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News
Stephen D. Reimers, PE
Reimers Systems, Inc.
Hyperbaric-Clearinghouse, Inc.
Something New (and Dangerous) to Watch For!!!
Nearly everyone is familiar with the risks that arise when a pocket warmer is taken into a hyperbaric chamber. Four fatal fires (three in monoplace chambers and one in a multiplace chamber) are believed to have been caused by pocket warmers smuggled into the chambers by patients.
"Old style" pockets warmers were the equivalent of a small butane lighter inside a metal cage. More modern ones consist of a small amount of finely divided iron inside a semi-permeable pouch. When the pouch is removed from its air-tight package, air seeps in and supports slow oxidation of the iron This releases a gentle heat that can last for several hours. These types of warmers are widely available during cold months, and are especially popular around ski areas. During cold weather they can be purchased for about a dollar each in many neighborhood convenience stores, ski shops, hardware stores, etc. A typical such device sold as a "hand warmer" is shown in Figure 1.
These handy gadgets, when used as intended, are a delightful comfort aid. However, when introduced into a hyperbaric chamber, they can become quite dangerous. The elevated oxygen partial pressure increases the rate at which the iron filings oxidize, and therefore the rate of heat production. The result is that the pouch can get quite hot; hot enough to create a nasty thermal burn or even start a fire.
Now, these pocket sized warmers have a "big brother" that has the potential to give hyperbaric
personnel even more concern. A major pharmaceutical company is distributing a full line of air-activated heat wraps under the tradename, "ThermaCare". See Figure 2. Like pocket warmers, when used correctly, they are a safe, comfortable and quite effective. They come in a variety of shapes and sizes that permit them to be applied with their standard adhesive backing to nearly any part of the body where heat would be beneficial. I tried one and found it to produce about as much heat as I could comfortably tolerate. I also found it to last for around the eight hours advertised.
Am I selling these things? Not at all. My point is that they are new, widely available and likely to become very popular. In my area (Northern Virginia) they are available, over the counter, in any well stocked pharmacy. Consequently, in the hyperbaric field, it is vitally important that all care providers become aware of their existence and do everything they can to ensure that one of these handy devices does not get inadvertently carried into a chamber. This has to potential to be an issue substantially more difficult and delicate that the issue of pocket warmers. These devices do appear to have legitimate therapeutic value, and they may also be applied in very private places. The package shown in Fig 2 is promoting their use for menstrual cramps. Current packaging also does not include any safety warning about taking the devices into elevated oxygen environments. Consequently, patients may erroneously assume that they are safe to wear into a chamber. The result is that these devices are going to present facility safety directors with some very interesting challenges.
As with most safety issues, the keys are awareness and vigilance. Please pass this article on to everyone you know that is associated with a hyperbaric service.
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