New Orleans could host the first hyperbaric ambulance concept
BY KEITH VAN METER, MD., LSUHSC EMERGENCY MEDICINE SECTION HEAD, NEW ORLEANS
The concept of a hyperbaric ambulance (an ambulance that could operate conventionally in transport of patient at one atmosphere to earn its keep in a fleet of regular EMS ambulances but that could switch and select in instances to hyperbaric oxygen mode for patient transport) has the potential to sit as a center post and a rich composite of capability seated in New Orleans.
Hyperbaric oxygen if immediately available 24/7 has a favorable impact on at least 10 medical emergencies including crush injuryDisplay footnote number:1, cardiopulmonary arrestDisplay footnote number:2, acute blood loss shockDisplay footnote number:3, traumatic brain injuryDisplay footnote number:4, acute vision loss (CRAO)Display footnote number:5, sudden sensorineural hearing lossDisplay footnote number:6, acute hypoxic SARS CoV2 eventsDisplay footnote number:7, acute burnsDisplay footnote number:8, necrotizing fascilitisDisplay footnote number:9, decompression illnessDisplay footnote number:10, carbon monoxide poisoningDisplay footnote number:11, and crush injuryDisplay footnote number:12. The transport of patients to the hospital while under pressure while breathing oxygen would have the potential to impact patient outcomes favorably for these medical events.
Louisiana has been the home and startup location for some of the world’s greatest commercial diving companies. The NASA Michoud Assembly Plant in New Orleans East has been one of the national stepping stones for the exploration of space. The Baromedical Research Institute Laboratory on the Westbank of New Orleans has done groundbreaking research in establishing the application of hyperbaric oxygen to resuscitation science. The old Charity Hospital in its repurposing in downtown New Orleans now houses the nation’s most advanced hyperbaric chamber simulation training laboratory for health care workers to include doctors, nurses, hyperbaric technicians and diver medical technicians. The LCMC UMC Trauma Center Emergency Department stands as the nation’s largest staffed facility with Tulane and LSU faculty cross-trained, board-certified emergency physicians with subspecialty training board certification in hyperbaric and diving medicine – the perfect destination for a hyperbaric ambulance.
Every day, our bodies replace our entire body weight with the energy-providing molecule of adenosine triphosphate ATP.Display footnote number:13 If we don’t make our body weight equivalent of ATP, we stand the risk of not having enough energy to power our body’s homeostasis. Oxygen on-site to every cell’s mitochondrial respiratory chains is necessary to make 95% of our daily ATP. In acute injury or illness, delivery of oxygen at one atmosphere of pressure is a tall order. One solution is to safely put into solution dissolved oxygen in plasma enough to support cellular ATP production even without oxygen carried by red blood cells. Hyperbaric oxygen does just this.Display footnote number:14
For example, if resupply by blood flow to the brain of either oxygen or glucose does not occur, then altered mental state and/or unconsciousness rapidly ensues. In the instance of a profoundly low blood sugar in a patient, health care providers would best choose intervenous 50% dextrose solution if immediately available rather than a “lifesaver under the tongue” to address the situation. Likewise, if the patient were acutely, profoundly hypoxic, critical care hyperbaric health care providers would choose hyperbaric oxygen surface equivalent of 200% to 280% oxygen if immediately available to address the previously mentioned medical conditions rather than the “lifesaver under the tongue” equivalent of 100% oxygen at one atmosphere of pressure.
With all the resources and connections available to Louisiana, I believe that for a $1 million grant, a working prototypic ambulance could be up and running in New Orleans to fit into the metropolitan prehospital EMS system. The cost of subsequent hyperbaric ambulance production would decrease, and treatment in the municipal and rural EMS in the US, as well as anywhere in the world, would be an immense benefit to the military, and oil and gas recovery operations
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