Diving and Hyperbaric Medicine

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Super User

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31 August 2022

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Chris developed an early passion for sailing and other water sports in the waters around Auckland and completed his scuba training while at the University of Auckland Medical School. After spending several years as a solo GP he joined the Royal New Zealand Navy as a medical officer to gain experience in occupational medicine, and specifically, diving and hyperbaric medicine. Naval service included being sole medical officer aboard the frigate HMNZS Canterbury during the East Timor crisis in 1999.

After an initial degree in chemistry, Chris completed his medical training followed eventually by his Masters and Doctoral degrees all at the University of Auckland. Because of New Zealand’s unique centrally-audited occupational diver certification system, Chris has been able to use the large volume of stored diver health data to study the long-term effect of diving on lung function and hearing and also assess the value of routine medical examinations in determining fitness to dive. These studies were the foundation for his masters and doctoral theses, and have led to significant evidence-based changes to the certification and health surveillance of professional divers.

For the past 20 years Chris has been the clinical director of the Devonport-based hyperbaric unit which is now owned and operated, not by the Navy, but by the public health system, now called Health New Zealand/Te Whatu Ora. He is a full-time clinician, but still teaches final year nursing and medical students. In his spare time he likes to dabble in art and music.

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Super User

Category: Information

22 May 2022

11283

Efficacy and safety of hyperbaric oxygen treatment to treat COVID-19 pneumonia: a living systematic review update

Sylvain Boet, Cole Etherington, Nibras Ghanmi, Paul Ioudovski, Andrea C Tricco, Lindsey Sikora, Rita Katznelson

Appendix 1. Search Strategies

Ovid MEDLINE(R)

coronavirus/ or betacoronavirus/ or coronavirus infections/
(nCoV* or 2019nCoV or 19nCoV or COVID19* or COVID-19* or COVID or SARS-COV-2 or SARSCOV-2 or SARSCOV2 or Severe Acute Respiratory Syndrome Coronavirus 2 or Severe Acute Respiratory Syndrome Corona Virus 2).ti,ab,kf,nm,ot,ox,rx,px.
((new or novel or "19" or "2019" or Wuhan or Hubei or China or Chinese) adj3 (coronavirus* or corona virus* or betacoronavirus* or CoV or HCoV)).ti,ab,kf,ot.
((coronavirus* or corona virus* or betacoronavirus*) adj3 (pandemic* or epidemic* or outbreak* or crisis*)).ti,ab,kf,ot.
((Wuhan or Hubei) adj5 pneumonia).ti,ab,kf,ot.
or/1-5
Hyperbaric Oxygenation/
(Hyperbaric adj5 Oxygen*).ti,ab,kf.
7 or 8 14951
6 and 9

Embase

coronavirus/ or betacoronavirus/ or coronavirus infections/
(nCoV* or 2019nCoV or 19nCoV or COVID19* or COVID-19* or COVID or SARS-COV-2 or SARSCOV-2 or SARSCOV2 or Severe Acute Respiratory Syndrome Coronavirus 2 or Severe Acute Respiratory Syndrome Corona Virus 2).ti,ab,kw,hw,fx,ot.
((new or novel or "19" or "2019" or Wuhan or Hubei or China or Chinese) adj3 (coronavirus* or corona virus* or betacoronavirus* or CoV or HCoV)).ti,ab,kw,ot.
((coronavirus* or corona virus* or betacoronavirus*) adj3 (pandemic* or epidemic* or outbreak* or crisis*)).ti,ab,kw,ot.
((Wuhan or Hubei) adj5 pneumonia).ti,ab,kw,ot.
or/1-5
hyperbaric oxygen therapy/
(hyperbaric adj5 (medicine or oxygen*)).ti,ab,kw.
(high adj3 (tension or pressure) adj3 oxygen).ti,ab,ot,kw.
or/7-9
6 and 10

Scopus

( TITLE-ABS-KEY ( ( ncov* OR 2019ncov OR 19ncov OR covid19* OR covid-19* OR covid OR sars-cov-2 OR sarscov-2 OR sarscov2 OR severe AND acute AND respiratory AND syndrome AND coronavirus 2 OR severe AND acute AND respiratory AND syndrome AND corona AND virus 2 ) ) AND TITLE-ABS-KEY ( hyperbaric AND oxygen* ) OR TITLE-ABS-KEY ( hyberbaric AND medicine ) )

Appendix 2. Patient characteristics for all studies included in this living systematic review; BMI – body mass index; COPD – chronic obstructive pulmonary disease; HBOT – hyperbaric oxygen treatment

First author, year

Patients

female

n (%)

Age (years)

Mean (SD) or range)

Ethnicity

n (%)

Comorbidities,

n (%)

Cannellotto, 2021

14 (35%)

55.2 (9.2)

Obesity 14 (35%)

Hypertension 13 (32.5%)

Diabetes 7 (17.5%)

COPD 2 (5%)

Asthma 2 (5%)

Chronic kidney disease 2 (5%)

Cancer 2 (5%)

Chen, 2020

1 (20%)

24−69 (mean 47)

Chinese: 5 (100%)

Hypertension: 1 (20%)

Cardiovascular disease: 1 (20%)

Gorenstein, 2020

7 (8.8%)

HBOT:

Median = 58

Range = 30−79

Control:

Median = 62

Range = 24−80

White: 23 (28.9%)

Black: 13 (16.3%)

Asian: 7 (8.8%)

Other: 37 (46.3%)

Hypertension: 40 (50%)

Diabetes: 24 (30%)

Cardiovascular disease: 8 (10%)

COPD: 4 (5%)

Guo, 2020

57 and 64

Chinese: 2 (100%)

Hypertension: 1 (50%)

Diabetes: 1 (50%)

Cardiovascular disease: 1 (50%)

Petrikov, 2021

44 (50.6%)

Control:

64.5 (12.7)

HBOT:

58.8 (13.6)

Thibodeaux, 2020

4 (80%)

39−63

(median 48)

White: 2 (40%)

Black: 3 (60%)

BMI (Obese): 4(80%)

Hypertension: 4(80%)

Diabetes: 3 (60%)

Zhang, 2020

56−67

Chinese: 4 (100%)

Zhong, 2020

Chinese

Cardiovascular disease

Chronic obstructive pulmonary disease

Appendix 3. Study characteristics for all studies included in living systematic review; ARDS – acute respiratory distress syndrome; atm abs – atmospheres absolute; CT – computed tomography; FiO₂ – inspired fraction of oxygen; HBOT – hyperbaric oxygen treatment; ICU – intensive care unit; NR – not reported; PaO₂ – arterial pressure of oxygen; PCR – polymerase chain reaction; SpO₂ – peripheral oxygen saturation

First author, year, country	Study design, n patients, single or multi-centre	Inclusion criteria	Exclusion criteria	Intervention planned (type of chamber, pressure, duration, frequency)	Control
Cannellotto, 2021, Argentina	Randomised controlled trial, n = 40 (20 per group), multicentre (n = 3)	“Patients in emergency department or ICU, > 18 years of age, with confirmed diagnosis of COVID-19 by PCR or nasal swab, with pneumonia with oxygen dependence and no previous hospitalisation within the last six months.”	“Patients unable to give consent, were pregnant or breast feeding, required mechanical ventilation, were unable to maintain prolonged sitting position (≥ 2 h) or had contraindications for HBOT.”	Monoplace, 1.45 atm abs, 90 minutes, ≥ 5, daily	Standard of care
Chen, 2020, China	Case series, n = 5, single	Progressive hypoxaemia, moderate-severe ARDS, laboratory confirmed COVID-19	NR	Multiplace 2.0 atm abs for one patient, 1.6 atm abs for four patients, 60-90 min, mean five HBOT sessions (range: 3−8)	None
Gorenstein, 2020, United States	Cohort study with propensity score matching, n = 80 (20 intervention; 60 control), single	Age ≥ 18, laboratory confirmed COVID-19, SaO₂ < 93% on room air	Pregnancy, pneumothorax, positive troponin	Monoplace, 2.0 atm abs, 90 min, once daily for five days	Identified among COVID-19 patients treated contemporaneously at the same hospital using propensity score matching with a 3:1 ratio.
Guo, 2020, China	Case reports, n = 2, single	Laboratory confirmed COVID-19, and one of the following criteria: shortness of breath; respiratory rate ≥ 30 breaths/minute; finger pulse oxygen saturation (SpO₂) ≤ 93% at rest state; and P/F ratio (PaO₂/FiO₂, where PaO₂ is the arterial oxygen partial pressure and FiO₂ is the percentage of inhaled oxygen concentration) ≤ 300 mmHg	Pneumothorax, bullae or other absolute contraindication to HBOT	Monoplace, 1.5 atm abs, 60 min, once daily for seven days	None
Petrikov, 2021, Russia	Randomised controlled trial, n = 87 (57 HBOT group, 30 control group), single HBOT group divided into two additional subgroups based on start of HBOT after admission: Group 1 (≤ 7 days): n = 28 Group 2 (> 7 days): n = 24	Patient admitted to hospital and clinical diagnosis of COVID-19	NR	Monoplace, 1.4−1.6 atm abs, 40 minutes, NR, NR	Standard of care
Thibodeaux, 2020, United States	Retrospective case series, n = 5, single	Impending respiratory failure, imminent intubation	NR	Type of chamber not reported; 2.0 atm abs, 90 min; Average five (range 1−6)	None
Zhang, 2020, China	Prospective case series, n = 4, single	Progressive dyspnoea, lung CT lesion area > 30%, SpO₂ < 90% on air, clear consciousness, able to communicate in words and language, minimal education level of junior high	Pneumothorax, pulmonary bullae	Portable monoplace chamber; 1.5 atm abs, 90 min, once daily for seven days	None
Zhong, 2020, China	Case report, n = 1, single	Critically ill with pneumonia and tracheal intubation, laboratory confirmed positive for COVID-19 from tracheal aspirate	NR	Multiplace chamber, 1.6−1.8 atm abs for 70−100 min, four sessions	None

Appendix 4. Risk of bias and GRADE assessments

New studies includes in the updated review

First author, year	Risk of bias arising from the randomisation process	Risk of bias due to deviations from the intended interventions	Risk of bias due to missing outcome data	Risk of bias in measurement of the outcome	Risk of bias in selection of the reported result	Overall risk of bias	GRADE assessment (certainty of evidence)
Cannellotto, 2021	Low risk	Some concerns	Low risk	Low risk	Low risk	Some concerns	High

Petrikov, 2021	Some concerns	High risk	Low risk	Some concerns	Some concerns	High risk	Moderate

5.2 Initial review

Newcastle Ottawa Scale Risk of Bias Assessment

Selection

Comparability

Outcome/

exposure

Overall quality assessment

GRADE assessment (certainty of evidence)

Gorenstein, 2020

****

***

Good

Moderate

*risk of bias assessment was not performed in the original review for the 5 case studies.

Appendix 5. Results of eight studies included in this living systematic review; CT – computed tomography; HBOT – hyperbaric oxygen treatment; HFOT − high-flow oxygen therapy; NILV − non-invasive lung ventilation; NEWS2 −National Early Warning Score; NR – not reported; OR – odds ratio; SD – standard deviation; PaO₂ – arterial pressure of oxygen; SpO₂ – peripheral oxygen saturation

First author, year	n patients	Timing of outcome measurement	Number of HBOT sessions received	Results
First author, year	n patients	Timing of outcome measurement	Number of HBOT sessions received	Clinical outcomes	Biological outcomes	Imaging outcomes	Safety outcomes
Cannellotto, 2021	40 (20 per group)	Within 30 days after admission	Mean 6.2 (SD 1.2)	Primary outcome: Proportion of patients that recovered from hypoxaemia (SpO₂ ≥ 93%): Control group: Day 3: 1 (8%) Day 5: 8 (40%) Day 10: 13 (65%) Day 15: 16 (80%) HBOT group: Day 3: 11 (55%) Day 5: 19 (95%) Day 10: 20 (100%) Day 15: 20 (100%) OR for recovery from hypoxaemia (SpO₂ ≥93%) for HBOT vs. control group: Day 3: 23.2 (95% CI 1.6 to 329.6; P = 0.001) Day 5: 28.5 (95% CI 1.8 to 447.4; P < 0.001) Co-primary outcome: Median time to recovery (P < 0.01): HBOT: median (IQR) 3 (1.0–4.5) days Control: 9 (5.5–12.5) days Secondary outcomes: Acute respiratory distress (P = 0.61): Control group: 3 (15%) HBOT group: 3 (15%) Mechanical ventilation (P = 0.61): Control group: 3 (15%) HBOT group: 1 (5%) Death (P = 1.0): Control group: 1 (5%) HBOT group: 1 (5%)	NR	NR	Ear discomfort (n = 1)
Chen, 2020	5	Assessed before and after course of HBOT (average of five sessions per patient)	5 (mean) 3−8 (range)	Oxygen saturation (SpO₂) increased mean (SD) 73 (6)% to 94 (2)%, P < 0.05)	PaO₂ and SaO₂ increased: numbers NR, (P < 0.05) Lymphocyte count increased, mean (SD): 0.61 (0.35) x 10⁹·L^-1 to 1.09 (0.24) x 10⁹·L^-1(P < 0.05) C-reactive protein levels decreased: numbers NR D-dimer decreased: numbers NR (P < 0.05) Fibrinogen decreased: numbers NR (P < 0.05)	CT improved (qualitatively)	NR
Gorenstein, 2020	80 (20 HBOT; 60 propensity matched controls)	Assessed at end of study (Patients received up to 5 daily treatments while oxygen still required)	5	In-hospital mortality (primary outcome): HBOT: two patients (10%) died (none remain hospitalised). Controls: 13 (22%) died (3 [5%] remained hospitalised at end of study period) Need for mechanical ventilation (secondary outcome): HBOT: two (10%) patients intubated Controls: 18 (30%) intubated Adjusted sub-distribution hazard ratios: Inpatient mortality = 0.37 (P = 0.14); Mechanical ventilation = 0.26 (P = 0.046) Secondary outcome of days on mechanical ventilation was not analysed	NR	NR	Claustrophobia, ear pain (n NR) Hypoxic arrest in unclear circumstances after patient transfer (n = 1)
Guo, 2020	2	Assessed over 7-day course of HBOT	7	Dyspnoea eliminated immediately after the first HBOT session Respiratory rate decreased daily; no need for mechanical ventilation SpO₂ > 93% after the first session and continued to improve	D-dimers reduced Lymphocyte counts improved Arterial blood gas indices (PaO₂, P/F ratio, bicarbonate, lactate) improved Liver function improved Numbers NR for any outcomes	On CT pulmonary inflammation gradually improved	No adverse effects
Petrikov, 2021	87; 57 randomised to HBOT, 30 randomised to control HBOT group divided into two additional subgroups based on start of HBOT after admission: Group 1 (≤ 7 days): n = 28 Group 2 (> 7 days): n = 24	Assessed over course of HBOT (7 sessions)	Mean (SD) Subgroup 1: 5.1(2.5) Subgroup 2: 4.2 (2.0)	SpO₂ increased day 14 from baseline and compared to control P < 0.05, mean (SD) Control group: Day 1: 92.6 (4.2) Day 3: 90.4 (4.9) Day 7: 91.3 (4.8) Day 14: 93.4 (4.7) HBOT subgroup 1: Day 1: 91.9 (5.3) Day 3: 91.4 (3.8) Day 7: 92.1 (3.9) Day 14: 96.1 (2.8) NEWS2 decreased from baseline in the HBOT group and compared to control group (P < 0.05), mean (SD) Control group: Day 4: 4.7 (2.3) points Day 10: 4.0 (2.3) points HBOT subgroup 1: Before:4.4 (2.2) points After: 1.2 (1.7) points Ordinal scale for clinical improvement score decreased (P < 0.05) from baseline in the HBOT group and compared to the control group, mean (SD) Control group: Day 4: 4.1 (0.7) points Day 10: 3.9 (0.8) points HBOT subgroup 1: Before: 4.2 (0.7) points After: 3.0 (0.6) points Respiratory support, defined as oxygen through the nasal cannula or face mask with a flow of 3–6 l·min^-1, in severe cases using HFOT or NILV, P-value NR: Control group: Day 4: 10 (33.3%) Day 10: 8 (26.7%) HBOT subgroup 1: Before: 9 (32.1%) After: 0 (0%) Oxygen flow rate 3−6 l·min^-1, P-value NR: Control group: Day 4: 14 (46.7%) Day 10: 13 (43.3%) HBOT subgroup 1: Before: 15 (53.6%) After: 5 (17.9%) No respiratory support required, P-value NR: Control group: Day 4: 6 (20%) Day 10: 9 (30%) HBOT subgroup 1: Before: 4 (14.3%) After: 23 (82.1%)	Blood malondialdehyde decreased (HBOT group), mean (SD) from 4.34 (0.52) μmol·l^-1 prior to HBOT to 3.98 (0.48) μmol·l^-1 at day 7 Total antioxidant activity decreased (HBOT group), mean (SD) from 1.26 (0.28) to 1.21 (0.05) mmol·l^-1 Open circuit potential of platinum electrode decreased (HBOT group) mean (SD) from -22.78 (24.58) mV to 30.45 (15.32) mV Apoptotic lymphocytes: No significant change	NR	Claustrophobia (n = 1) Pain in the ears (n = 4)
Thibodeaux, 2020	5	Assessed before and after HBOT course	Mean 5 Range 1−6	SpO₂ improved, mean (SD): 96 (3)% to 96 (1)% All patients recovered without need for mechanical ventilation Respiratory rate decreased, mean (SD): 35.4 (8.5) to 28.0 (7.6)	Inflammatory markers decreased (reported for one patient, NR for four patients)	NR	No adverse effects
Zhang, 2020	4	Assessed before and after HBOT course	7	SpO₂ increased, mean (SD): 86 (5)% to 92 (4)% (P = 0.042) 6-minute walking distance (m) improved: 272 (62) to 346 (43) (P = 0.05) Shortness of breath improved	Blood gas analysis indexes improved	CT resolution of inflammation to different degrees	NR
Zhong, 2020	1	Assessed before and after HBOT course	4	Oxygenation improved Patient was eventually extubated	CO₂ reduced, coagulation normalised, renal function improved	NR	NR

Super User

Category: Information

10 May 2022

1514

A prospective single-blind randomised clinical trial comparing two treatment tables for the initial management of mild decompression sickness

Neil Banham, Philippa Hawkings, Ian Gawthrope

Appendix 1 - Vann RD, Denoble PJ, Uguccioni DM, Freiberger JJ, Perkins R, Reed W et al. Report on decompression illness, diving fatalities and Project Dive Exploration: DAN’s Annual Review. DAN’s Annual Review of Recreational Scuba Injuries and Diving Fatalities. 2002 Edition. Durham, NC: Divers Alert Network; 2002:35.

Arbitrary severity classification	Group symptom (alphabetical order)	Reported signs or symptoms
1. Serious neurology	Bladder or bowel	bladder or bowel dysfunction
	Coordination	ataxia, ↓coordination, gait
	Consciousness	↓consciousness
	Hearing	↓hearing, tinnitus
	Mental status	dysphasia, ↓memory, mental status, mood, orientation, personality
	Reflexes	↓ or ↑reflexes
	Strength	hemiparesis, motor weakness, muscle weakness, paraplegia
	Vision	↓vision
2. Cardiopulmonary	Cardiovascular	arrhythmia, cardiovascular, palpitations
2. Cardiopulmonary	Pulmonary	cough, haemoptysis, respiratory distress, shortness of breath, voice change
3. Mild neurology	Paresthesia	numbness, numbness & tingling, paresthesia, ↓sensation, tingling, twitching
4. Pain	Pain	ache, cramps, discomfort, joint pain, pain, pressure, sharp pain, spasm, stiffness
5. Lymphatic/skin	Lymphatic	swelling
5. Lymphatic/skin	Skin	burning of skin, itching, marbling, rash
6. Constitutional/ non-specific	Dizziness	dizziness, dizziness/vertigo
	Fatigue	fatigue
	Headache	headache
	Nausea	nausea, nausea & vomiting, vomiting
	Other	chills, diaphoresis, heaviness, heavy head, light-headedness, malaise, restlessness
	Vertigo	vertigo

Super User

Category: Information

10 May 2022

12881

Decompression illness in Finnish technical divers: a follow-up study on incidence and self-treatment

Laura J Tuominen, Sofia Sokolowski, Richard V Lundell, Anne K Räisänen-Sokolowski

Questionnaire for demographic data

1. Research ID

2. Age

3. Height

4. Weight

5. Do you smoke or use other nicotine products?

6. Have you had a hyperbaric (HBO) treated decompression illness at some point in your diving career?

7. What is your diving experience in years?

8. What is your number of dives altogether?

9. What has been the deepest dive in your diving career?

10. Main diving system?

11. Highest certification for cave/mine?

Cavern
Intro-to-cave
Full cave
Mine 1
Mine 2
Other, what?

12. Highest diving certification?

MOD1
MOD2
MOD3
Rec Trimix
Normoxic Trimix
Full Trimix
Other, what?

13. Are you an active instructor?

This questionnaire was filled out every two months. The first period was 1.7.2020-30.9.2020.

Research ID?
How many dives have you done to depths from 0-20m?
How many dives have you done to depths from 20-40m?
How many dives have you done to depths from 40-60m?
How many dives have you done to depths from 60-80m?
How many dives have you done to depths over 80m?
How deep has the deepest dive been (in meters)?
What is the total dive time after these two months (in minutes)?
Other comments?

Questionnaire for decompression illness (DCI) symptoms

1. Research ID?

2. The date of the event?

3. Diving system used?

4. Maximum depth of the dive (in meters)?

5. Average depth of the dive (in meters)?

6. Dive time (in minutes)?

7. GF, if known?

8. Gas / diluent?

9. Symptoms (you may choose more than one option)

tingling / itching
skin rash, heat sensation, swelling
joint pain
abnormal pain in muscles
fatigue
headache
vertigo
numbness
shortness of breath / heavy breathing
visual disturbances
hearing impairment
bladder symptoms
verbal disturbances
other?

10. Possible contributing factors (you may choose more than one option)

dehydration
ascent rate
shortened decos
cold or wet
tiredness
ceiling violation
multiple dives a day
multiple days of diving (2-3)
multiple days of diving (> 4)
nothing
Other?

11. When did the symptoms start?

12. What did you do after noticing DCI symptoms? You may choose more than one option.

nothing
used 100% normobaric oxygen
hydration orally
rest
in water recompression
recompression in chamber
other?

13. What was the outcome after possible treatment?

symptoms gone
symptoms decreased
symptoms remained

14. Additional comments

Super User

Category: Information

26 April 2022

1302

Appendix 1: Initial Delphi Survey (English)

Initial Delphi Survey

(First page)

Which scenarios in hyperbaric oxygen therapy are relevant to simulation-based education?

Despite the broad implementation of simulation-based education in the majority of healthcare areas, simulation has yet to be used in the context of hyperbaric medicine education.

We are looking for healthcare providers involved in the provision of hyperbaric oxygen therapy (hyperbaric physicians and allied health providers, e.g. Respiratory Therapists or Registered Nurses) to help by completing this online survey.

Learn more about how you can help us develop a simulation-based education curriculum for hyperbaric oxygen therapy to ultimately improve practice and patient safety, and get a chance to win a $200 (CAD) Visa gift card.

(Second page)

Your participation in this Delphi survey will help us to determine which scenarios in hyperbaric oxygen therapy should be included in the development of a simulation-based education curriculum.

This questionnaire is the first round of the survey. The number of rounds will be determined based on response agreement, but will most likely involve a total of 2. If you participate in the first round of the survey, you will be asked to participate in all subsequent rounds.

It will take approximately 15 minutes to complete each round. Your participation in this study is completely voluntary. You can choose not to participate, or decide to participate now and then change your mind without loss of any benefit that you are otherwise entitled to. Participation and your individual responses will remain confidential.

If you complete all rounds, you can choose to be entered into a draw for a $200 (CAD) Visa gift card.

By completing this survey, your consent to participate in this study is implied.

(Third page)

INSTRUCTIONS:

Rank the scenarios provided according to how relevant you believe they are for inclusion in the simulation-based curriculum.
Answer all questions with a ranking number.
A space is also provided for you to include additional comments.

We will also ask you to provide some brief demographic information and to forward the survey link to your colleagues (optional).

Once we have received responses from all participants, we will collate and summarize the findings and develop the second questionnaire. You should receive this within 60 days.

(Fourth page)

Please select your profession:

Physician
Registered Nurse
Respiratory Therapist
Other (Specify): ___________

Are you a trainee?

Please indicate the country in which you are currently practicing: (***DROP DOWN MENU***)

Canada
United States
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas, The
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burma
Burundi
Cambodia
Cameroon
Cabo Verde
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curacao
Cyprus
Czechia
Denmark
Djibouti
Dominica
Dominican Republic
East Timor (see Timor-Leste)
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia, The
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
North Korea
Norway
Oman
Pakistan
Palau
Palestinian Territories
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe

How many post-training years of experience do you have? _____

(Fifth page)

Please rate each of the scenarios below in terms of how relevant they are for inclusion in a simulation-based education curriculum for hyperbaric oxygen therapy.

Please add AND rank any additional scenarios you feel are missing.

1 indicates least relevant/least likely to benefit from simulation practice and 5 indicates most relevant/most likely to benefit from simulation practice.

Scenarios should be rated according to the following criteria:

The clinical scenario should be either high stakes (i.e. if an optimal course of actions is not implemented in a timely manner, the patient may suffer severe consequences) or lower stakes but with a high potential for becoming critical if the optimal actions are not followed (e.g. intubated and ventilated child who undergoes HBOT);
Training on this clinical scenario is best done with the use of a full-body mannequin versus other potential educational modalities.

Clinical scenario	Rating (1=least relevant; 5=most relevant)	*IF UNABLE TO JUDGE: Please explain why you indicated “unable to judge”*
Cardiac arrest in the hyperbaric chamber.	1 2 3 4 5 Unable to judge
Seizure in the chamber.	1 2 3 4 5 Unable to judge
Fire in the chamber.	1 2 3 4 5 Unable to judge
Pneumothorax in the chamber.	1 2 3 4 5 Unable to judge
Intubated and ventilated patient in the chamber.	1 2 3 4 5 Unable to judge
Newborn patient in the chamber.	1 2 3 4 5 Unable to judge
Panic attack due to claustrophobia in the chamber.	1 2 3 4 5 Unable to judge
Chest pain in the chamber	1 2 3 4 5 Unable to judge
Shortness of breath in the chamber	1 2 3 4 5 Unable to judge

If you have any further comments, please list them below:

PLEASE FORWARD THIS LINK TO YOUR COLLEAGUES: (survey link)

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