Overview
Emergency HBOT protocols are among the oldest and most clinically established. Decompression sickness and arterial gas embolism use US Navy Treatment Table 6 (2.8 ATA with extensions) or Table 6A for severe cases. Carbon monoxide poisoning typically follows the Weaver protocol: three sessions in the first 24 hours — the first at 3.0 ATA, subsequent sessions at 2.0 ATA. These are acute, time-critical, hospital-based interventions.
Emergency HBOT is the original clinical application of hyperbaric medicine. US Navy diving operations developed the Treatment Tables for decompression sickness in the mid-20th century, and these protocols — refined through decades of operational experience — remain the gold-standard global reference. The Weaver 2002 NEJM carbon monoxide trial established the modern CO protocol. UHMS Tier 1 approval covers the primary emergency indications.
Delivery requires tertiary hyperbaric facilities with 24/7 emergency capability. Decompression sickness treatment is typically coordinated through the Divers Alert Network (DAN) +1-919-684-9111 (24/7 US hotline). CO poisoning cases are directed from emergency departments to the nearest hyperbaric-capable facility. Gas gangrene and necrotising fasciitis cases are coordinated through surgical and critical-care teams.
Time-criticality distinguishes emergency HBOT from routine courses. Treatment effectiveness diminishes with delay. US Navy Table 6 for DCS can still produce benefit hours to days after symptom onset, but earlier is better. The Weaver CO protocol requires initiation within 24 hours. Necrotising infection HBOT must be adjunctive to urgent surgical debridement.
Protocol Parameters
| Pressure | 2.8–3.0 ATA (DCS/AGE), 2.0–3.0 ATA (CO Weaver protocol) |
|---|---|
| Session length | 4–8 hours (Table 6/6A); 90 min (CO Weaver) |
| Frequency | Single or back-to-back acute sessions |
| Typical course | 1–3 sessions (CO), 1–5 (DCS/AGE) |
Indications
- Decompression sickness
- Arterial gas embolism
- Carbon monoxide poisoning
- Clostridial myonecrosis (gas gangrene)
- Crush injury & acute traumatic ischaemia
- Necrotising soft-tissue infection
Each emergency indication has a specific protocol. DCS/AGE: US Navy Treatment Table 6 or 6A. CO: Weaver protocol (3 sessions in 24 hours). Gas gangrene / necrotising fasciitis: 2.5–3.0 ATA sessions coordinated with surgical debridement. Crush injury: Bouachour protocol (3 sessions in first 24 hours).
Evidence Base
UHMS-approved; Weaver et al. 2002 (CO); US Navy Diving Manual Tables 6/6A (DCS/AGE); Bouachour 1996 (crush injury); multiple retrospective series for gas gangrene and necrotising fasciitis.
Cautions & Notes
- Requires 24/7 hyperbaric facility access
- Multidisciplinary emergency team coordination
- Patients often critically ill — multiplace capability needed
- Delay reduces benefit
Practical Considerations
Emergency HBOT is delivered at tertiary hyperbaric facilities. For divers: DAN (+1-919-684-9111) coordinates US emergency response. For CO poisoning: emergency departments direct to nearest hyperbaric-capable facility. For gas gangrene / necrotising fasciitis: initiated by surgical team at admission.
Frequently Asked Questions
How quickly must emergency HBOT be delivered?
As quickly as possible. DCS: within hours to days (earlier is better); Table 6 remains effective for most cases up to 48 hours. CO: within 24 hours (Weaver protocol). Gas gangrene / necrotising fasciitis: initiated during the first surgical debridement.
Where do I go for emergency HBOT?
For diving injuries, call DAN +1-919-684-9111 (24/7) for coordination. For CO poisoning, present to the nearest emergency department. For infections and crush injury, standard emergency medical transport to a trauma centre with hyperbaric capability.
Can every hospital provide emergency HBOT?
No. Emergency HBOT requires a hyperbaric facility with 24/7 capability — typically a tertiary hospital with a multiplace chamber. Patients may be transferred from community hospitals to specialised centres for emergency HBOT.
Research disclaimer: This protocol summary is for educational purposes only. HBOT is a regulated medical treatment that must be administered under appropriate professional supervision. Always consult a qualified physician before initiating hyperbaric therapy.