Hyperbaric Chamber Emergency Procedures: A Canadian Clinic Owner Guide

Reading time: 11 minutes

TL;DR: A hyperbaric chamber emergency procedure is a documented protocol that clinic staff follow when a patient or chamber suffers a sudden adverse event during treatment. Canadian clinic owners must build written procedures for fire suppression, rapid decompression, oxygen toxicity seizures, in-chamber medical events, and middle-ear barotrauma. Recent research published in 2025 shows that fewer than half of hyperbaric units run regular emergency drills, and that standardised cardiac arrest protocols remain inconsistent across facilities. Building a defensible safety system requires written procedures, scheduled drills, equipment certification, and staff competency records.

Hyperbaric chamber emergency procedures are the most consequential operational documents a Canadian hyperbaric clinic owns. A fire, rapid decompression, oxygen toxicity seizure, or in-chamber cardiac event can escalate in seconds, and the difference between a contained incident and a regulatory shutdown often comes down to whether staff have rehearsed a written protocol. This guide outlines the emergency categories every clinic owner must address, the Canadian regulatory framework that governs them, and the operational practices that the most recent peer-reviewed safety literature supports. Canada Hyperbarics maintains this resource for operators building or auditing their safety programmes.

What counts as a hyperbaric chamber emergency in a Canadian clinic?

A hyperbaric chamber emergency is any in-chamber or chamber-adjacent event that requires immediate deviation from the planned treatment profile to protect the patient, the operator, or the facility. Canadian operators should classify emergencies into five operational categories, each with a distinct response pathway.

1. Fire or thermal event inside a pressurised, oxygen-enriched space.
2. Rapid or uncontrolled decompression caused by seal failure, hatch breach, or operator error.
3. Patient medical emergency, including cardiac arrest, oxygen toxicity seizure, severe hypoglycaemia, or pneumothorax.
4. Mechanical or gas-supply failure, including loss of treatment gas, compressor failure, or ventilation breakdown.
5. Communication or behavioural emergency, including patient claustrophobia, panic, or refusal to equalise during compression.

Each category needs its own written protocol, its own escalation chain, and its own quarterly drill. Lumping them into a single “emergency plan” is the most common documentation failure on Canadian provincial inspections.

How often do hyperbaric emergencies actually happen?

Serious hyperbaric emergencies are rare, but minor adverse events are common enough that every clinic will see them. The published incidence varies by event type:

Event type	Reported incidence	Source
Middle-ear barotrauma (per patient)	9.2 to 10.0%	Nasole 2019; Edinguele 2020
Treatment discontinued for ear injury	1.49 to 16.2% of cases	Nasole 2019
Oxygen toxicity seizure	1.47%	Elfil 2025 retinal artery occlusion review
Epistaxis (nosebleed)	0.83%	Elfil 2025
Cardiac arrest requiring in-chamber defibrillation	0 cases across 14 Australasian units surveyed	Beilharz 2025
Adverse events overall (fibromyalgia cohort, low-pressure HBOT)	23.8% mostly transient	Chen 2023

The data point Canadian clinic owners should internalise is this: middle-ear barotrauma is the single most common adverse event, and it accounts for the majority of treatment discontinuations. According to a five-year retrospective on 2,610 patients, premature treatment discontinuation traced to middle-ear injury was the dominant cause of incomplete therapy in one Marseille centre (Edinguele 2020). A separate review of 5,962 patients at an Italian multiplace centre reported a 9.2% middle-ear barotrauma rate, with rhinitis and impaired equalisation as the leading modifiable risk factors (Nasole 2019).

What does the fire safety protocol need to cover?

Fire is the lowest-frequency but highest-consequence hyperbaric emergency. Because the chamber atmosphere can be oxygen-enriched and pressurised, ignition sources that would be trivial at surface pressure become catastrophic at treatment depth. A defensible fire protocol must address ignition control, suppression, and post-event documentation.

Ignition control starts with patient screening. Canadian operators should verify that patients enter the chamber wearing 100% cotton garments, with no electronics, no battery-powered hearing aids unless the manufacturer has documented hyperbaric clearance, no petroleum-based lotions, hair products, or makeup, and no static-generating fabrics. Many provincial inspectors now ask to see the written patient-prep checklist signed by both the patient and the technician before each session.

Suppression equipment for monoplace acrylic chambers typically includes a deluge water system pre-plumbed into the chamber envelope. For multiplace steel chambers, the protocol usually combines internal water deluge with rapid depressurisation drills and external Class D extinguishers in the chamber room. Every Canadian clinic should have documented commissioning records from the chamber manufacturer, an annual third-party safety inspection, and monthly visual checks recorded in the chamber logbook.

Defibrillator policy is a fire-related decision that many Canadian operators have not formally documented. A 2025 scoping review of in-chamber defibrillation concluded that defibrillation is strictly contraindicated inside monoplace chambers and that, in multiplace chambers, the risk-benefit calculus must be made case by case (Nohl 2025). The companion survey of 14 Australasian hyperbaric units found that no in-chamber defibrillation had ever been performed across the surveyed centres and that only 43% of units ran regular cardiac arrest drills (Beilharz 2025). Canadian clinics should adopt an explicit written policy stating whether in-chamber defibrillation is permitted at their facility and, if not, document the surface-decompression sequence used to deliver shocks safely.

How should staff respond to an oxygen toxicity seizure?

Central nervous system oxygen toxicity is rare at standard treatment pressures of 2.0 to 2.4 atmospheres absolute, but it remains the most common acute neurological emergency in a hyperbaric clinic. The 2025 retinal artery occlusion review reported a seizure incidence of 1.47% across nine pooled studies, which is the most cited current figure for this complication (Elfil 2025).

A defensible seizure response protocol for a Canadian clinic should include these documented steps:

1. Remove the patient from oxygen by switching them onto chamber air or air-break mask immediately.
2. Do not begin decompression while the patient is actively seizing, because the closed glottis during a tonic phase creates a real risk of pulmonary barotrauma.
3. Once the seizure resolves and normal breathing returns, begin a slow decompression following the chamber manufacturer’s seizure profile.
4. Notify the supervising physician before the chamber reaches surface.
5. Document the time of onset, the duration of seizure, the inspired gas mixture, the ambient pressure at onset, and the treatment indication.
6. File the event in the clinic incident log and report it according to the chamber manufacturer’s adverse-event reporting policy and provincial requirements.

Lowering the treatment pressure is one of the most evidence-supported preventive strategies. A 2023 systematic review of HBOT for fibromyalgia found that lower treatment pressures, below 2.0 atmospheres absolute, were associated with fewer adverse events while preserving clinical benefit (Chen 2023). For recognised indications that require higher pressures, the trade-off must be assessed individually by the supervising physician.

What is the rapid decompression protocol for Canadian operators?

Uncontrolled decompression is a low-frequency event in modern Canadian hyperbaric practice because chamber engineering has improved substantially over the past two decades. When it does occur, it is typically caused by a hatch seal failure during the compression phase, a viewport gasket failure at depth, or operator error during a manual decompression sequence.

The Canadian clinic protocol should distinguish between three operational scenarios:

• Controlled emergency decompression: the staff-initiated rapid descent used when an in-chamber medical emergency requires patient extraction. Every clinic should have a written timed profile for this manoeuvre, signed off by the supervising physician.
• Operator-initiated abort: the protocol used when equipment monitoring detects a fault. Staff should know the exact button or valve sequence, the audible alarms expected, and the patient-communication script.
• Uncontrolled decompression: the rare seal-failure event. Staff response is focused on patient assessment for pneumothorax, arterial gas embolism, decompression sickness, and barotrauma, plus immediate facility shutdown and chamber-manufacturer notification.

The chamber room itself should be configured so the operator can reach all emergency valves without leaving the line of sight of the chamber. Canadian provincial inspectors increasingly ask for a copy of the chamber room layout diagram with emergency stations clearly marked.

How often should Canadian clinics run emergency drills?

The most cited gap in current hyperbaric safety practice is drill frequency. Beilharz and colleagues surveyed 14 hyperbaric medicine units and found that only 43% ran regular cardiac arrest drills, despite near-universal recognition that drills are the single most important predictor of effective emergency response (Beilharz 2025). The UHMS Hyperbaric Facility Accreditation Manual calls for regular emergency drills covering all five categories on a rotating schedule, and many Canadian programmes adopt a quarterly cadence.

A practical drill calendar for a small Canadian clinic looks like this:

Quarter	Primary drill	Secondary drill
Q1	Fire response, full team	Oxygen toxicity seizure
Q2	Rapid decompression, full team	Patient claustrophobia and abort
Q3	Cardiac arrest, full team	Loss of treatment gas
Q4	Multi-failure scenario, full team	Ear barotrauma recognition and management

Each drill should be documented with date, scenario, participants, observed time-to-action, deviations from protocol, and the remediation plan. Provincial inspectors and accreditation reviewers consider drill documentation one of the highest-weight safety signals.

What patient screening prevents the most emergencies?

The cheapest way to reduce in-chamber emergencies is rigorous pre-treatment screening. The 2020 Marseille retrospective identified clear, modifiable risk factors for middle-ear barotrauma: age over 55, female sex, history of ENT disease, smoking, obstructive breathing disorders, and impaired tympanic mobility on initial examination (Edinguele 2020). The Italian 5,962-patient series confirmed that pre-existing rhinitis and any reported difficulty equalising during the descent phase predicted barotrauma at significantly elevated rates (Nasole 2019).

Every Canadian clinic should build a structured screening checklist that captures:

• Otoscopy and pneumatic otoscopy at initial consultation, repeated weekly during multi-session courses.
• Recent upper respiratory infection or active rhinitis status before each session.
• Current medications, with attention to insulin, antiepileptics, doxorubicin, bleomycin, and disulfiram.
• Smoking status and last cigarette before treatment.
• Recent imaging where pneumothorax risk is suspected.
• Pregnancy status for women of reproductive age, with the supervising physician’s documented risk-benefit assessment.

For an evidence-based review of patient selection, refer to the broader research database maintained by Canada Hyperbarics, which includes more than 14,000 indexed studies on hyperbaric oxygen therapy. To verify the operational standards of accredited hyperbaric facilities across Canada, visit our directory of hospitals and regulated facilities.

What does emergency documentation need to include?

Documentation is the single most defensible asset a Canadian clinic owner has after an adverse event. The threshold standard expected by provincial regulators, Canadian medical device licensing under Health Canada, and most commercial insurers is a written record of every emergency containing the following fields:

• Date, time of onset, and time of resolution.
• Patient indication and prescribed treatment profile.
• Inspired gas mixture and ambient pressure at onset.
• First responder’s role and time-to-action against the written protocol.
• Supervising physician notified at what time, by what method.
• Post-event clinical disposition, including follow-up imaging or specialty referral.
• Equipment status confirmed by the chamber manufacturer or service technician before next use.
• Patient consent for incident review and any data sharing.

Many Canadian clinic owners discover at audit time that they have informal notes and verbal recall, but no signed, dated, structured record. Adopting a one-page incident report template, signed by both the responding technician and the supervising physician, closes this gap with minimal operational friction.

Frequently asked questions about hyperbaric emergency procedures

Are Canadian hyperbaric clinics required to file incident reports with Health Canada?

Yes, in many situations. Under the Medical Devices Regulations, a serious incident involving a licensed hyperbaric chamber that contributes to a death or serious deterioration in health must be reported to Health Canada by the manufacturer and, where applicable, the importer. Clinic operators should also notify the chamber manufacturer in writing of any adverse event, who will trigger the regulatory chain if the event meets the reporting threshold. Provincial requirements may add reporting duties on top of the federal framework.

How long should a Canadian clinic keep emergency drill records?

Most provincial regulators, accreditation bodies, and commercial insurers expect drill records to be retained for at least the lifetime of the chamber installation, plus a defined post-decommissioning archival window. A common practical standard is to retain electronic records indefinitely and paper records for a minimum of ten years. Clinic owners building a new programme should set the retention policy in the safety manual and never delete drill documentation.

Who can authorise an emergency decompression in a Canadian clinic?

The chamber operator on duty must be authorised to initiate an emergency decompression when patient safety requires it, without first obtaining physician approval. Waiting for a physician phone call during an acute event is not a defensible protocol. The supervising physician should sign off on the written authorisation framework, the operator competency record, and the documented timed profile for each chamber model in use.

Do monoplace and multiplace chambers need separate emergency protocols?

Yes. The physics of the two chamber types differ substantially, and the in-chamber response options are different. A monoplace chamber has no attendant inside, so any in-chamber emergency requires extracting the patient before clinical care can begin. A multiplace chamber has an attendant who can deliver basic care at pressure, which changes the decision tree for cardiac arrest, seizures, and decompression illness. Clinic owners who operate both chamber types should maintain two parallel protocols, not one merged document.

What is the role of the supervising physician during an in-chamber emergency?

The supervising physician sets the standing orders, reviews the written protocols, signs off on operator competency, and remains reachable during all treatment hours. During an acute event, the on-duty chamber operator follows the standing orders without delay. The supervising physician is notified during or immediately after the event, attends in person where the situation warrants, and signs the post-event clinical disposition record.

What should a Canadian clinic owner do next?

If you operate or are commissioning a hyperbaric facility in Canada, audit your written emergency procedures against the five categories outlined above, confirm the quarterly drill cadence is documented, and ensure your incident report template captures every field a regulator or insurer would expect to see. For comparative reference against accredited Canadian hyperbaric programmes, visit our directory of hospitals and regulated facilities. For the underlying evidence base, the Canada Hyperbarics research database indexes peer-reviewed publications on hyperbaric safety, adverse events, and chamber operations.

Canada Hyperbarics is a Canadian-focused information resource for patients, referring physicians, clinic owners, and researchers. We do not provide treatment directly. We index the evidence and the accredited Canadian facilities that deliver hyperbaric care.

Medical disclaimer: This content is for informational purposes only and does not constitute medical advice. Hyperbaric oxygen therapy decisions, including safety protocol design and emergency response planning, must be made in consultation with the supervising physician, the chamber manufacturer, accredited safety auditors, and the applicable Canadian provincial and federal regulators.