Recompression Chamber Utilization at Naval Base Guam: An Update.

INTRODUCTION: Since 1971, the U.S. Naval Base Guam recompression chamber (NBGRC) has provided hyperbaric oxygen therapy (HBO2) to primarily treat diving decompression sickness (DCS) but also to treat other indicated medical conditions. In 2017, Rendina et al. last reviewed the NBGRC's utilization. The current paper is an update of the chamber's activity from January 2017 through October 2024 including pre- and post-COVID-19 data. The goal of the current study is to report the diagnoses, treatments, demographic data, and estimated costs when providing HBO2 at NBGRC. This information will potentially assist the Defense Policy Review Initiative plan for future staff and resources.

MATERIALS AND METHODS: All cases of HBO2 performed at NBGRC from January 1, 2017, to November 1, 2024 were retrospectively reviewed. Paper and electronic medical records including consents, transport summaries, consult notes, insurance records, and hospital records were abstracted for diagnoses, treatments, and eligibility data. In addition, using the eligibility data and Medicare/Medicaid billing codes, charges for HBO2 services for non-Tricare beneficiaries were determined.

RESULTS: From 2017 to 2024, 66 patients underwent 176 HBO2 treatments: 31 civilians (47%); 29 active duty (AD) personnel (44%); and 6 retirees (9%).During the study period, there were 180 HBO2 indications. There were 106 (59%) indications for non-dive diagnoses such as diabetic ulcers and wound therapy; 63 (35%) for DCS; 6 (3%) for arterial gas embolism (AGE); 4 (2%) for carbon monoxide (CO) poisoning; and 1 (1%) for cabin decompression. There were 70 HBO2 indications for decompression illness (DCI) (which includes DCS, cabin decompression, and AGE) from January 2017 to October 2024. Pre-COVID, 2017-2019, there were 42 DCI indications; during COVID, 2020-2021, there were 19 DCI indications; and post-COVID, 2022-2024, there were 9 DCI indications. There was a significant difference in DCI indications pre-COVID (M = 14 ± 4.97) compared to post-COVID (M = 3 ± 0.82); t(2) = 3.13, P = .044. Total Reimbursement for non-Tricare beneficiaries from 2017 to 2024 was $102,274.94. Pre-COVID charges were $56,377.18; during COVID, $29,587.52; and post-COVID, $16,310.24.

CONCLUSION: The primary purpose of NBGRC is to support AD operations. However, the current study demonstrates that the treatment of civilian dive injuries is actually the major utilizer of the recompression chamber. Meticulous billing and collecting of facility fees and physician fees from non-Tricare patients for HBO2 services should be emphasized. The COVID decline in treatments has not rebounded to pre-COVID levels, in large part, because of the decline in the Guam tourism industry. Hyperbaric oxygen therapy treatments are expected to increase as Guam tourism improves. In addition, the upcoming relocation of Marines from Okinawa to Guam will also increase HBO2 treatment numbers. The Defense Policy Review initiative needs to factor in the increase in HBO2 treatments because of both these factors. Although the intent of this article is not necessarily to discuss the impact, it should be emphasized that the Navy undersea community and the utilization of recompression chambers and hyperbaric medicine is a life-saving service. Policy changes and resource allotment should always remember this most important mission.