Purpose

The purpose of this document is to describe the training and competencies necessary to be a certified hyperbaric technologist without attempting to specify the way in which these competences should be achieved. CHT is not an entry-level qualification, rather an additional certification beyond the applicant’s qualifying profession (refer to vocation list). The CHT should maintain competencies in the licensure or certification or other education requirements in the original vocation that allowed them candidacy.

Qualifying Vocations:

1. Respiratory Therapist
2. Diver Medic
3. Physician Assistant
4. Corpsman
5. Medical Services Specialist
6. EMT
7. Paramedic
8. Registered Nurse or LPN
9. Nurse Practitioner
10. Physician
11. Life Support Technician
12. Certified Nurse Aide
13. Medical Assistant
14. Physiologist 
15. Researcher (medical)

Legal Status
This document has no legal status.

Criminal Background Check (paid for by applicant) is required for all patient care providers in hospital settings.

Training and Competence
Be at least 18 years of age with a high school diploma or equivalent.
The CHT must have completed a National Board of Diving and Hyperbaric Medical Technology (NBDHMT) approved hyperbaric medicine introductory course.
The CHT must maintain the training/education requirements of their original qualifying vocation.

As part of the clinical internship, the CHT must complete the Transcutaneous Oxygen Monitoring (TCOM) Module.
The CHT must meet a minimum clinical internship of 480 hours of undersea, hyperbaric medicine or aviation medicine technology.
Military personnel must complete 1000 clinical hours in addition to required, approved training received in the military (unless 480 hours of approved clinical internship can be completed at an approved facility)

Maintain a minimum 12 continuing education credits every two years with at least six of those specific to undersea, hyperbaric, or aviation medicine.

Recertification
The employer, administrator or medical director must provide a letter of recommendation and verification of 100 hours minimum of continued experience in undersea, hyperbaric or aviation medicine.

Competency Standards
This document describes the minimum general requirements and competency levels required of a CHT.

1. Understand:
   
   
1. Physics related to pressure exposures
2. Basic calculations for the conversion of common units used in diving and hyperbaric practice (examples include feet/meters, psi/bar/Pa, Kg/pound etc.)
3. Basic physical units used in diving and hyperbaric practice
4. Boyle’s Law (calculating air volumes and air consumption)
5. Dalton’s Law (partial pressure of gases at various depths)
6. Charles’ Law (the relationship between pressure changes and temperature changes)
7. Henry’s Law (the effect of partial pressures on the solubility of various gases in liquids and their corresponding effects on decompression)
8. The principles of heat transfer by conduction, convection and radiation
9. Mechanism of Action in all approved hyperbaric oxygen indications
10. Direct effects of pressure change; how and where barotrauma occurs
1. Ear
2. Sinus
3. Dental
4. Pulmonary
11. Signs and symptoms of decompression illness (DCI)
12. Relevant aspects of anatomy and physiology pertaining to these systems:
    1. Musculoskeletal
    2. Neurological
    3. Integumentary
    4. Cardiovascular
    5. Respiratory
    6. Endocrine
    7. Gastrointestinal
    8. Hematologic

2. Possess the capability to provide clinical support and assist in the prevention and/or management of pressure related problems:

1. Squeeze and other barotraumas
2. Carbon Dioxide (CO2) retention
3. Carbon Monoxide (CO) poisoning
4. Hyperbaric chamber contamination
5. Built in breathing system (BIBS) contamination
6. Oxygen (O2) toxicity
7. Anoxic and hypoxic events
8. Nitrogen (N2) narcosis
9. DCI
10. Hypothermic and hyperthermic events

B. Gas Systems

1.  Understand and/or conduct procedures for chamber operations and life support systems

1. Test for purity of gases
2. Elemental gas schematics and their interactions when mixed
3. Mathematical calculations of gas usage

2.  The principles and use of gas analyzers

1. Methods of identifying gas impurities
2. The importance of oxygen purity in a gas delivery system
3. Gas line filtration
4. Calibrate gas analyzers             
   1. Delivery of multiple gases during hypo/hyperbaric operations
   2. Monitor the chamber for depth, temperature and humidity using available types of equipment
   3. Calibrate analyzing equipment
5. Rationale for gas stratification and its prevention
6. Maintain a legible and accurate record of all aspects of a hyperbaric system
7. Maintain a gas status board showing gas reserves and mixtures

C. Chamber Operations and Environment

            Understand:

1. Procedures for operating a hypo/hyperbaric chamber
2. Inside attendants’ responsibilities in a hypo/hyperbaric chamber
3. The conduct of a post-exposure therapeutic recompression
4. The checks and user maintenance needed after using a hypo/hyperbaric chamber 
5. Pre and post dive checks of a hypo/hyperbaric chamber complex using specific checklists
6. The operation and design of medical locks, including various types of interlocks and safety devices
7. The principles of operation of various items of equipment used in a typical hyperbaric system, such as compressors, fire suppression systems, oxygen scrubbing and gas reclaim equipment
   The characteristics of and maintenance requirements for acrylic viewports/
8. The monitoring of internal chamber operations
9. The monitoring of internal/external chamber gas quality and gas system quality
10. The operation, function testing and selection of gas supplies for BIBS and overboard dump systems, including routine maintenance and repairs
11. Compression and decompression procedures for multiple indications
12. The construction and purpose of valves, fittings, gauges, regulators, hoses and pipe work
13. How to carry out normal operations, maintenance and basic repairs on gas and fluid systems
14. The differences between various thread forms and rationale
15. The principles of chamber life support systems with priority on pre-operational checklists, monitoring during use, routine maintenance and basic repairs
16. Proper identification of various gas cylinders; mandatory hospital grade gases
17. Proper handling and storage of gas cylinders
18. Emergency preparedness for fire, loss of oxygen, medical complications
19. The use of various types of fire suppression systems including routine maintenance and operational checks
20. The various substances and materials, which are prohibited inside a chamber, such as medical preparations, combustible materials, etc.
21. Operate telephone emergency signals and other communications systems
22. Risks/benefits involved with emergency decompression
23. Appreciate the unique differences between monoplace and multiplace chambers
24. Familiarity with the following regulatory agencies and other related organizations: Food and Drug Administration (FDA), Centers for Medicare and Medicaid Services (CMS), Occupational, Safety and Health Administration (OSHA), Centers for Disease Control and Prevention (CDC), National Fire Protection Association (NFPA), American Society of Mechanical Engineers (ASME), American Society of Mechanical Engineers’ Committee on Pressure Vessels for Human Occupancy (ASME PVHO), Association of Diving Contractors (ADC), Joint Commission for Accreditation of Healthcare Organizations (JCAHO), Undersea and Hyperbaric Medical Society (UHMS)

1. Have a basic understanding in the operation of biomedical devices within the
   department
2. Be able to carry out relevant diagnostic and clinical procedures such as:

1. Ability to report to nurse or physician an accurate medical history
2. Assess patient for pain and document
3. Obtain vital signs, pulse, respiratory rate, body temperature, and blood pressure
4. Observe for changes in neurological status
5. Know when to use appropriate clean or sterile techniques
6. Collection and removal of patient waste products
7. Assist in patient care procedures; dressing changes
8. Basic EKG recognition; set alarm parameters; print and post strip
9. Ability to safely operate all stretchers, gurneys, wheelchairs, beds and other assistive devices
10. Comply with quality control(QC) measures; glucometer
11. Prepare patient for treatment

1. Body positioning of patients
2. All cotton garments or other approved materials only for in chamber
3. EKG placement on patient, as ordered
4. Age specific patient education on fundamentals of HBO treatment; clearing ears
5. Provide comfort measures with approved safety constraints.

3. Generalized Clinical Knowledge

1. Have a basic understanding of the risks, side effects and hazards of certain medications in the hyperbaric chamber.
2. Maintain CPR, ability to establish an open airway
3. Describe the signs, symptoms and treatment of hyper- and hypothermia
4. Describe the effects of gases on the body and their limits under pressure
5. Describe the effects of pressure on the body and the principles of decompression and therapeutic procedures
6. Proper body mechanics to protect self from injury
7. Communicates with all levels of hyperbaric medical team
8. Reinforce age-specific teaching
9. Perform Transcutaneous Oximetry (TCOM), as ordered
10. Basic medical terminology
11. Proper use and application of restraints when ordered by physician; assess circulation
12. Patient privacy and confidentiality; observe HIPPA requirements
13. Medical record keeping; secure

4. Infection control measures

1. Universal precautions
2. Use of approved disinfectants for chamber and equipment; recognizing the risks associated with off gassing of chemicals in the chamber
3. Hand washing
4. Personal protective equipment (PPE)