Top Ten Things You Need to Know About HBOT #5: HBOT Is Mostly for Emergency Indications

In the sixth article in a series, this review article will discuss and give updates on top ten things we need to know about hyperbaric oxygen therapy (HBOT).

 
5

Did you know that the majority of the indications approved for HBO therapy are emergency indications?

HBOT is most commonly known by health care professionals in the setting of wound healing, but did you know that the majority of the Food and Drug Administration (FDA)-approved indications for HBOT are emergency indications? As of July 2021, there are 13 approved indications for HBOT. These indications include emergencies like air emboli, crush injuries, decompression sickness, central retinal artery occlusion, idiopathic sensory neural hearing loss, iatrogenic gas embolism, gas gangrene, necrotizing fasciitis, and carbon monoxide poisoning.   
 
In the past two decades, the number of HBOT treatment centers has increased dramatically. It is estimated that at the moment in the USA, there are about 1,250 HBOT centers with at least one HBOT chamber, according to Medicare billing records. However, despite most of the indications being emergency-related, the number of HBOT centers providing emergency indications has decreased and it is estimated that fewer than 10% of the HBOT centers in the whole country provide emergency services. This is a stark contrast to what HBOT access was two decades ago.
 
In August 2020, the Undersea and Hyperbaric Medical Society (UHMS) and the American College of Hyperbaric Medicine (ACHM) put out an open letter calling authorities to action and bringing attention to the potential crisis related to the decreasing availability of emergent access to HBOT.¹ In this letter, they describe obstacles such as funding, staffing, and medicolegal liability as barriers to providing emergent HBOT.
 
As we are all too familiar with, often the centers/institutions that still provide emergent HBOT end up with the financial burden of providing this access. In addition to this, the UHMS points out how the lack of access to emergent HBOT can be detrimental to our patients leading them to permanent disability or death.
 
Denise Nemeth is a second-year medical student at the University of the Incarnate Word School of Osteopathic Medicine in San Antonio, TX. Formerly a general and vascular surgery PA in a rural community, Ms. Nemeth aspires to become a general surgeon. She is certified wound specialist with the American Board of Wound Management. Her interests include rural health, wound healing, colorectal surgery, and minimally invasive surgery.
 
Jayesh B. Shah is Immediate Past president of the American College of Hyperbaric Medicine and serves as medical director for two wound centers based in San Antonio, TX. In addition, he is president of South Texas Wound Associates, San Antonio. He is also the past president of both the American Association of Physicians of Indian Origin and the Bexar County Medical Society and Current of Board of Trustees of Texas Medical Association.   

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References
 
1.    Undersea and Hyperbaric Medicine Society. Emergency hyperbaric oxygen therapy—a service in need of resuscitation: an open letter. Published 2020.
2.    Huang ET. Hyperbaric medicine today: an historically noble discipline challenged by loss of critical access and overutilization—an introduction to invited commentary. Undersea Hyperb Med. 2017.; 44(1):1–3.
3.    Moon RE, et al. Hyperbaric Oxygen Therapy Indications, 14th Edition, 2021.