Education of nurses, operatorsand techniciansin hyperbaric facilities in Europe
EBAss/ECHM Resources manual

Brussels – September 2008

Document prepared by

European Baromedical Association for Nurses, Operators and Technicians
EBAss is an international, non profit association
Registered office: 9, Sainte Anne – B 7880 FLOBECQ – BELGIUM
Website: www.EBASS.org
E-Mail: secretary@ebass.org
Document approved by

European Committee for Hyperbaric Medicine
E-Mail: office@echm.org

Website: www.ECHM.org

Education of nurses, operators and technicians in hyperbaric facilities in Europe
Resources manual: a document of EBAss/ECHM
Version 20081

Table of contents

Purpose.................................................................................3
List of authors: ............................................................................. 3

1. Responsibilities .....................................................................4
Operators.................................................................................... 4
Nurses ....................................................................................... 4
Nurses intensive care....................................................................... 5
Attendants NOT nurses: ................................................................... 5

2. Entry levels ........................................................................6
3. The modules of education .........................................................9
3.1 Common Module for Operators and hyperbaric nurses (attendant) ................ 9
3.2 Specific Module for Chamber operator..............................................11
3.3 Specific Module for Hyperbaric Nurses (Attendant)...............................12
3.4 Specific Module for Hyperbaric Nurses in Intensive Care (attendant) ...........14
3.5 Module for hyperbaric attendant (Not Nurse) .....................................15

4. Level of Knowledge .............................................................. 16
5. Resources manuals ............................................................... 17
6. Levels of lecturer’s competence ................................................ 17
7. Examination of the candidates.................................................. 17
Annex: Principles of the Modules .................................................. 18

Education of nurses, operators and technicians in hyperbaric facilities in Europe
Resources manual: a document of EBAss/ECHM
Version 20082

Purpose
The purpose of this document is to describe the training, based on the ECHM
recommendations, of nurses, operators and technicians working in a hyperbaric
facility in Europe.
This document is intended to be a reference document for European countries
for guidelines, regulations and standards in hyperbaric medicine.
This document was written by the members of the Education Committee of theEuropean Baromedical Association for nurses, operators and technicians(EBAss).
This document was approved by the European Committee for Hyperbaric Medicine (ECHM) on….
List of authors:

President of Education Committee:
Mc Kenna, Steve (London – UK)
Atkey, Peter (Plymouth – UK)
Campanaro, Valeria (Roma – Italy)
Chandrinou, Angeliki (Athens – Greece)
Damiens, Didier (Lille – France)
Geels, Judith (Amsterdam – The Netherlands)
Houman, Rob (Brussels – Belgium)
Kanstinger, Andreas (Murnau – Germany)
Kelner, Bert (Amsterdam – The Netherlands)
Ruggiu, Alberto (Cagliari – Italy)
Salarbux, Sheida (Amsterdam – The Netherlands)
Tzavellas, Damienos (Athens – Greece)
Van der Tol, Max (Amsterdam – The Netherlands)

Education of nurses, operators and technicians in hyperbaric facilities in Europe
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1. Responsibilities
Ref: ECHM
Operators- Operation of the internal and external devices of the Chamber.
- Control and operation of the mechanisms for compression and decompression, and for delivering gas mixtures and oxygen.
- Control and application of the safety regulations concerning preventionof fire, and oxygen toxicity.
- Calculation, application and control of compression and decompression
schedules for all chamber occupants, applying decompression stops, whennecessary.
- Be available for intervention inside the Chamber under pressure, in order
to control or check the correct operation of determined parts of the circuits or devices.
- Adaptation and checking of the medical instruments carried by the patients before being introduced into the Chamber, in order to ensure theircorrect operation, and to avoid dangerous or undesirable effects.
- Control and checking of the operation of auxiliary facilities to the Chamber: air-compressors, sources of compressed air or medical gases, gas/air
reserves, pneumatic circuits, control systems etc.
- Maintenance of the facility. Small repair jobs or technical interventions
due to problems which occasionally might occur, and which do not require
the intervention of highly specialised technical staff.
- Safe handling of technical emergency situations.
- Check the calibration of technical equipment relating to the hyperbaric
facility.
- Steering, Controlling and documentation of the HBO-Treatment according to prescribed procedure.
- Duties in emergency situations (locking in and out of personnel).
- Adherence to national law of the appropriate member state.

Nurses- Nursing measures belonging to the common pathologies of the Hyperbaric therapeutics to be applied to the patients in a hyperbaric chamber.
- Nursing assistance of patients inside the hyperbaric chamber, taking
special care of the specific conditions of the hyperbaric environment.
- Where possible adaptation of conventional medical techniques and specific treatments of each illness to the hyperbaric environment, so that
Education of nurses, operators and technicians in hyperbaric facilities in Europe
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other treatments the patient is habitually receiving will not need to be interrupted while in the chamber.
- In some cases, operating the external controls of a Monoplace Hyperbaric chamber according to the compression and decompression schedules
established.
Care of patients including sporadic emergency treatments conducted either inside or outside of HBO chamber.
Nurses intensive care

Nursing assistance of intensive critical care patients during hyperbaric
treatment.

Attendants NOT nurses:- Patient care in non invasive, non-specialised medical activities inside andoutside the chamber.
- Accompanying patients who are receiving treatment inside theMultiplace Chamber, but who do not need special assistance by doctors
and nurses, but only by way of support, control, and to give themconfidence.
- Other activities to develop inside or outside the Chamber, indicated by
the Medical Director or the Nurse.

Education of nurses, operators and technicians in hyperbaric facilities in Europe
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2. Entry levels
Precondition
Common Modulefor
Chamber Operators andhyperbaric nurses (attendant)

Specific Modulefor
Chamber
operator

medically fit forworking under
hyperbaric conditions
Current BasicLife Support
certificate (BLS)or higher (max. 1
year old)

succesfull graduation of „Common
Module …“
medically fit

Competence will be
lost
If the individual
does not progressto the appropriate
specialist module
within 12 month after graduation

Recovering

-

-

-

-

-

Carries out lessthan 10 hyperbaric proceduresor simulations ayear, to operate
under supervisionAnd carries out
less than 10 hyperbaric treatments a yearwith patients, tooperate autonomous.
no participation
on a BLS course
according to theEuropean Resuscitation Council
guidelines
Has not beenworking in a hyperbaric chamber as an operator for morethan 5 years--

Education of nurses, operators and technicians in hyperbaric facilities in Europe
Resources manual: a document of EBAss/ECHM
Version 2008

10 autonomous
steered treatments (under
supervision).
participation on
a BLS course according to theEuropean Resuscitation Council
guidelines
participate in
hyperbaric operator training(hyperbaric operator module
only)

6

Specific Modulefor Hyperbaric
Nurse (Attendant)--

Specific Modulefor Hyperbaric
Nurse in Intensive Care (attendant)

-

-

-

Module for hyperbaric attendant (Not Nurse)--

medically fit forworking under
hyperbaric conditions
nursing
qualification
succesfully
graduation„Common Module…“ except in thecase of recertification-

medically fit forworking under
hyperbaric conditions
registered nurse(RN)
current qualification dependingon the member
states national
legislation foraccompany of intensive care patients
successful
graduation „Module Hyperbaric
Nurse“-medically fit forworking under
hyperbaric conditions
Current BasicLife Support

-

-

-

-

no participation
on a BLS course
according to theEuropean Resuscitation Council
guidelines
Has not beenworking in a hyperbaric chamber as a nurse
for more than 5
years

-

-

participation on
a BLS course according to theEuropean Resuscitation Council
guidelines
participate in
hyperbaric nurse
training (hyperbaric nurse
module only)

If the HNIC
does not havethe required ICU
Nurse experience within theprevious 18
monthsIf the HNIC
does not work as an ICU nurse inside a hyperbaric chamberwithin the previ- ous 18 months
no participation
on an ALS course
according to theEuropean Resuscitation Council
guidelines

current requalification depending on themember statesnational legislation for accompany of intensive
care patients
participate in
HNIC training(HNIC module
only)participation on
an ALS course
according to theEuropean Resuscitation Council
guidelines

attends lessthan 10 hyperbarictreatments ayear inside thechamber withattends at least3 hyperbaric
treatments under supervisionparticipation on
a BLS course ac---

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certificate (BLS)or higher (within
the previous 12
months)-patients
no participation
on a BLS course
according to theEuropean Resuscitation Council
guidelines

Education of nurses, operators and technicians in hyperbaric facilities in Europe
Resources manual: a document of EBAss/ECHM
Version 2008

cording to theEuropean Resuscitation Council
guidelines83. The modules of education
3.1 Common Module for Operators and hyperbaric nurses (attendant)

TheoryOverview
Types of hyperbaric facilities
History of hyperbarics
Hyperbaric facility organisation
Basic Technical overview
Hyperbaric Chamber Technology
Basic chamber technology
HygieneGeneration of compressed Air (low andhigh pressure)
Oxygen supplies, Handling of oxygen
Oxygen Hazards
Electrical supplies, routine and emergency
Physics and Physiology in a hyperbaric
environment
Concepts of pressureBoyle, Dalton, Henry, General Gas Laws:
Pressure/Volume/Temperature etc.
Physio- and Pathophysiology under hyperbaric conditions
Air filled cavities, Pressure equalisation,
Barotrauma, Oxygen toxicity,
Arterial Gas Embolism, Decompression
Illness.
Monitoring
ECG, NBP, TcPCO2/TcPO2, ExO2 & CO2
O2-Monitoring of the Chamber
Relative Humidity
SafetyRisk Assessment and Management
Fire Protection
Prevention by limiting materials enteringchamber
Clothes and other possible fuels
Procedures in case of fireFire extinguishing systems

Level Practical
L1
Hyperbaric chamberand devices
Set up of chamber
Driving chamber pressure increase
L1
Pressure decrease
Patient problems
Locking (personnel andmaterials)
Built in breathing system (BiBS)
Breathing masks andHood-tent
L2
Illumination and communication
Disinfection of chamber and associateddevices
L2
Post treatment shut
down
Patient education
Introduction into general rules
Fitting of the breathL1
ing mask
Behaviour during
chamber treatment
Behaviour in emergency situations
L2
Prohibited items andL3devices
Emergency training
Manual Handling
CPR within a chamber
Fire

Education of nurses, operators and technicians in hyperbaric facilities in Europe
Resources manual: a document of EBAss/ECHM
Version 2008

Level
L2

L2

L2

9

Practice of fire extinguishing
Treatment profiles and decompression
tables for patients and personnel

Total:

16 Hr

L1

Evacuation

Total:

Education of nurses, operators and technicians in hyperbaric facilities in Europe
Resources manual: a document of EBAss/ECHM
Version 2008

16 Hr

10

3.2 Specific Module for Chamber operator

TheoryControl panel
Chamber steering, Chambermonitoring, Computer control,
manual steer , Steering at thepneumatic control panel
Communication, Video monitoring
O2, CO2, Temperature & Relative
Humidity – Monitoring, Patient
Monitoring

Level
L3

Prescriptions and documentation
Awareness of relevant nationallaws
Records of chamber operations
Equipment maintenance records

L3

Clinical-HBO
Therapeutic effects of the HBO
Indications

L2

Complications
Barotrauma, OxygenIntoxication

L3

Practical
Hyperbaric chamber
Daily checking, Starting and tagout
Set up of the hyperbaric chamber
Steering of the chamber (Computer, manual, pneumatic)
Documentation of the HBOtreatment
Take care of an ASA 1 (otherwise healthy) patient, Locking(personnel)

Level
L3

Maintenance of the chamberTechnical failures, (emergency
power supply), Built in breathing
system (BiBS), Technical monitoring, Compressors, Emergency
power supply

L3

Recognition and necessary behaviour in emergency situations
Medical Emergencies (infiltrateand exit of personnel), Obscureoperating states (in case of fire,loss of computer control, loss ofgas supply etc.)

L3

Depending on the job activities
Carrying out of more than 30
hyperbaric treatments
Total:

16 Hr

Total:

Education of nurses, operators and technicians in hyperbaric facilities in Europe
Resources manual: a document of EBAss/ECHM
Version 2008

32 Hr

11

3.3 Specific Module for Hyperbaric Nurses (Attendant)

TheoryLevel

Practical

Level

Effects of the HBO Therapy
and oxygen
Oedema reduction by vasoconstriction‘Squashing’ of gas bubbles in caseof gas embolism, Bacteriostatic
effects (anaerobic organisms),
Competitive displacement of CO
Activation of fibroblast proliferation and collagen synthesis, Activation of osteoclasts
Angio-neogenesis, Activation ofmacrophages

L2

Pre-examination of patients
Suitability for HBOTreatment(ECG, Pulmonary function
etc.)

L3

L3

Physiology of hyperbaric exposure
Functional Anatomy, Breathing,Ears
Decompression, Thermoregulation,
Immersion

L2

Hyperbaric Pathophysiology andcomplications
Theory of decompression
Acute decompression Illness
Toxic effects of oxygen (Acute &Chronic)
Effects of inert gas (HPNS)L2Practice of assisting patients with HBOTreatments
Before treatment
Preparation of the chamber, Checking patients
During treatment
Accompanying of patients,
Caring during chamber
treatment
Specification of medication under hyperbaric conditions (for example - infusion), Drainage (z.B. Redon, Colostomy etc.)
After Treatment
Documentation

Suitability and contraindications
for hyperbaric exposure
Patients , HBO-staff

L3

HBO: Indications by UHMS and
ECHM
Indication in case of emergency,
Approved Uses

L3

Emergency training
L3
Practice of resuscitation in
hyperbaric environment
Infiltrating into the chamber in case of emergency
Leading and assistance of
patients in event of emergency
Behaviour during technicalproblems
Evidence of more than 30
accompanied hyperbaric

Education of nurses, operators and technicians in hyperbaric facilities in Europe
Resources manual: a document of EBAss/ECHM
Version 200812

Caring and leading of patientsduring chamber treatment
Psychology, Professional-client
relations
Nursing & Medical records
Patient Care Plans

L3

Hygiene in hyperbaric facilities
Specialities of disinfection in hyperbaric environment
Requirements of disinfection andcleaning of the chamber fixturesand fittings
MRSA and other infectious diseases in HBO
Self protection

L3

Total:

16 Hrtreatments under supervision (3 monitored attended
treatments during practical training)

Total:

32 Hr

Education of nurses, operators and technicians in hyperbaric facilities in Europe
Resources manual: a document of EBAss/ECHM
Version 200813

3.4 Specific Module for Hyperbaric Nurses in Intensive Care (attendant)

TheoryPhysiology and Pathophysiology under hyperbaric conditions
e.g, Heart-circulation, Lungs, Kidney-function
Extended Monitoring Expiratory
oxygen measurement
e.g, Online Blood gas analysis,
TcPCO2 , IBP, Camino-Sonde
Legal prescription for operation of
medical devices in hyperbaric
chambers
National or EU policies, EN norms,…
Medication
e.g, Effects under hyperbaric conditions, Specific procedures & requirements for giving of medication
under hyperbaric conditions
Drainage systems
e.g, Redon, Bülau, Ventrikel, VAC
etc.
Special requirements for mandatory ventilation in hyperbaric environment
Volume measurement, Oxygen measurement, Open lung manoeuvre
Case examples and discussion of
the examples
e.g, CO Intoxication, Burns andsmoke inhalation injury, Brain abscess, Anaemia
Decompression illness, Emphysema
Total:

8 Hr

Level Practical
L3
Respirators & Ventilators
applicable for use under
hyperbaric conditions
An awareness of the difL3
ferent types and their capabilities
Working practices
at a top level hyperbaric
L2
facility
HygienePreparation specialities ofbreathing devices and acL3
cessories
The infectious patient
Giving critical intensive
care of patients (incl. 5
accompany of intensive
L3
critical care patients)
e.g, Cuff pressure control,
Bülau-Drainage
L3
Intracranial pressure
control, Complications

Level
L3

L2

L3

L3

L2

Total:

Education of nurses, operators and technicians in hyperbaric facilities in Europe
Resources manual: a document of EBAss/ECHM
Version 2008

32 Hr

14

3.5 Module for hyperbaric attendant (Not Nurse)

TheoryHyperbaric Chamber Technology
Physics in a hyperbaric environment
Physio- and Pathophysiology under hyperbaric conditions
SafetyFire Protection
Prevention by limiting materials enteringchamber
Clothes and other possible fuels
Procedures in case of fireFire extinguishing systems
Practice of fire extinguishing

Level
L1
L1
L1

Treatment profiles and decompression
tables for patients and personnel

L1

Total: 8 Hr

L1
L2
L2
L2
L2
L3

Practical
Hyperbaric chamberand devices- Locking (personnel
and material)- Built in breathing
system (BiBS)- Breathing masksand Hood-tent- Illumination andcommunication
Patient education
Chamber hygiene
Emergency training

Level
L3

L2
L2
L2

Total: 8 Hr

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Version 200815

4. Level of Knowledge
Source:CERTIFICATION SCHEME FOR WELDING AND INSPECTION PERSONNELDOKUMENT NO.CSWIP-DIV-9-03
Requirements for General Inspectors of Offshore Facilities
3rd. Edition November 2004
Appendix 1: Examination Syllabus, S. 9
http://www.cswip.com/pdfs/cswipdiv903.pdf"The level of knowledge required by the candidate varies according to topic. To
ensure comprehension by all parties the following terms have been defined todemonstrate an increasing level of knowledge.
DEFINITIONSOUTLINE KNOWLEDGE:
The candidate must be familiar with the subject in outline terms.
He/She should know that the topic exists and what it is applied to. In the context of hyperbaric methods/techniques the candidate would be expected toknow the „what it is, what it does“ but would not be expected to know the finer
points of application of the technique.
KNOWLEDGE:
The candidate must have a working knowledge of the subject and be able to apply it.
DETAILED KNOWLEDGE:
The candidate must have a depth of knowledge sufficient to enable him/her toexercise judgment.“

Level 1 = Outline Knowledge = L 1
Level 2 = Knowledge=L2
Level 3 = Detailed Knowledge = L 3

Education of nurses, operators and technicians in hyperbaric facilities in Europe
Resources manual: a document of EBAss/ECHM
Version 200816

5. Resources manuals
Handbook on hyperbaric medicine / Ed. Daniel Mathieu / Springer (HHM)
Recommendations of the ECHM consensus conferences (REC)European Code of good practice of hyperbaric oxygen therapy (CGP)
EN 14931 (EN)

6. Levels of lecturer’s competence
For level 1 (Outline Knowledge) and Level 2 (Knowledge) depending the topic(medical or technical) a recognised operator or nurse, member of a HBO team.
For level 3 (Detailed Knowledge) on medical topic, a hyperbaric physician (ECHM
level IIb) or, under the responsibilities of the hyperbaric physician (level IIb), a
registered nurse specialised on HBO.
For level 3 (Detailed Knowledge) on technical and safety topics, a safety manager or a medical director (ECHM level III).

7. Examination of the candidates
The examination of the candidate is in two steps: theory and practical.
The theory examination is based on multiple choice questions each with four
possible answers as recommended by ECB/EBAss. All questions will be at therequired level for the qualification according to the EBAss resource manual.
Before progressing to the practical examination, the candidate needs more than
70% of the points for the theory examination.
The practical examination is a practical situation/problem that the candidate will
be required to solve. The recommended situations are listed by EBAss.
Following successful completion of the above the candidate can apply for certification of the ECB/EBAss.
In order to guarantee to the candidates, the same level of knowledge, EBAss
recommend the use of EBAss questions and scenario.

Education of nurses, operators and technicians in hyperbaric facilities in Europe
Resources manual: a document of EBAss/ECHM
Version 200817

Annex: Principles of the Modules
Common Module for Operator and Hyperbaric Nurse
Theory: 16 h
Practical: 16 hSpecific module
Chamber Operator

Specific module
Hyperbaric Nurse

Theory: 16 h
Practical: 32 h

Theory: 16 h
Practical: 32 hSpecific module
Hyperbaric Nurse forIntensive Care (IC)Theory: 8 hPractical: 32 h

Module for Attendant (not nurse)
Theory: 8 hPractical: 8 hEuropean Baromedical Association for Nurses, Operators and Technicians
EBAss is an international, non profit association
Registered office: 9, Sainte Anne – B 7880 FLOBECQ – BELGIUM
E-Mail: secretary@ebass.org
Website: www.EBASS.org
Education of nurses, operators and technicians in hyperbaric facilities in Europe
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