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MILITARY MILITARY
MEDICINE MEDICINE

The World of including the BAMC UHM clinic, also provide advanced
Most clinics that provide hyperbaric medicine services,

Hyperbaric Medicine wound management. Wound care is more than just put-
ting a dressing on a wound. It's also about looking into the
patient’s general health, lifestyle and factors that might
slow healing down. Wound care may consist of application
By Lt. Col. Jason Kelly, MD, Jayesh Shah, MD and Earl G. Wolf, Jr. MD of specialty dressings or ointments, negative pressure as-
sisted wound closure, bio-engineered skin, debridement
to remove infected tissue, compression therapy, transcuta-
P resident Kennedy dedicated the Aerospace Medical Health neous oxygen studies and vascular studies.

Center (AMHC) in San Antonio on December 21, 1963. De-
As the need for the wound care and hyperbaric service
compression illness (DCI) in military divers resulted in the use
of hyperbaric pressure treatment protocols developed by the military in San Antonio for veterans is so much, sometimes BAMC
facilities are not able to accommodate all the veterans. This
in the early 1900s. However, it was not recognized as an etiology of occurs with veterans who have Medicare/Tricare for Life
DCI at altitude as aircrew returned to ground level. In the 1950s, high as a military benefit or live outside mileage limits. Patients
altitude conditions resulted in reconnaissance aircraft as well as altitude can be treated in civilian wound healing and hyperbaric
chamber research for space efforts that had deaths. A case of neurocir- facilities. Group physicians and providers take pride in
culatory collapse DCI was treated with hyperbaric oxygen therapy treating our veterans who have provided a lifetime of serv-
(HBO2) with success. This resulted in adding a large hyperbaric cham- ice to our nation. Veteran patients who are referred to civil-
ber to treat DCI cases at USAF School of Aerospace Medicine as part ian wound and hyperbaric centers have diagnoses of
of AMHC. The dedication was President Kennedy’s last official duty diabetic wounds, sensory neural hearing loss, radiation cys-
before going to Dallas the next day. titis and all other UHMS approved diagnoses.
World research of HBO2 for clinical conditions blossomed in the
late 1970s. Robert Marx at Wilford Hall Medical Center (WHMC) President John F. Kennedy delivers an Address at the Dedication of the Aerospace Lt. Col. Jason Kelly, MD is the Undersea and
used HBO2 to treat osteoradionecrosis secondary to cancer radiation Medical Health Center in San Antonio at Brooks Air Force Base on November 21, Hyperbaric Medicine Consultant to the USAF
1963. Photo courtesy: AmericanRhetoric.com.
treatment with publications starting in 1983. Soft tissue and bone ra- Surgeon General and the fellowship Program Di-
diation injury treatments are now common. The USAF became the an individual breathes near 100% oxygen intermittently while inside rector at Brooke Army Medical Center. He is certified in
DoD Lead Agent for Clinical Hyperbaric Medicine in 1986. Partner- a hyperbaric chamber that is pressurized to greater than sea level pres- Family Medicine and Undersea and Hyperbaric Medicine.
ship with WHMC, Brooke Army Medical Center (BAMC) and Audie sure. It is used extensively to treat a variety of medical conditions
Murphy Memorial Veterans Hospital (ALMMVH) resulted in central amongst active-duty members, their families, military retirees and vet- Jayesh Shah, MD, a wound care specialist cer-
retina artery occlusion data in the 1990s. Due to the DoD Base Re- erans. Approved indications most frequently encountered involve se- tified in Internal Medicine and Undersea and
alignment and Closure (BRAC) of Brooks Air Force Base, the clinic lected problem wounds, such as diabetic foot ulcers and wounds support through the management of regional DCI cases and consul- Hyperbaric Medicine, is a member of the Board
was moved to the renamed Wilford Hall Ambulatory Surgical Center involving chronic refractory osteomyelitis, as well as delayed radiation tation on worldwide U.S. Air Force pressure-related injuries. In addi- of Trustees of the Texas Medical Association and the Bexar County Med-
(WHASC) with a new rectangular multiplace and monoplace cham- injuries, such as osteoradionecrosis and radiation cystitis. HBO2 is tion, the BAMC UHM clinic hosts fellowship training in UHM, one ical Society.
bers in 2007. The Undersea and Hyperbaric Medicine (UHM) Clinic also indicated as an adjunct treatment in more urgent conditions such of only eleven programs nationwide. Over the decades, many of the fel-
led the first DoD study for the potential use of HBO2 treatment for as compromised surgical flaps and grafts, clostridial myonecrosis, acute lowship graduates have settled in San Antonio, making it a robust com- Earl G. Wolf, Jr. MD is board-certified in Aerospace Medi-
traumatic brain injury and post-traumatic stress disorder (PTSD) in traumatic ischemias, necrotizing soft tissue infections, iatrogenic ar- munity of hyperbaric medicine facilities in the country. cine and Undersea and Hyperbaric Medicine, both under the
2009-2011. BRAC hit again as the WHASC facility was to be demol- terial gas embolism, central retinal artery occlusion and idiopathic The BAMC UHM clinic serves as one of two regional facilities that American Board of Preventive Medicine and has 43 years in
ished once the new WHASC facility was completed. The USAF Sur- sudden sensorineural hearing loss. is capable of providing 24/7 emergency care, to include critical care UHM experience.
geon General Green subsequently authorized a Military Construction HBO2 is the primary treatment for DCI, which includes diving and services. As BAMC is one of San Antonio’s Level 1 Trauma centers,
Program connected to BAMC and approved by U.S. Army Surgeon altitude-related decompression sickness and arterial gas embolism. not only does the clinic serve DoD/Tricare beneficiaries and veterans, The view(s) expressed herein are those of the author(s) and do not reflect
General Schoomaker. The existing chambers were moved to the state- These conditions are experienced as a result of recreational and occu- but it also treats some civilians who are admitted through the BAMC the official policy or position of Brooke Army Medical Center, the U.S.
of-the-art facility at BAMC in 2017. pational hazards in both civilian and military populations, however, Trauma Service. The program is also frequently involved in research Army Medical Department, the U.S. Army Office of the Surgeon General,
The use of hyperbaric oxygen therapy lectures are rarely given in the nature of military operations can result in greater risk of occurrence. and other projects aimed at expanding the utilization of HBO2. Cur- the Department of the Army, the Department of the Air Force and De-
medical schools, so the information here may be new to many of our The BAMC UHM staff serves a dual purpose, treating routine outpa- rently, the staff is collaborating with the Department of Veterans Af- partment of Defense or the U.S. Government.
San Antonio providers. HBO2 is defined as an intervention in which tient and inpatient conditions, but also providing military operational fairs to expand the treatment of veterans with PTSD.

16 SAN ANTONIO MEDICINE • February 2022 Visit us at www.bcms.org 17