 stations

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Diving accident treatment Chamber pressure rating : 4.5 ATA (3.5 Bar) Mixed gases available : Nitrox 50/50 Heliox 50/50 Treatment tables used : USN 6 (Goodman II) Comex30 Heliox USN 5 (Goodman I) HBO sessions (2.5 ATA, 70 min)

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Staff 6 full-time hyperbaric chamber operators (CHT) 1 full-time secretary 4 (PT) hyperbaric & diving medicine specialists 15-25 nurses and paramedical personnel for patient surveillance (attached to the centre normal place of work = hospital wards) Regular trainees (nurses, physiotherapists)

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Medical environment Emergency department : EMS team with emergency medical specialist and nurses heli-pad, availability of heli Medevac within 30-45 minutes 24 Hour call-center (HBO, joint with Military Ops and Burn Unit) toll-free number within Belgium

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Medical environment Critical Care Department : Burn Unit : Intensive Care capacity 1-4 beds for non-burn patients Intensive Care nurses trained for hyperbaric treatments Trauma surgeon / Intensive Care specialist on site Respiratory physiotherapists on site Regular hospital wards 30 beds, expandable

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Medical activities Integration in regional EMS Only referral point for emergency and non- emergency HBO in central Belgium (60 km area) Coordination of diving emergencies in Belgium (via DAN Europe)

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Clinical activity

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Civilian patients : agreement Min.Health 1999 for all-in price for ICU treatments International aid : transfer from Ops Theatres (Kabul, Lebanon, Congo) Military patients : minority

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Emergency Medicine Carbon Monoxyde Decompression sickness CAGE Gas Gangrene Crush Acoustic Trauma Blast 24/24, 7/7 availability

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Diving Accident Management 2010 : 33 diving accidents treated 54 diving counselling consultations

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Research activities Diving medicine Role of PFO in decompression sickness Epidemiology of DCS in Belgium Mechanism of bubble formation in diving Hyperbaric Medicine Treatment of thermal burns with HBO Idiopathic sensorineural hearing loss Erythropoietin stimulation by normobaric oxygen Hyperbaric Safety and education Fire behaviour and fire fighting in hyperbaric environments

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Research activities Characteristics: Clinical, practical scope Multidisciplinary, multicentric Diver-oriented Spin-offs Expertise Education

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Expertise Selection tests of Belgian military divers Medical Direction DAN Europe Benelux Teaching and CME for MDs and nurses in HBO (ACHOBEL : Belgian Advisory Committee for Hyperbaric Medicine) European Cooperation in Science and Technology (COST Action B-14: Hyperbaric Oxygen Therapy) Quality assurance development of European guidelines for HBO centres (COST Code of Good Practice for HBO Centres; CEN European Norm) European Committee for Hyperbaric Medicine : expert panel on Research and Intensive Care HBO treatments

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Hyperbaric Medicine Treatment by inhalation / respiration of pressurised gas Requires pressurisation in hyperbaric chamber Breathing gas : Pure oxygen (hyperbaric oxygen therapy) Mix Helium-Oxygen (Heliox) Mix Nitrogen-Oxygen (Nitrox) Pressures : 2.5 to 3 Atmospheres absolute (ATA)

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Oxygenation = cellular survival Hyperbaric Medicine

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Anaerobic infections Hyperbaric Medicine

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Stimulation of wound healing Hyperbaric Medicine

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Compression of gas bubbles (in blood vessels or tissues) Hyperbaric Medicine Dont eat the yellow thing at the back, it will make you fart !