Special Operations Forces Medical Handbook

8-37

gauge, ventilation pump (hand-, foot- or battery powered), connecting hoses
Useful/Optional: Carbon dioxide absorption device (‘CO 2 scrubber’; placed inside chamber), mat or blanket
for patient to lie upon (for increased comfort), supplemental oxygen (can be placed inside chamber or added
to ventilation air at pump)

What To Do:
NOTE: Follow specific instructions for the type/brand of pressure chamber being used.
Begin Treatment

1. Attach ventilation pump to chamber using hose.


2. Place patient in chamber. (Be sure patient’s head is visible in viewing window.)


3. Close chamber. (If patient is alert, instruct them to hold the fabric away from their face.)


4. IMMEDIATELY begin pressurizing/ventilating the chamber with ventilation pump.


5. Watch pressure gauge. When chamber is pressurized enough, ventilation valve will open automatically to
   exhaust CO 2 and prevent over-pressurization. Listen for sound of air exhaust to confirm ventilation.


6. Continue pumping at slower rate to maintain pressure and ventilation. Do not stop pumping while patient
   is inside chamber.

Length of Treatment

1. No absolute guidelines. Treat until symptoms resolve (usually takes more than 2-3 hours) or until patient
   can be evacuated to lower altitude.


2. Continuously observe patient through chamber window. Talk to patient to reassure—chambers transmit
   voices easily.


3. Consult US Navy Treatment Tables in this book for guidelines on the treatment of DCS and
   AGE/POIS with hyperbaric oxygen.

End Treatment

1. Instruct patient to equalize ears as necessary during chamber decompression by swallowing or Valsalva
   maneuver.


2. Open exhaust (‘dump’) valve. Continue pumping at low rate to maintain ventilation.


3. Watch pressure gauge. When pressure inside chamber is equal to pressure outside (gauge reads
   “0”), open chamber and remove patient. Opening chamber before pressures are equal causes sudden
   decompression and can damage patient’s ears or sinuses. Theoretically, sudden decompression could
   also cause decompression sickness (‘bends’).

What Not To Do:
Do not stop ventilation pump while patient is inside chamber. (Constant pumping is required to insure
continued oxygen supply and to exhaust carbon dioxide.)
Do not decompress chamber at rapid rate or open it before pressure inside is equal to pressure outside.
(Necessary to avoid sudden decompression problems.)

Procedure: Pain Assessment and Control

LTC Michael Matthews, MC, USA & COL Warren Whitlock, MC, USA

What: Pain control is an integral part of the overall management of the sick or injured patient and often the
most neglected. Many studies have shown that health care providers are poor at recognizing and treating
pain and that untreated acute pain can lead to chronic pain syndromes. The medic should not allow his
own feelings toward pain influence how he perceives his patient’s reaction, but simply recognize that each
person handles pain in their own way and try to alleviate the pain to the maximum extent possible given the
circumstances. The SOF medic should teach the patient that it is easier to prevent pain than to “chase” or
treat it once it has become established, and that communication of unrelieved pain is essential to its relief.