ECHM Educational and Training Standards for the Staff of Hyperbaric Medical Centres 1997

EDUCATIONAL AND TRAINING STANDARDS FOR
THE STAFF OF HYPERBARIC MEDICAL CENTRES
Written by
Jordi Desola* and Jurg Wendling**
for theJoint Educational Subcommittee(*) European Committee for Hyperbaric Medicine (ECHM)(**) European Diving Technical Committee (EDTC)FOREWORD
These educational and training standards are the result of some years ofinternational discussion which began prior the 1st European Consensus Conference
on Hyperbaric Medicine, Lille, in September 1994 where one session was devoted to"Personnel education and training policies". A comprehensive paper and thesubsequent debate defined the 5 different personnel categories ideally involved in
the staff of a Centre of Hyperbaric Medicine.
A working group being formed to define the requirements for medical doctors in thefields of diving and hyperbaric medicine. An important feature of this project was thecollaboration between the European Committee for Hyperbaric Medicine (ECHM),
which is primarily a medical committee, and the European Diving Technology
Committee (EDTC) which is a 15-nation committee with not only government,
industry and trades union representatives but also with a doctor nominated from eachmember country. This joint subcommission was formed by J. Desola (Spain), D.Elliott(United Kingdom), P. Longobardi/ P. Pelaia (Italy), F. Wattel (France), and J.
Wendling (Switzerland). It was chaired by J.Desola on behalf of the ECHM and
J.Wendling by the EDTC.
The Goal-setting Principles for Harmonised diving Standards in Europe waspublished by the EDTC in 1997 and includes a section on the "Qualifications,education and training of medical doctors"(appendix 2).
The work presented here has been done by the Joint Medical Subcommittee of these
two main committees and, from time to time, reports by this Subcommittee havebeen submitted to and approved by each of the two parent bodies.
It is the purpose of this paper to summarise what has been accomplished and to lookat the future tasks of a Joint Medical Subcommittee of the ECHM & EDTC.

1ECHM Educational and Training Standards for the Staff of Hyperbaric Medical Centres 1997

INTRODUCTION
A Hyperbaric Centre must guarantee the best use of its equipment, and services.
Depending on the kind of facility and of the final aim of its services, the Hyperbaric
Centre can function on a continuous (24 hours a day) basis or intermittently, during
periods of time scheduled in advance.
Depending on its technical availability’s, the location, and the available medical
services, the Hyperbaric Centre can be a hospital facility, or an open self standing
Centre.
A hospital Hyperbaric Centre must guarantee its assistance 24 hours a day, andmust be able to offer adequate treatment for all kinds of diseases, including thoserequiring critical care inside the Chamber.
A self standing Hyperbaric Centre might have a certain work schedule, and must limit
its services to those patients not in emergency situation. It must be in functional
relation or contact with a general hospital.
In cases that a transportable hyperbaric chamber is used, the schedules, profiles,
staff and regulations will be the same of a self standing centre.
Staff requirements affecting these types of facilities should agree with theaforementioned conditions of availability and system of work.
This work aims to review the kind of staff needed by the Hyperbaric Centre, to define
their behaviour and giving some general rules to be applied in each situation,
depending on the conditions of each Centre. In the final items, the minimal personalrequirements of a Hyperbaric Centre will be mentioned.
In order to develop its functions correctly, a hyperbaric Centre needs different
professional qualifications. These could be summarised as follows:
1) The Medical Director and Physicians/Medical Doctors
2) Nurses
3) Attendants
4) Chamber Operators
5) Technicians6) Others
Characteristics, functions and background which should be followed by the whole
staff will be reviewed. In each category the following items will be detailed:A) Definition of functionsB) BackgroundC) Specific educational profile
D) Academic requirements and degrees
E) Continuous Education
F) Dedication

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ECHM Educational and Training Standards for the Staff of Hyperbaric Medical Centres 1997

1 – THE MEDICAL DIRECTOR
THE PHYSICIANS / MEDICAL DOCTORSA) Functions.
The Medical Director is responsible for all functions developed in the Hyperbaric
Centre. This includes the following aspects.
1. Supervision of the correct operation of the hyperbaric facilities.
2. Medical care to the patients inside the Chamber, if a multiplace facility isused and whenever it might be necessary, due to reasons of critical caredepending on the severity of the case, or special controls during
therapeutical procedures.
3. Quality assurance.
4. Follow up of patients.
5. Definition of protocol procedures for treatment.
6. Organisation and participation in multicentric over all protocols andtreatments.
The functions of the main Medical Director are complemented by a variable numberof collaborators of the same or similar background and education, in which theMedical Director can delegate some responsibilities, but always under his control.
One or two people will not be enough to guarantee a 24 hours a day service, as thelong stays inside the Chamber (when a multiplace facility is used) that they must
often endure, renders them incapable of further decompressions in the following
hours. A whole hyperbaric medical staff working in shifts would therefore benecessary.
B) Background.
The Medical Director is a Medical Doctor with a wide multidisciplinary education.
Internal Medicine, Critical Care and/or Intensive Medicine, Reanimation andAnaesthesiology, can provide the best background.
Other specialisation might also be adequate, if the candidate has documented
experience and he has received the necessary education and training in Hyperbaric
Medicine.
Sport or commercial diving can give to the Medical Director a great deal of additional
knowledge. This also provides awareness of the whole problem concerning thisspecialisation and it can add some complementary knowledge on diving andhyperbaric technology and practice. However this actual diving experience will not be
required for the recognition of the Medical Director.
C) Educational profile.
The Medical Director should have followed a full Medical Educational
Multidisciplinary Programme, in different fields of Medicine. A Medical Doctorate in
Medicine is the basis. The medical education must be completed with Postgraduate
courses in both Diving and Hyperbaric Medicine, preferably followed in University
Departments.

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ECHM Educational and Training Standards for the Staff of Hyperbaric Medical Centres 1997

D) Academic requirements and degrees.
The Medical Director, like all the medical staff in a Hyperbaric Centre, will be
subjected to all regulations of WORK UNDER PRESSURE established by theEuropean Community.
Even if Medical Directors have received a good self-trained education, they need a
specific titulation degree, in order to avoid legal problems concerning the possible
responsibilities deriving from the practice.
Definition of jobs
The training objectives of each job need to be defined in relation to the competencies
that are expected from the incumbent. A number of the jobs in diving and hyperbaric
medicine have tasks and objectives in common and so it is possible to optimise theefficiency of the educational program and avoid too much overlap by adopting a
modular structure.
I. The Medical examiner of divers
 Competent physician to perform the periodic "Fitness to dive assessments" ofworking and recreational divers and compressed air workers, except the initialassessment of novice professional divers.
IIa. The Diving medicine physician
 Competent to perform the initial and all other assessments of working andrecreational divers or compressed air workers.
 Can manage diving accidents and advise diving contractors and others on diving
medicine and physiology* (with the back-up of a hyperbaric expert or consultant).
 Should have knowledge in relevant aspects of occupational health. (He or she does
not need to be certified specialist in occupational medicine to be in accordance withthe standards).
IIb. The Hyperbaric oxygen physician
 Responsible for HBO sessions at the treatment site (with backup of a hyperbaric
expert or consultant) Should have appropriate experience in anaesthesia and intensive care in order tomanage the HBO patients (he or she does not need to be certified specialist inanaesthesia to be in accordance with the standards)
 Competent to assess and manage clinical patients for HBO treatment
III. The Hyperbaric expert or consultant (hyperbaric and diving medicine) Competent as chief of a hyperbaric facility (HBO centre) and/or to manage themedical and physiological aspects of complex diving activities1.
 Competent to manage research programs.
 Competent to supervise his team (HBO doctors and personnel, health professionals
and others).

1

optional additional qualification for bell diving (saturation, mostly off-shore)

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ECHM Educational and Training Standards for the Staff of Hyperbaric Medical Centres 1997

 Competent to teach relevant aspects of hyperbaric medicine and physiology to allmembers of staff.
IV. The Associated specialists
This title is not a job qualification, but rather a function. It covers experts, consultants
and specialists of other clinical specialities who can be nominated as competent toadvise within their own speciality upon specific problems in the diving and hyperbaric
field.
Contents of the Modules
Levels of competence:a - basicb - need to knowc - must be expert

Modules of formation and subjects

Jobs:

1

I

IIa

IIb

III

Physiology & pathology of diving and hyperbaric exposure:1

Hyperbaric physics

b

c

c

c

2

Diving related physiology I (functional anatomy, respiration, hearing and

b

c

b

c

b

c

a

c

equilibrium control, thermoregulation)
3

Hyperbaric pathophysiology (Immersion effect, blackout mechanism incl
apnoea, psychology, working performance/endurance under water)

4

Hyperbaric pathophysiology (decompression theories, bubbles)

b

c

b

c

5

acute Dysbaric disorders, DCI (Barotrauma, DCS)

b

c

b

c

6

chronical Dysbaric disorders (Long term effects)

b

c

a

b/c

7

HBO-Basics (effects of hyperbaric oxygen)

-

b

c

c

8

O2 Intoxication

a

c

c

c

9

Inert gas-effects (Narcosis/HPNS)

a

c

a

c

10

medicaments under pressure

b

c

c

c

11

non-dysbaric diving pathologies (Hypothermia, near drowning, fauna&flora

a

c

-

c

a

a

-

b/c

-

a /c

effects, injuries and accidents in water, the sick diver)122

diving fatalities
Diving technology and safety:

1

b

1

1

diving procedures (Bell diving)b

2

Diving procedures (SCUBA, surface supplied, bell, TUP, SURD, 02-Deco,

b

c

a

a/ c

b

b

a

a/c

b

b

a

a/c

b

b

b

a/c

3
4

mixed gas diving
Divers (Recreational SCUBA diving, technical and deep diving, Apnoeadiving, professional diving: offshore, inshore, scientific, media, recreational
diving instructor, Caissonwork, astronauts)
Diving gear (SCUBA, SSUBA, mixed gas, rebreathers, monitoring
equipment, working tools, suits)

5
1

Diving tables and computers (incl altitude and interval)

as required5

ECHM Educational and Training Standards for the Staff of Hyperbaric Medical Centres 1997

6

Regulations and standards for diving

b

b

-

a/c

7

Safety planning / management (monitoring)

b

b

-

a/c

c

c

c

c

3

Fitness to dive1

Fitness to dive criteria and contraindications (for divers, tunnel workers andHBOT patients and chamber personnel)

2

Fitness to dive assessment (diagnostics)

c

c

c

c

3

Fitness to dive standards and regulations (prof and recreational d.)

c

c

b

c

a

c

a

c

-

c

c

c

4

Diving accidents:
1

Diving accidents / incidents (assessment and preclinical treatment incl.
ORL, barotraumas, CPR)

2

Diving accident management clinical (Diagnostics, patient care, follow-up)

3

Diving accident management: Differential diagnosis

a

c

c

c

4

HBO-T for diving accidents (Tables and strategies)

a

c

c

c

5

Rehabilitation of disabled divers

-

a

a

b/c

b

c

c

5
1

Clinical HBO:
Chamber technique (multiplace, monoplace, transport chambers, wet
recompression)

2

HBO: Mandatory Indications

-

a

c

c

3

HBO: Recommended Indications

-

-

c

c

4

HBO: experimental and anecdotal Indications

-

-

b

c

5

Data collection / statistics / evaluation

-

b

b

c

6

general basic treatment (nursing)

-

b

c

c

7

Diagnostic, monitoring and therapeutical devices in Chambers

-

c

c

c

8

Risk assessment, incidents monitoring and safety plan in HBO-Chambers

-

b

c

c

9

Safety regulations

-

c

c

c

6

Diverse:1

Research standards

-

a

a

c

2

Paramedics teaching program

-

b

a

c

3

Management /Organisation of HBO facility

-

a

a

c

7

Practical training:
1

Fitness for chamber-dive test (of the course participants)

-

+

+

+

2

CPR

-

+

+

+

3

Practice in field first aid (diving accidents)

-

+

-

+

4

Practical training FTD exam (skills)

+

+

+

+

5

Demo : professional diving

+

+

-

+

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ECHM Educational and Training Standards for the Staff of Hyperbaric Medical Centres 1997

6

Demo : HBO-T-

7

Introduction to (wet)-Diving(+)

8

Practice in HBO-T (including pressure test)-

9

Practice in attendants teaching

-

+
2

+

4

+
+

3

+

+

-

+

+

+

-

+

Standards for course organisation and certification
Teaching courses
In order to comply with this EDTC/ECHM standard the person responsible for the
professional contents of the course must be a hyperbaric medical expert orconsultant (job type III)
1. The course curriculum should be declared as being ”in conformity with the
ECHM/EDTC standards” and the educational objective (jobs I and IIa, IIb) stated.
2. The course organisers are invited to send a copy of the curriculum to the joint
medical subcommittee of ECHM/EDTC (through the national co-ordinator).
3. The final tests for individual evaluation are mandatory, and should cover all thetaught subjects (see list) at the level of competence required for each subject.
The standards do not prescribe the status of the teaching institution but it is strongly
recommended that courses are university based, are approved for such training
courses by national health authorities, speciality training boards or are under the
auspices of the national scientific society for diving medicine and/or hyperbaric
medicine.
How a course is to be organised is not prescribed in these standards. Evenings,
week-ends or full weeks are possible. For clinical teaching, an internship or residency
may be appropriate. The acknowledgement of a high teaching standard is based ona credible final test of the candidates.

Modules and course organisation
The actual organisation and conduct of the modules will be influenced by local
factors and so it is proposed that these details can be decided on a national basis
and probably left to the individual course directors. The following proposal indicates
the total teaching hours considered necessary to achieve appropriate competencies
in the following jobs.

2

recommended
exceptions possible, if important reasons of unfitness to dive3
as required
4

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ECHM Educational and Training Standards for the Staff of Hyperbaric Medical Centres 1997

I
IIa
IIb

III

Medical examiner of divers

25 lecture hours + 3 hours
practical
Diving medicine physician
The above + 30 additional lectures+ 10 hours practical
Hyperbaric medicine physician
60 hours + a practical phase (5different types of clinical caseswith different indications fortreatment)
Diving and hyperbaric medicine expert This needs further review (seeor consultant
below)The proposal serves as a guideline and is not mandatory. When one of theseteaching programmes includes topics covered elsewhere a reduction in the numberof lecture hours may be justifiable.
Recognition of an expert
The experience needed to become an expert cannot be learned from a course. The
essentials have already been described in general terms. The candidate should
already be an accredited specialist or equivalent.
Except in those countries where some equivalent or higher standards already exist,
those who wish to be acknowledged as experts or consultants in the fields of diving
and hyperbaric medicine should send their curriculum to their national co-ordinator(representing the Joint Medical Subcommittee or to that subcommittee itself if thatnation has no co-ordinator) who may decide on the basis of the agreed standards.
The Joint Medical Subcommittee will be informed by the national co-ordinator and
can issue a list of experts if required. In the future the verification of achieved
qualifications will be done by a national health authority or a scientific body (EUlegislation). The aim is to achieve a recognition of the standards by those so that they
automatically could take over the role of the national co-ordinator.
E) Continuous Medical Education (Quality Control and Competency).
The Medical Director should undertake a periodic Continuous Education programme,
about the main aspects of Underwater and Hyperbaric Medicine. Participation in
Courses, Workshops and Conferences organised by International Societies well-known
in this field, such as the European and Baromedical Society (EUBS), the Foundation for
the International Congress on Hyperbaric Medicine, the Undersea & Hyperbaric
Medical Society (UHMS), or other courses approved or reviewed by the ECHM, could
also be adequate.
Professional ethics and medical deontology oblige all Medical Directors to communicate theirobservations and improvements in the different fields of Diving and Hyperbaric Medicine totheir colleagues of the international scientific community. In addition, the Medical Director musttake advantage of the experiences of his international colleagues, and must take part in the
wide-spread studies that might be performed.

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ECHM Educational and Training Standards for the Staff of Hyperbaric Medical Centres 1997

The highest qualified Hyperbaric Centres should organise Courses, Workshops andperiodical activities aiming to improve the education of specialised staff at all levels.
In most countries, the conditions for maintaining the active status of an individual aredefined by some system of continuous medical education credit points (CME, asintroduced in the USA some time ago). The ECHM & EDTC need to define theminimum requirement for this in a flexible way that provides enough freedom for thenational bodies to establish a more detailed system. It is expected that these national
requirements will be compatible with this guidance.
The following procedure is proposed:
Job I:A minimal activity of 10 medical assessments of divers fitness per year is neededplus attendance at one refresher course (usually 2-days) in two years. Reactivation
after a lapse needs participation in two 2-day refresher courses or a repeat of the fullbasic course.
Job IIa:
Continuing experience in the field of professional diving (e.g. advising a professional
diving contractor or some equivalent activity) and participation in a course orcongress previously approved by the national co-ordinator. Reactivation after a lapse
should be on the basis of a specifically approved course. Where this cannot be
achieved, the candidate should submit an alternative training programme to thenational co-ordinator for approval.
Job IIb:
Active employment in an HBO facility (or equivalent activity) and attendance at one
national and/or international congress on hyperbaric medicine per year. Reactivation
after a lapse needs a 10 working days in a HBO facility and attendance at two
congresses in two years.
Job III:
Will rely on the decision of the national co-ordinator
The refresher seminars can serve to update the participants in order to confirm theiractive status and to reactivate those who temporarily have not maintained theirrequired activity. They can also serve as an introduction to doctors of otherspecialities who may also gain CME credits in their own specialities. This not only
can help the financing of a course but can be a chance for promoting HBO to those
who would not attend the HBO scientific congresses.
F) Dedication.
All Hyperbaric Centres should have a permanent Medical Director, with partial or
full-time dedication depending on the characteristics of each Centre, complemented bya variable number of collaborators of the same or similar background and education.
Hospital centre treating patients in situation of emergency will probably need more than
three medical doctors.

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ECHM Educational and Training Standards for the Staff of Hyperbaric Medical Centres 1997

2 – NURSESA) Functions.
As in all fields of Medicine, nurses complete medical treatment and they are responsible
for the practical implementation of patient treatment.
The Hyperbaric Nurses perform the usual functions of their profession with somevariations due to the characteristics of the hyperbaric activity :1. Nursing measures belonging to the common pathologies of the Hyperbaric
Therapeutics to be applied to the patients in a self standing chamber.
2. Nursing assistance of patients inside the hyperbaric chamber, taking special
care of the specific conditions of the hyperbaric environment.
3. Adaptation of conventional medical techniques and specific treatments of each
illness to the hyperbaric environment, so the other treatments that the patient ishabitually receiving have not to be interrupted while in the chamber.
4. In some cases, operating the external controls of a Monoplace Hyperbaric
chamber according to the compression and decompression schedules
established.
B) Background.
The Hyperbaric Nurse must have the corresponding degree of her profession. Specificeducation in Critical Care Nursing will be very useful. Knowledge of other specialisation
like angiology, traumatology, and wound care will also be appropriate.
Special courses on Diving and Hyperbaric Medicine are essential.
The nurse may receive the necessary training in the same institution from the Medical
Director.
C) Specific educational profile.
Hyperbaric Nurses should also receive a complementary education, according to theirprofessional level, in the following matters:
1. General principles
Pneumatics.

ofDecompression

Theory,DivingTechnique,and

2. Hyperbaric Technique.
3. Safety and preventive measures.
4. Operation of monoplace hyperbaric chambers.
5. Intensive critical care of patients.
6. Other aspects inherent in both Diving and Hyperbaric Medicine, concerning her
profession.
D) Academic requirements and degrees.

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ECHM Educational and Training Standards for the Staff of Hyperbaric Medical Centres 1997

A basic education and a nursing degree will be required.
Special courses for hyperbaric nurses are highly recommended but they will not bestrictly required.
The hyperbaric nurse will be subjected to the regulations on WORK UNDERPRESSURE established by the European Community.
E) Continuous Education.
As in all fields of Health and Medicine, Hyperbaric Nurses must complete and continue
their education by reading specialised texts, and attending Courses and Congresses.
Their affiliation to specialised professional societies, such as the Nurses Baromedical
Association or to other entities that might be created, would be of the greatest interest.
F) Dedication.
All hospital based Hyperbaric Centres should have a permanent team of Nurses, withpartial or full-time dedication depending on the needs of each Centre.
One or two people will not be enough to guarantee a 24 hours a day service, as thelong stays inside the Chamber that they must often endure (when a multiplace facility isused) renders them incapable of decompressions in the following hours. A whole teamof hyperbaric nurses working in shifts would therefore be necessary.

3 – ATTENDANTS
A) Functions.
Patients inside a multiplace chamber need always to be under the control andsupervision of trained personnel. Critical patients will always be joined by a doctor, anurse, or both.
Other patients however do not need such kind of direct and special medical and nursing
assistance, and in those cases the participation of a type of staff, specially trained,
although not necessarily highly qualified may be adequate.
These are some of the activities attributed to attendants:
1. Patient care in non invasive, non-specialised medical activities inside andoutside the chamber.
2. Accompanying patients who are receiving treatment inside the Multiplace
Chamber, but who do not need special assistance by doctors and nurses, but
only by way of support, control, and to give them confidence.
3. Other activities to develop inside or outside the Chamber, indicated by the
Medical Director or the Nurse.
If monoplace chambers are used, the majority of these activities may be adopted bydoctors and/or hyperbaric specialists and nurses.
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ECHM Educational and Training Standards for the Staff of Hyperbaric Medical Centres 1997

B) Background.
Attendants can come from different professions regarding Underwater and Hyperbaric
Medicine, such as:
1. Sport or commercial divers.
2. Health auxiliaries, medical students, paramedics, or assistants.
3. Other professions preferably although not necessarily health/related.
Items 1 and 2 are the most adequate conditions or origins for working as an attendant.
However, these degrees should not be necessarily requested.
Their education and training may be accomplished in the same hyperbaric institution.
C) Specific educational profile.
At a level according to their capacity, previous experience and kind of work, Attendantsshould be instructed in the following aspects:
1. General principles of Medicine and Therapeutics.
2. Medical First Aid.
3. General principles of Diving and Hyperbaric Medicine.
Their basic education may be received in the same institution
specialist and/or doctors and nurses.

from a hyperbaric

As a result of this non-specific education programme, the Attendants should meet thefollowing requisites.
a) To feel comfortable in the hyperbaric environment.
b) Excellent practice with hyperbaric techniques and necessary manoeuvres foradapting patients to the pressure.
c) Sufficient knowledge of the main non invasive medical instruments generally
used under pressure.
d) Capacity to interpret, but not to operate, the meaning of the control instruments
placed inside the Hyperbaric Chamber. They must also be familiar with thepressure and control devices.
e) To give First Aid care in the case of an emergency.
D) Academic requirements and degrees.
There is no specific degree providing the requirements of an Attendant. Some entities
organise educational courses adapted to this activity. However only a course on
Medical First Aid should be strictly required.
The Attendants will be subjected to the regulations of WORK UNDER PRESSURE
established by the European Community.
E) Continuous Education.
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ECHM Educational and Training Standards for the Staff of Hyperbaric Medical Centres 1997

The Attendants will be informed in the same Institution, about any news on Underwaterand Hyperbaric Medicine and Technique which could affect their activity. Theirattendance at activities in the field of Diving and Hyperbaric Medicine should be
encouraged.
F) Dedication.
All hospital and self standing Hyperbaric Centres using multiplace hyperbaric chambers
should have a permanent team of Attendants, with partial or full-time dedication
depending on the needs of each Centre. One or two people will not be enough toguarantee a 24 hours/day service, as the long stays inside the Chamber that they must
often endure (if a multiplace facility is used) renders them incapable of further
decompressions in the following hours.
If monoplace chambers are used, the attendants may not be necessary since all theirfunctions are done externally by nurses and doctors and/or hyperbaric specialists.

4 - CHAMBER OPERATORSA) Functions.
A Hyperbaric Facility may achieve a high level of sophistication that will require
specialised attention and care.
The Hyperbaric Chamber itself, the air-compressors, other pressurised gas sources, or
the gas reserves, have some special devices whose manipulation might be very
complex.
Monoplace chambers are handled sometimes by nurses and doctors and/or Hyperbaric
specialists.
When multiplace chambers are used, the Hyperbaric Centre must have qualified
personnel to manage the hyperbaric facilities. These functions must be preferably
carried out by specialised chamber Operators.
The functions of the Chamber Operator of a Multiplace facility will be:
1. Operation of the internal and external devices of the Chamber.
2. Control and operation of the mechanisms for compression and decompression,and for delivering gas mixtures and oxygen.
3. Control and application of the safety regulations concerning prevention of fire,and oxygen toxicity.
4. Calculation, application and control of compression and decompression
schedules for patients, Specialists and/or Doctors, Nurses and Attendants,
applying decompression stops, when necessary.
5. Sometimes, interventions inside the Chamber under pressure, in order to control
or check the correct operation of determined parts of the pneumatic circuits ordevices.
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ECHM Educational and Training Standards for the Staff of Hyperbaric Medical Centres 1997

6. Adaptation and checking of the medical instruments carried by the patients
before being introduced into the Chamber, in order to assure their correct
operation, and to avoid dangerous or undesirable effects.
7. Control and checking of the operation of auxiliary facilities of the Chamber: aircompressors, sources of compressed air or medical gases, air reserves,pneumatic circuits, control systems.
8. Maintenance of the facility. Small repair jobs or technical interventions due toproblems which occasionally might occur, and which do not require theintervention of highly specialised technical staff.
B) Background.
Hyperbaric Operators usually come from a commercial diving environment, where often
received specialised training. This is not indispensable and Operators can come fromother areas.
Despite the fact that they come from a non-health-related profession, they will need tolearn elemental principles of health since they will be in contact with patients.
Some paramedical professions and health-related activities common in hospitals, may
provide a good basis from which the candidate may be trained by the same institution to
become a chamber Operator.
C) Specific educational profile.
Whatever their previous experience might be, the Hyperbaric Operator need goodknowledge in the following subjects:
1. General Pneumatics.
2. General Mechanics and Electromechanics.
3. Decompression Theory. Decompression schedules.
4. Diving and Hyperbaric Technology.
5. Medical First Aid
6. General principles of Medicine, and Medical Therapeutics.
Courses on Diving and Hyperbaric Medicine for auxiliary staff, will provide good training
in all these matters.
D) Academic requirements and degrees.
Some diving centres, off-shore facilities, and other specialised entities, result in somecountries in specific degrees adapted to the activity of a chamber Operator. However,this condition should not be regarded as indispensable until the European Community
establishes a specific degree for chamber Operators.
A Degree in professional diving with a specialisation in hyperbaric systems and facilities
will be adequate.

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ECHM Educational and Training Standards for the Staff of Hyperbaric Medical Centres 1997

A technical speciality degree in pneumatic systems, or similar titulation, would be ofgreat benefit although it is not absolutely indispensable.
The Chamber Operators will be subjected to the regulations of WORK UNDERPRESSURE established by the European Community.
E) Continuous Education.
Hyperbaric Operators will need to receive Continuous Education according to theadvances in the field of hyperbaric technology and also in decompression theory. They
must be regularly updated on the main aspects of the diseases that will be treated in
the chamber.
For this reason, his periodical contact with other specialised Centres is highly
recommended.
F) Dedication.
Since Chamber Operators are in charge of the operation of the Multiplace Hyperbaric
Chamber, their presence is absolutely essential in all hospital or self standing Multiplace
Hyperbaric Centres.
A permanent Chamber Operator, with partial or full-time dedication depending on theneeds of each Centre, will therefore be needed.
In monoplace facilities, their services are also appreciated, but their functions can bealso attributed to other types of trained personnel.

5 – TECHNICIANS

A) Functions.
The Hyperbaric Centre needs employ to specialised technical staff, whose functions willbe the checking and control of the chamber, pneumatic circuits, gas or compressed air
reserves, air-compressors and the rest of the technical parts of the facility.
B) Background.
The Hyperbaric Technician must have a high level of knowledge in high, middle and low
pressure pneumatics. They should also possess a deep knowledge of diving andhyperbaric technology. Some experience in the field of medical technology would bevery suitable.
Some Chamber operators can also be technicians.
C) Specific educational profile.

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ECHM Educational and Training Standards for the Staff of Hyperbaric Medical Centres 1997

In some areas, real specialists in diving systems or hyperbaric facilities will probably bevery difficult to find. In many cases, a high pressure Technician and some of thetechnical staff of a Hospital will quite easily be able to adapt his knowledge receiving
some additional instruction on pneumatics and high pressure.
D) Academic requirements and degrees.
The Hyperbaric Technician must have either an official degree with speciality inPneumatic Systems, or an official specific degree in Hyperbaric technology, in the
countries where these degrees exist.
This activity should not be entrusted topersons or firms which, although experienced, might not be in a legal condition to give
warranties, and cover responsibilities in case of a possible disfunction, emergency, oreven catastrophe.
E) Continuous Education.
The Hyperbaric Technician, being a high level Specialist, must always be aware of thelatest technological advances and new changes which might occur in his sector, inorder to use the most adequate systems.
F) Dedication.
Depending on the amount of work and of the technical characteristics of eachHyperbaric Centre, maintenance of the facilities might be performed by full-timeHyperbaric Technicians or by subcontracted specialised firms or enterprises. Bothconditions are equally acceptable.

6 - OTHER STAFF

Many other professionals with different qualifications may and should be engaged witha Hyperbaric Medical Centre, depending on the special characteristics of each and thehospital or institution where it is situated. Some of them are listed below.
1. Administrative
2. Statisticians
3. Rehabilitation
4. Fire specialists
5. Engineers
6. Others
Since the activities of these professionals do not adopt special characteristics ormodifications by being carried out in a hyperbaric centre, and as their duties will besimilar to their usual jobs, their functions, background, requirements, and dedication will
not be detailed in this document. All these conditions will be developed as in otherplaces or jobs.
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ECHM Educational and Training Standards for the Staff of Hyperbaric Medical Centres 1997

7 - ACREDITATIONS AND CREDENTIALSThe ECHM will create a Subcommittee for specialist assessment or accreditation, thatwill establish a credential document as explained in the aforementioned criteria in
section 1 of this document.
The selection and guarantee process will be established by the Subcommittee in a
separate document, in which the following items will be specified:
1. Educational criteria.
2. Procedure for obtaining the credential.
3. Usefulness and validity of the credential.
In the meantime, lacking specific degrees in Underwater and Hyperbaric Medicine, theaforementioned credential will be the guarantee for a Hyperbaric Specialist.

8 - MINIMAL REQUIREMENTS

The aforementioned staff may be adapted to each facility according their particularconditions. The number of persons integrating the full staff will be enough to provide in
any case at least the following persons and professions for every session of hyperbaric
treatment.
A) Multiplace chambers facility.
1 Medical Director
1-3 Physicians / Medical Doctors
1 Nurse
1 Chamber OperatorB) Monoplace chambers facility.
1 Medical Director
1 Nurse or attendant
The dedication and functions of each one will be developed as explained above. Other
types of staff will be included optionally according to the special characteristics of eachcentre and their needs.

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ECHM Educational and Training Standards for the Staff of Hyperbaric Medical Centres 1997

9.- THE JOINT MEDICAL SUBCOMMITTEE OF
ECHM AND EDTC
This committee will operate on the basis of the tasks outlined above. The members
are the two chairmen of the education and training subcommittee of the ECHM andof the medical subcommittee of the EDTC respectively. Further two to threemembers are nominated by the chairmen on the basis of their special competence
and experience in one of the relevant topics. As the chairmen each represent a
specific subcommittee, any major changes or decisions must be discussed withinthese subcommittees before going to the meetings of the EDTC or ECHM
respectively.
Each country interested in educational courses recognised by EDTC/ECHM should
be represented by a member who has been acknowledged by the national hyperbaric
medicine authority (or of all such authorities if there are more than one such authority
in a country). Normally this would be either the national member of ECHM or thenational medical representative on the EDTC. If not the same individual, both could
attend if appropriate.
The EDTC and ECHM representatives of each country should nominate a national
co-ordinator of teaching programmes, who could be the joint subcommittee member
himself or who could delegate for that purpose (for instance to the national healthand safety authority or any representative scientific body covering all aspects ofhyperbaric medicine). The national co-ordinator will have the duty to supervise thenational programs, the certification procedures and the status of the course directors.
In order to enhance credibility of certification and to help those who do not yet have theexperience necessary to establish a good validation system, the Joint Medical Subcommittee
will create a pool of multiple choice questions with an evaluation grid, in the main European
languages. This will be available for all members. Evaluation of the answers should be doneby an international group nominated by the Joint Medical Subcommittee. This Subcommittee
may also certify a national teaching syllabus or educational course if desired by its organisers,
thus helping the national societies or other authorities in getting accepted by theirgovernmental health and safety department or by their speciality boards.
Correspondence:
Jordi Desola, MD,PhD
Chairman
Educational Subcommission of the E.C.H.M.
FAX: +34-934-503-736
E-Mail: cris@comb.es
Jurg Wendling, MD
Chairman
Medical Subcommission of the E.D.T.C.
FAX: +41-323-223-839
E-Mail: mail@wendling.ch
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