title: Decompression tables for inside chamber attendants working at altitude.
abstract: BACKGROUND
  Hyperbaric oxygen (HBO2) multiplace chamber inside attendants (IAs) are at risk for decompression sickness (DCS). Standard decompression tables are formulated for sea-level use, not for use at altitude.
  
  
  METHODS
  At Presbyterian/St. Luke's Medical Center (Denver, Colorado, 5,924 feet above sea level) and Intermountain Medical Center (Murray, Utah, 4,500 feet), the decompression obligation for IAs is managed with U.S. Navy Standard Air Tables corrected for altitude, Bühlmann Tables, and the Nobendem© calculator. IAs also breathe supplemental oxygen while compressed. Presbyterian/St. Luke's (0.83 atmospheres absolute/atm abs) uses gauge pressure, uncorrected for altitude, at 45 feet of sea water (fsw) (2.2 atm abs) for routine wound care HBO2 and 66 fsw (2.8 atm abs) for carbon monoxide/cyanide poisoning. Presbyterian/St. Luke's provides oxygen breathing for the IAs at 2.2 atm abs. At Intermountain (0.86 atm abs), HBO2 is provided at 2.0 atm abs for routine treatments and 3.0 atm abs for carbon monoxide poisoning. Intermountain IAs breathe intermittent 50% nitrogen/50% oxygen at 3.0 atm abs and 100% oxygen at 2.0 atm abs. The chamber profiles include a safety stop.
  
  
  RESULTS
  From 1990-2013, Presbyterian/St. Luke's had 26,900 total IA exposures: 25,991 at 45 fsw (2.2 atm abs) and 646 at 66 fsw (2.8 atm abs); there have been four cases of IA DCS. From 2008-2013, Intermountain had 1,847 IA exposures: 1,832 at 2 atm abs and 15 at 3 atm abs, with one case of IA DCS. At both facilities, DCS incidents occurred soon after the chambers were placed into service.
  
  
  CONCLUSIONS
  Based on these results, chamber inside attendant risk for DCS at increased altitude is low when the inside attendants breathe supplemental oxygen.
authors.affiliation: Hyperbaric Medicine, Intermountain LDS Hospital, Salt Lake City, Utah, USA. james.bell@imail.org
authors.forename: James
authors.initials: J
authors.lastname: Bell
authors.forename: Paul A
authors.initials: PA
authors.lastname: Thombs
authors.forename: William J
authors.initials: WJ
authors.lastname: Davison
authors.forename: Lindell K
authors.initials: LK
authors.lastname: Weaver
mesh_terms: D000531:Altitude; D001274:Atmospheric Pressure; D002249:Carbon Monoxide Poisoning / Q000628:therapy; D002985:Clinical Protocols; D003120:Colorado; D003664:Decompression / Q000592:standards* / Q000706:statistics & numerical data; D003665:Decompression Sickness / Q000517:prevention & control*; D006282:Health Personnel; D006801:Humans; D006931:Hyperbaric Oxygenation / Q000009:adverse effects / Q000706:statistics & numerical data*; D009326:Naval Medicine / Q000592:standards; D009784:Occupational Diseases / Q000517:prevention & control*; D010102:Oxygen Inhalation Therapy / Q000379:methods*; D012016:Reference Values; D014589:Utah; D014945:Wound Healing