HCMC NETWORK FEATURE: New Center for Hyperbaric Medicine
A new era has begun with the opening of the Center for Hyperbaric Medicine at HCMC (Photo 1). From early plans and funding applications, through installation of a multiplace hyperbaric chamber and construction of a brand new hyperbaric medicine suite, a dedicated and multifaceted team on two continents has worked to make this state-of-the-art facility a reality.
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HCMC was the first and, from 1964 to 2008, the only provider of hyperbaric oxygen therapy to Minnesota and the region. HCMC remains the only facility that provides emergency hyperbaric oxygen treatments 24/7 for critical patients with carbon monoxide poisoning, life- and limb-threatening infections, decompression sickness, and arterial gas embolism while also providing evidence-based care for non-emergency patients with radiation injury, non-healing wounds from diabetes, and other conditions (Photos 2 and 3). Hyperbaric medicine treatments at HCMC have increased annually as hyperbaric oxygen therapy has been shown effective for a growing number of chronic medical conditions. A total of 3335 hyperbaric treatments were administered in 2011, including 135 emergency treatments and 3200 scheduled (non-emergent) treatments.
Efforts for a new hyperbaric chamber began in the early 2000’s, when it was determined that renovations of the old chamber would be insufficient to safely meet the growing need. Dr. Cheryl Adkinson, Medical Director for Hyperbaric Medicine since 1985 (Photo 4), worked extensively with HCMC/Hennepin Health Systems personnel to obtain a combination of hospital, county, state and federal stimulus funds for the project. A contract was secured with Fink Engineering, of Queensland, Australia, whose unique rectangular multiplace hyperbaric chambers are recognized as the most technically advanced, safe, and user-friendly in the world. HDR was selected as the architectural firm and plans begun in September 2010 for a 10,288 ft2 renovation of street level space to house the new hyperbaric chamber in a brand new hyperbaric medicine suite within the hospital.
The new 48-foot long hyperbaric chamber is one of only six rectangular multiplace chambers in North America (Photo 5). The rectangular shape provides more useable interior space per square foot and less external volume than traditional cylindrical or spherical chambers (Photo 6). Interior spaces also look, feel, and function like other hospital rooms, lessening patient anxiety and enhancing comfort. While the chamber and control console were being constructed in Australia, extensive site preparation was underway at HCMC. Unlike the previous location of the chamber two blocks away, the new hyperbaric medicine suite is centrally placed within the main hospital, with rapid access to the Emergency Department, Operating Rooms, Intensive Care Units, lab, x-ray, and pharmacy. This central location is ideal for treatment of critical patients and outpatients with mobility issues, but it placed the six-ton chamber directly above an existing HCMC tunnel, steam lines, and water lines. Kraus Anderson Construction Company worked closely with HCMC Facilities for three months prior to arrival of the chamber to construct the foundation and support framework, re-route steam lines, lay plumbing and medical gas piping, and build a gantry system to lift and place the chamber on-site. Tom Bravo (HCMC Facilities, Director, Photo 7) described the construction of the facility as a “once in a lifetime experience, completely unique. We had a building within a building, the chamber, which came from another country, was delivered from across the ocean and shipped by truck across the US,” to be installed through an opening in the outside wall of the hospital. With only inches to spare on the top and the bottom of the opening, the 60-ton chamber was eased in through the opening and brought to rest perfectly in its new home (Photos 8-11). Tom Bravo, Julie Moline (HCMC Facilities, Manager), and their Facilities team worked closely with HDR, Kraus Anderson Construction, and Fink Engineering, managing building construction through all phases, with minimal disruption to ongoing hospital operations and the surrounding city blocks (Watch a Kraus Anderson video about construction of the facility).
Fink Engineering was responsible for the assembly and installation of the chamber and related components. The multi-place chamber and control console were built to specification in Australia, where controls, boxes, and panels were pre-assembled and internal wiring and piping were installed. Eric Fink (Fink Engineering, Owner, Photo 12) was onsite for the November 2011 arrival and early installation phases, returning periodically during the project. Winston Chee (Fink Engineering, Senior Project Manager) was onsite for seven months with his Australian team members, completing the installation (Photo 13). Girish Kurra (Fink Engineering, Electrical Engineer) assisted in initial chamber design and construction in Australia and spent six months at HCMC, working first with local electrical contractors to connect the chamber and console and then testing and fine-tuning software systems. He also worked extensively with HCMC hyperbaric technicians to familiarize them with the new chamber, software, and safety features and to prepare them for day-to-day operation, ongoing maintenance, and trouble-shooting (Photos 14-15). For Mr. Kurra, meeting patients at previous chamber installations and seeing the healing effects of hyperbaric treatments has been key to his job satisfaction and ongoing commitment to his work. “I saw the people who were cured and I was amazed… many patients wounded in house fires, diabetic patients, and others were thanking us, holding our hands, and telling us what hyperbaric oxygen therapy does for them. I was very appreciative of hearing from them.”
The fundamental goal of HBO therapy is to dissolve high concentrations of oxygen in the blood and tissues, through breathing 100% oxygen inside a pressurized chamber. (Read an MD News article about hyperbaric oxygen therapy at HCMC). Treatment profiles (sequences of treatment pressures and times) and the total number of treatments vary according to medical condition; emergency treatment of decompression sickness may require one treatment of many hours, while healing of compromised skin grafts and flaps in cancer patients may entail 30 to 40 daily two-hour treatments.
The new multiplace hyperbaric chamber operates on the same principles as the old chamber, but has numerous state-of-the art features designed for optimal function and maximum flexibility and safety. The chamber is comprised of three separate and independently controlled treatment locks. Lock 1 can be pressurized to 3 atmospheres absolute (ATA), equivalent 66 feet of sea water (fsw). Locks 2 and 3 can be pressurized to 6 ATA (165 fsw). Each lock is equipped to accommodate seated patients or patients in ICU beds, with a total capacity of up to 23 seated patients or 5 critically ill patients or a combination of both. Locks 1 and 3 can be run simultaneously on the same or different treatment profiles, with emergency access maintained through Lock 2. Additional personnel may pressurize in Lock 2 and enter Lock 1 or Lock 3 if they are needed to assist or replace attendants, who may then exit and safely de-pressurize in Lock 2, with no interruption of ongoing treatments.
A unique constellation of design features enables optimal function, patient care, comfort, and safety of patients and attendants (see Photos 16-31, of contrasting features of the old and new hyperbaric chambers). Headwalls (wall panels with hook-ups for equipment, oxygen, etc.) in the chamber are customized to mirror ICU headwalls, ensuring a seamless transition for caregivers. Doors slide easily, with thresholds specially designed for smooth transit of gurneys and wheelchairs. Square medical locks enable easy passage of specimens, medications, and supplies in and out of the pressurized chamber. Touchscreen environmental controls enable rapid adjustment of temperature and lighting from inside and outside the chamber. The chamber technician, inside medical attendant, and supervising physician wear headsets, enabling constant private communication during treatments. Cameras and monitors inside, an intercom, and display screens on the control console facilitate close monitoring of patients and chamber functions. Customized software records and saves minute-by-minute treatment profiles for every treatment. Safety features are incorporated throughout the chamber and software systems, with multiple back-ups for key processes. In the event of malfunction or problems inside or outside the chamber, operators can immediately activate emergency systems, which are independently controlled for each treatment lock. If the power fails, hospital generated power kicks in. If generators fail, a dedicated battery system automatically keeps the chamber systems running. If a computer system fails, manual systems ensure uninterrupted control. The emergency systems are very sophisticated. Pushing the “Fire Deluge” button automatically 1) causes immediate “deluge” of up to 700 gallons of water into the chamber in 90 seconds; 2) cuts off non-essential power; 3) opens water drains; 4) switches breathing systems from oxygen to air; and 5) de-pressurizes the chamber.
The expertise and dedication of HCMC’s hyperbaric technicians, nurses and physicians is unsurpassed. As they worked in the old chamber to provide ongoing hyperbaric treatments to scheduled patients, as well as emergency treatments of critically ill patients, they also worked to prepare the new chamber and hyperbaric medicine suite. Marc Pullis (Lead Hyperbaric Technician and Safety Coordinator) and Joe Harris (Hyperbaric Technician) are certified hyperbaric technicians as well as Emergency Medical Technicians. They have a combined 15 years of experience in the HCMC hyperbaric chamber between them and both have extensive background in scuba diving. While continuing to run the old chamber for patient treatments for part of each day, they also trained extensively in the operation of the new chamber. Additionally, they have played an integral role in testing and fine-tuning chamber operations, including oxygen delivery systems, gas consumption, nitrogen purging of electronic equipment, test dives, and development of extensive checklists for chamber operation, maintenance, and troubleshooting (Photos 32-34). They are excited by the challenges and rewards of launching the new chamber. Joe Harris has extensive background in commercial diving, compression chambers, and gas supply systems; he has appreciated the opportunity to “use knowledge and experience from the past and apply it to the new.” They look forward to the new chamber and its computerized controls, but also appreciate the manual features the old chamber. Joe will miss “the elegance and simplicity. All you need is right there in front of you, standing in front of that back wall, opening and closing the valves by yourself” (Photo 35, Marc Pullis). In addition to the technical demands of their work operating the hyperbaric chamber, both emphasize the reward they feel from the human connections. Marc Pullis explained that “patients come 30 to 40 times. I see how they progress, I get to know them, and I see them from start to finish.” Joe Harris loves “working with patients and watching them heal” and looks forward to the increased comfort level that patients will have in the new hyperbaric chamber. Referring to the old chamber, he said “I love this big blue machine, but people can be intimidated by it. They are very much aware that they are locked inside … you talk patients through it, keep them distracted, maintain eye contact, and let them know you’re in there with them. You calm them down and keep talking.”
The team of hyperbaric nurses, Andrea Jensen (Senior Staff Nurse), Mary Herbon, and Ginny Nolting, have 18 years of combined experience in the HCMC hyperbaric chamber, as well as extensive experience in critical care nursing (Photo 36). In addition to caring for patients in the old chamber, they have been training in the new facility and have worked to set up the new hyperbaric medicine suite for optimal patient care (Photos 37-39). Like Mark Pullis and Joe Harris, attractive features of the new chamber are flipsides of things that they will miss from the old chamber. While they look forward to the new high-tech chamber and the greater space and privacy of patient care areas, they will also miss the unique character of the old chamber and the closeness and community that its tight quarters facilitated. Ginny Nolting emphasized the importance of patients being treated together. “At first they think it will be horrible, to have to come for 30 to 40 days of treatment, but then they meet others in the group, see someone who is worse off than they are, and they support each other.” Dr. Adkinson explained that the new facility was explicitly designed with a sitting area for patients adjacent to the chamber to provide a place “where patients gather before a treatment, because they are a great support for each other – if we were to separate them in this new facility, each person would lose the care and comfort he receives from the others. They make friends, share rides, and stay in touch with one another, which, I believe, is therapeutic.” Steve Omodt (Nurse Manager) came to the Hyperbaric Medicine department in 2011 after 24 years in the HCMC Burn Unit (Photo 40). He has worked extensively to ensure a seamless transition of patients and staff to the new facility. He also emphasizes that patients are an important part of the team, noting that hyperbaric oxygen therapy “is a treatment, but it’s also something much more… the patients connect, they are here with the same group of people for 30 or 40 treatments. There is an emotional connection that they make with staff and physicians that is maybe overlooked. You are who you are for the 30 days that you’re here. The camaraderie between patients and staff is something that needs to be highlighted as part of the treatment. It’s synergistic.”
The new hyperbaric suite is designed to admit maximal natural light and utilizes the most energy efficient products in the hospital. Construction complies with 99% sustainability, using flooring, lighting, fixtures, and finishing products that are recyclable. Decorated in shades of blue and gray, with beautiful terrazzo flooring, the suite is calm and peaceful. The front wall of the new chamber is bathed in shimmering blue light, like water. Julie Moline commented that the lighting feature, created by LED strobes, “while such a simple thing, pulls it all together.” Attributing the insight for this simple design feature to the unique talents of Dr. Adkinson, Steve Omodt says the rippling light is “calming, soothing, a visual representation of what this place is.”
The vision, attention to detail, and quiet leadership of Dr. Adkinson and the coordinated efforts of a multi-talented team from two continents has positioned the new Center for Hyperbaric Medicine to take the HCMC tradition of statewide service to new levels. Staff from departments throughout the hospital, from Biomedical Services, Health Information Management, Pharmacy, Public Relations, Telecommunications, Supply Chain, and Security, many more than could be mentioned here, made invaluable contributions and will continue to support the critical work of Hyperbaric Medicine. Praising the dedication, knowledge, and passion of the hyperbaric medicine team, Steve Omodt added, “It’s the same for all of HCMC. We do the right thing for the patient for the right reasons. It’s good to strive for idealism and altruism. I think that people go the extra mile and I think that the patients deserve that. That’s what we do here.”
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