Royal Hobart Hospital’s new $12m hyperbaric unit almost complete
Step inside the Royal Hobart Hospital’s new $12 million hyperbaric unit and discover how it is playing a crucial role in both medical treatment and space research.
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WE are punching so far above our weight it’s incredible, says diving and hyperbaric medicine specialist Dr David Cooper. He’s talking about the Royal Hobart Hospital’s new $12 million hyperbaric unit, which is almost complete — and his excitement is palpable. The state-of-the-art 66-tonne, 14m-long multi-place chamber is dual-purpose — meaning it can both pressurise (hyperbaric) and depressurise (hypobaric).
Significantly, this latter capability — which exists in only a few places worldwide — opens up exciting possibilities for space research in Tasmania by allowing researchers to create and test “intermediate atmospheres” in which astronauts or space tourists can live safely without compromising their health.
“At this stage it offers the potential to be something really special,” says Cooper, a pilot and aviation and space medicine specialist who is medical co-director of the RHH’s Department of Diving and Hyperbaric Medicine.
“This is the opportunity of a lifetime — that’s how exciting it is. We believe we will be able to contribute significantly to the safety and efficiency of human space exploration in terms of some of the modelling we can do in the chamber [and] of the human testing of equipment [such as space suits].
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“It gives Tasmania a foot in the door for a lot of growth and development in STEM (science, technology, engineering and mathematics) fields.
“This is a unique facility [the only one in the Southern Hemisphere] and we are already getting a lot of interest from people overseas and around the country who are interested in coming down in future years to work with us and benefit from the facility.”
Dr Alicia Tucker, the unit’s current Fellow in Diving and Hyperbaric Medicine, says she’s excited by the opportunities for space research in Tasmania. The UTAS medical school graduate completed a month-long sabbatical in space medicine with the University of Texas Medical Branch/NASA Johnson Space Centre last year and is a designated aviation medical examiner for Australia’s Civil Aviation Authority (CASA).
“We hope to be involved in projects whereby people will have to live in or stay in [the chamber] for a week or so to see if they can tolerate these intermediate atmospheres,” Tucker says.
“We will be simulating alternative space environments that we may one day colonise. The reality is the commercial space industry is evolving very rapidly with [aerospace companies] SpaceX and Virgin Galactic and that’s an aspect I am very interested in.
“At the moment we know the space flight environment can be dangerous even for extremely fit people like astronauts. What we don’t know is how will people with already ill health [but] who are well financed enough to be able to afford a space flight or space tourism, manage.”
Astronauts can get decompression sickness or “the bends”, which is more typically associated with underwater diving, because the pressure in the spacesuits they wear on spacewalks is significantly lower than the ambient pressure of the International Space Station.
They have to prepare for this by going through a denitrogenation process, which can take up to 12 hours and includes sleeping in an airlock, prior to all spacewalks.
“Another way we can prevent decompression sickness in space habitats is to create different or intermediate atmospheres in which people can live in. These conditions would have the right mix of oxygen and other gases, which will make it safe to live in a space habitat environment without compromising normal physiological needs,” Tucker says.
THE Royal’s temporary hyperbaric unit is small and cramped in comparison to the one it has replaced. It’s been operating for about 18 months, in proximity to the building works. There was one notable hiccup early on when a monoplace chamber was dropped from a forklift as it was delivered. Repairs, however, did not delay the overall redevelopment process — nor dampen the team’s enthusiasm for the project.
“It was damaged enough to have to send it back to the manufacturer and get it all checked and retested and easily repaired. We are using it now,” the unit’s co-director, Dr David Smart says.
Hyperbaric oxygen treatment has been offered at the RHH for more than 30 years. It is a well-known treatment for decompression illness that assists by squashing bubbles which form in the blood and tissues after divers have been exposed to pressure underwater.
It is also used to treat tissue injury from radiation treatment for cancer, diabetic wounds and serious infections such as gangrene.
Patients have the option of sitting either in a pressurised multi-chamber wearing a clear plastic hood, which feeds pure oxygen, or a monochamber for just one person. As the pressure is increased patients have to pop their ears in the way scuba divers do, or as passengers do on an aircraft.
“Our core business [of hyperbaric medicine] is divided into four patient groups,” Smart says. “One quarter are diabetics with non-healing ulcers; one quarter are cancer survivors who have had radiation injuries from radio therapy and they have wounds that won’t heal because of the damaged tissue; one quarter are divers; and one quarter are a mixed bag of miscellaneous conditions, from severe infections through to carbon dioxide poisoning.”
The last chamber was decommissioned because of its age and proximity to the construction site at the hospital. In 25 years, it assisted 1850 patients and was used in more than 29,600 treatments. It has been entombed behind a wall within the temporary unit.
“We were up for a rebuild,” Cooper says. “Twenty five to 30 years is the rough life span of one of these facilities. We were up for one and the K block redevelopment just happened to come about at the right time.
“It takes the best part of a decade to plan for this sort of chamber. Obviously with a 20-30 year lifespan, when a chamber reaches its halfway mark you start the process of the ball rolling for its design and future planning.”
The decommissioned chamber — a quirky, submarine-style cylinder with porthole windows — has been replaced with a square one, which has capacity for up to 10 patients to be treated simultaneously.
“Now we have a square style, like a room, so you can fit more patients in,” Hyperbaric Facility Manager Corry Van den Broek says.
“It’s more user-friendly and it doesn’t look like a chamber, so it’s not so scary. You walk in and feel like you’re in a room.
“Even basic things like toilet facilities and hand basin facilities are all inside the chamber now. It used to have very primitive facilities such as a pan, whereas these ones have flushing toilets and hand cleaning facilities so infection control is much better. We are the last of all Australian states to get a square chamber.”
The new facility has the “capability of receiving divers straight off the helipad into the acute care room for resuscitation and then into the chamber, to minimise the time to treatment,” Scott says.
THE team’s upbeat mood is irrepressible when the conversation shifts again to the chamber’s hypobaric capability. The idea for a dual-capacity chamber was formalised just two years ago, when planning for the unit was well under way.
The new hyperbaric chamber had a price tag of $5 million. The team had discussed the potential of a dual capacity chamber intermittently for many years. Cooper was especially keen on the idea given his interest in space and aviation.
When they realised that retro-fitting the chamber with hypobaric capability would be too expensive, they moved quickly to convince the Health Minister Michael Ferguson that hypobaric capability was worth investing in — and it was now, or never.
“We realised that to do it at the time of building the chamber, it would cost about [an additional] quarter of a million, but to try and retrofit something like that, you can imagine it’s a major building operation, it would probably cost 10 times that amount,” Smart says.
What had been just an idea years earlier became a firm plan when the minister agreed to fund the new capability if they were able to secure additional funds from industry. Several partners — Tasmanian Salmonid Growers Association, the Tasmanian Abalone Council, the Diver Alert Network Asia Pacific, the UTAS School of Medicine and the Tasmanian Polar Network — supported the idea.
Smart says the result is a world-class “multi-environment centre”. “We’ve got this amazing capability to do research and provide commercial services to the airline industry and that means a potential income stream for the State Government out of the capability of this chamber — for training pilots and aircrew, and exposing them to altitude,” Smart says.
“It gives us the opportunity to synergise with Tasmania’s strong suits. We have the Antarctic Division and they go to altitude all the time when they’re on the ice caps. Some of the research being done there is at 3600m above sea level.”
Cooper agrees: “There’s a capability for us to do research before they even go down to Antarctica on what the effects will be. There’s enormous potential for things I probably haven’t even thought of.”
HYPERBARIC oxygen treatment is an important treatment for decompression illness and is essential for Tasmania’s commercial and recreational diving industries.
It is also used to treat a number of other conditions, including tissue injury from radiation treatment for cancer, diabetic wounds and serious infections, such as gangrene.
It helps wounds heal by:
- Decreasing swelling, allowing greater blood flow to the wound.
- High oxygen levels helping white blood cells kill bacteria.
- New growth in blood vessels.
- Encouraging collagen production, which acts as a framework for new cells to grow around.
Hypobaric chambers are used for aerospace, or altitude research and training to simulate the effects of high altitude on the body, with potential application to high altitude, space and extreme medicine research and testing, and airline defence training.
penelope.mcleod@news.com.au
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