October 6, 2015

The National Board Of Diving And Hyperbaric Medical Technology (NBDHMT) Exam

The National Board of Diving and Hyperbaric Medical Technology has certified hyperbaric technologists, nurses, diver medics, and veterinarians since 1985, first as the National Association of Diver Medic Technicians and since 1991 as the National Board of Diving and Hyperbaric Medical Technology. The name was changed because more and more nurses and technicians working in the area of hyperbaric medicine in hospitals were seeking certification. In 1991, the newly named National Board of Diving and Hyperbaric Medical Technology began certifying hyperbaric technologists. Four years later, in 1995, the Board began to certify hyperbaric nurses as well.

The purpose of the original National Association of Diver Medic Technicians was twofold. The Association intended to establish and standardize its training approaches, and also wanted to bestow certification upon diver medic technicians as well. In the mid 1070s, commercial oilfield installations began encouraging medic technician divers to become certified by allowing onsite training, particularly at sites that were isolated.
Until the last sixty years, recompression, or hyperbaric, chambers were for the most part found at dive operations rather than within hospital walls. While today hyperbaric technologists, nurses, vets and medic divers, who are involved with delivering hyperbaric oxygen therapy and deep ocean medicine, must be highly trained and carefully monitored, the period lasting until the middle of the last century used dive team members with an interest in or talent for this specialized type of work to take on the required tasks.

After the midpoint of the century a medical interest in the importance of hyperbaric programs caused a gradual shift in the training setting to hospitals and other medical specialty locations. Developments in technology and new perspectives resulted in research that suggested hyperbaric quantities of oxygen could produce therapeutic advantages both in hyperbaric and non-hyperbaric situations. As a result, an increase in hospital interest meant technologists who were trained to a consistent and high quality standard were necessary.

While commercial and military divers initially worked as trainers during the time period in which hyperbaric education began transitioning from remote onsite locations to medical settings, it became increasingly clear that hyperbaric professionals without healthcare training could not fulfill certain responsibilities. Medically trained healthcare workers such as respiratory therapists, emergency medical therapists, nursing staff members and paramedics began to join the ranks and undergo hyperbaric oxygen therapy training.

Today, the purpose of the National Board of Diving and Hyperbaric Medical Technology is to promote diving medicine and hyperbaric oxygen therapy safety; to institute high standards for curriculums used in introductory training courses; to create, offer, assess and maintain certifications for hyperbaric technologists and nurses; and to support professional growth. The Board offers as its mission statement to“(e) nsure that the practice of diving medicine and hyperbaric oxygen therapy is supported by appropriately qualified technologists and nurses, through respective board certification pathways.”

The National Board Of Diving And Hyperbaric Medical Technology Technologist Training And Certification

In order to qualify for certification, a hyperbaric technologist must undergo basic hyperbaric medicine instruction. This instruction is offered through a limited number of hospital settings that have been approved by the National Board of Diving and Hyperbaric Medical Technology (NBDHMT), and familiarizes candidates with fundamental concepts such as hyperbaric hyperoxia physiology applications in oxygen therapy. This basic instruction stresses the requirements and expectations of the FDA, health care programs, and the Undersea and Hyperbaric Medical Society. Potential problems that can arise in dosing, side effects to treatments and other dangers are examined, as well. Some hospital programs are set up to permit students to look at monoplace hyperbaric delivery systems as well as multiplace systems. Some training environments are also equipped to teach students to utilize and monitor transcutaneous oximetry.

Graduates interested in pursuing certification must attend and complete an introduction to hyperbaric medicine course through a program that has been approved by the National Board of Diving and Hyperbaric Medical Technology. In addition to attending classes and workshops, certification is also dependent upon a candidate’s successful completion of a preceptorship in which practical hands- on experience under the expert guidance of a specialist has been obtained.

In order to obtain hyperbaric technology certification, candidates must have completed certification in a qualifying field. There are a number of acceptable pathways, including holding certification as a Respiratory Therapist; Physician’s Assistant; EMT or Paramedic; Military Corpsman; Licensed Practical Nurse or Registered Nurse; Nurse Practitioner; Certified Nurse’s Aide; Physician; Certified Medical Assistant; or Physiologist.

Other qualifications include completing a Transcutaneous Oxygen Monitoring Module. In addition once coursework has been completed, candidates must document 480 hours of experience working in hyperbaric medicine, undersea medicine or aviation medicine technology. Of these hours, 40 of them must have been in the form of a supervised internship with a Certified Hyperbaric Technologist (CHT) or Certified Hyperbaric Registered Nurse (CHRN) preceptor. A further requirement is that candidates must document at least 12 credits in continuing education seminars, classes, workshops or other qualifying education every two years; of these hours, six must focus on hyperbaric medicine, undersea medicine or aviation medicine.

To become certified, a candidate must be able to demonstrate a clear general understanding of physics as it relates to pressure exposures; units used to hyperbaric and diving; how to convert units of measurement; Dalton’s Law of partial gas pressure; Boyle’s Law of air volume and consumption; Charles’ Law of the interrelatedness of temperature and pressure changes; Henry’s Law; barotraumas on ear, sinus cavity, dental and pulmonary systems as a result of pressure change; decompression illness and anatomy and physiology of the cardiovascular, respiratory, musculoskeletal, endocrine and other systems. Candidates must also be able to answer questions regarding gas systems as they relate to life support systems and chamber operations; chamber environments; and clinical skills and knowledge.

The certification examination is created out of a database of hundreds of vetted questions. The question test bank is monitored and updated as technology and techniques change. Candidates must earn a score of at least 70% in order to pass; however, it is in the test taker’s best interest to earn a score of 90% or better, because that score comes with the additional recognition of With Distinction.

The certification test is given throughout the year at a variety of regional and national conferences and meetings. Board- approved community colleges or other organizations can also proctor the exam.

Two hours in total is allotted for a range of multiple choice or true/ false format questions. Registration must be completed in advance; candidates may not register for the certification exam immediately prior to taking it. Pocket calculators are permitted, and decompression tables will be available.

Hyperbaric Registered Nurse Training And Certification

According to the Baromedical Nurses Association, baromedical nursing is “the diagnosis and treatment of human response to actual or potential health problems in the altered environment of the hyperbaric chamber”. Baromedical nurses work as educators, clinicians, and researchers with the ultimate and essential goal of providing safe and high quality care to patients.

Hyperbaric Registered Nurse Training And CertificationThe National Board of Diving and Hyperbaric Medical Technology (NBDHMT) has offered a Hyperbaric Registered Nurse Training and Certification credential since 1995. The field of hyperbaric nursing can be traced to European roots in the middle of the last century, when nurses were required to assist with multiplace chambers, and were trained on- site. With the introduction of monoplace hyperbaric chambers in the mid 1960s, hyperbaric nurses were required to undergo formal training.

The first wave of hyperbaric nurses was for the most part experienced with emergency room nursing, surgical assisting and critical care. Part of their training included hyperbaric oxygen therapy. At the first hyperbaric conference held in the United States in 1978, nurses were able to attend workshops specifically designed for them. This conference, which was sponsored by the Long Beach, California Baromedic Department at Memorial Medical Center, marked the recognition of important contributions made by hyperbaric nurses.

The Baromedical Nurses Association was established in 1985 and has grown into an international association since. The Baromedical Nurses Association creates standards of practice in the area of baromedical nursing and ensures that these standards are maintained.

By the 1990s, the Baromedical Nurses Association created an examination for hyperbaric nurses as a first step toward an examination that could be given for certification. At that point, the National Board of Diving and Hyperbaric Medical Technology offered to administer the Baromedical Nurses Association certification examination, and extended the invitation to the Association to become part of the Board.

The resulting certification exam combines questions concerned with both nursing activities and safety, operational and technical concerns for hyperbaric nurses. In all, 40% of the questions on the certification examination focus on nursing tasks, with the remainder given to the other areas. By 1995, the newly established Baromedical Nurses Association Certification Board administered the first hyperbaric nursing certification exam. Currently, three levels of certification are offered; Certified Hyperbaric Registered Nurse (CHRN), Advanced Certified Hyperbaric Registered Nurse (ACHRN) and Certified Hyperbaric Registered Nurse Clinician (CHRNC).

Certified Hyperbaric Registered Nurse training programs are offered or approved by the National Board of Diving and Hyperbaric Medical Technology as accredited medicine courses. After certification is achieved, nurses must undergo continuing education in order to be permitted to maintain their certification requirements.

The Certified Hyperbaric Registered Nurse (CHRN) credential is nationally recognized and valid for four years. The certification exam is created from a database of questions that are reviewed on a regular basis to ensure all questions address current issues, are comprehensive and up to date.

Prior to applying for a CHRN credential, a candidate must be a Registered Nurse with an active license in the state. Applicants must provide evidence of Basic Life Support certification, and have at least two years of hospital clinical experience, or critical care experience of at least one year. A 40- hour course in introductory hyperbaric medicine approved by the National Board of Diving and Hyperbaric Medical Technology is also required.

Additional requirements include at least a full year of work experience in hyperbaric medicine that has been completed within the last two years. This experience must include at least 480 work hours completed after the candidate graduated from the 40- hour course. A letter of recommendation from a supervisor or employer is also required.

Preparing For The National Board Of Diving And Hyperbaric Medical Technology Exams

It is safe to say that anyone who is taking the National Board of Diving and Hyperbaric Medical Technology Technologist Training and Certification (NBDHMT), Hyperbaric Registered Nurse Training and Certification, Diver Medic Technician Training and Certification, or Veterinary Hyperbaric Training and Certification exam is absolutely serious about succeeding. These tests require a tremendous amount of theoretical and content knowledge, as well as the techniques, training and ability to apply such knowledge. It is highly unlikely if not impossible that an applicant could sit for one of these certifications and pass on the first try without a tremendous amount of preparation.

Because these tests are so intense, the wise candidate will begin preparing for the exam well in advance. How you prepare depends, in part, upon your personal learning style. Some people learn best in a face- to- face test preparation environment where a live teacher is available to answer specific questions. Having a ready learning community composed of other students can be a great way to go if you like to bounce ideas off of others, argue points, and dive into deep review together. Another benefit of going this route is that your classmates might think of questions you haven’t gotten to yet. You’ll not only learn from the material presented by the instructor and from asking your own questions, you’ll also learn by osmosis from others.

But some people find that learning online or independently is the best way to go. If you’ve already got a full time job, young children or other obligations, you might not have enough flexibility in your schedule to be able to meet with a regularly scheduled class. If that’s your situation, you might do better either forming your own study group that meets when everyone can, or by learning on your own through an online test preparation class or using a study guide, flash cards or other materials you purchase.

The first step to guaranteeing you’re sufficiently prepared is to download and closely study the booklet posted on the National Board of Diving and Hyperbaric Medical Technology website for your particular certification type. These materials contain a tremendous amount of information, and by reviewing them you’ll have a good idea what will be covered in the test itself. Use a highlighter or make a list of the areas you feel you are weakest in. There’s not much point in spending your valuable study time reviewing the areas of concentration you already know like the back of your hand.

Next, do some online research. Considering your weakest areas, find as much information as you can that discusses recent developments in technology, applications, theory or approaches. Begin your focus here.

The first level of study should be fairly broad; consider those aspects that affect your area of certification in a number of ways. Once you’ve gotten a handle on the big picture, it’s time to move in for closer and closer looks. Keep in mind that you cannot learn everything there is to learn, if for no other reason than because it’s always evolving! If you’ve got a solid understanding of the basics and are comfortable with deeper layers in most areas, you’ll most likely do fine on the examination.

The National Board Of Diving And Hyperbaric Medical Technology Diver Medic Technician Training And Certification

The National Board Of Diving And Hyperbaric Medical Technology Diver Medic Technician Training And CertificationDiver medic technicians provide a highly specialized and very important service to professional, scientific and commercial divers who become ill or experience an accident on- site. Oftentimes these divers are working in a remote location, isolated by rugged terrain, vast bodies of water, and limited small plane or helicopter landing areas. Rapid recompression can mean the difference between life and death or long- term neurological damage.The exam is the National Board of Diving and Hyperbaric Medical Technology Technologist Training and Certification (NBDHMT)

Many diver sites have a recompression chamber available. They might be located on research ships, oil or gas platform support ships, off- shore drill rigs, or in an island marine science building that is located on a nearby shore. A physician is available to guide and supervise medical treatment, but rarely is the physician near enough to work directly with an ill or injured diver. This role is fulfilled by a certified Diver Medic Technician who is on- site and readily available to follow the instructions given by the off- site contracted physician.

Diver Medic Technicians must be certified and closely monitored. While they act as diver paramedics, they may at times be required to utilize invasive treatments and otherwise handle decompression trauma complications.

The National Board of Diving and Hyperbaric Medical Technology certifies diver medics who have completed Board approved training. Hospitals and other training facilities as well as instructors themselves can apply to the Board to request approval of their programs. The Board will examine the course curriculum, faculty experience, knowledge and reputation, and the training setting to determine if approval is appropriate. Provisional approval may be given to training facilities or educators that the Board feels will earn final approval.
To qualify for certification, a Diver Medic Technician must complete an approved training course and be certified to work in a pressurized location. Being fit to dive is not a requirement. The applicant must also hold an emergency medicine training program certificate, and submit these documents together with an Instructor Evaluator form and a Diver Medic Certification form.

The initial certificate is good for two years, following which time recertification is necessary. Recertification requirements can be fulfilled in a number of ways, although in all cases diver medics must attend 24 hours of continuing training courses during the two year period of time. In addition, diver medics must be able to show proof of at least 24 hours of observation spent in an ambulance, emergency room, or combination. Diver medic technicians who are not working on land can substitute emergency medical cases they managed or observed during the two year window, but the medic’s supervisor must sign off on this.

Diver medics should select their continuing education courses to reflect the type of work environment they are in. The goal of continued training is to constantly elevate the diver medic’s skills, ability and knowledge, as well as to help them keep abreast of the most up- to- date developments in the field in terms of equipment and approaches. Prior skills should be enhanced by continuing education, and new information addressed as well. Some diver medics will satisfy the requirements in a single course, while others will find it more advantageous to take a number of shorter workshops.

A minimum of four hours per two- year cycle must include a course in diving medicine that is led by a National Board of Diving and Hyperbaric Medical Technology approved teacher. In the event a diver medic wants to take this course with an instructor who is not approved, approval must be requested prior to the course beginning.

A minimum of 16 hours per two- year cycle must be basic EMT level or higher general emergency medicine. These hours can be satisfied with any recognized organization, such as the American Red Cross or a community college.

Four hours of instruction given by an approved teacher can address remote duty medicine, diving medicine, or hyperbaric medicine.

The National Board Of Diving And Hyperbaric Medical Technology Veterinary Hyperbaric Training And Certification

In order to be permitted to become a Certified Hyperbaric Technologist Veterinary, candidates must currently be a working Veterinarian DVM, Certified Assistant; Vet Tech; Medical Doctor; Animal Science Technician; EMT, Registered Nurse or Licensed Practical Nurse. In addition, all test candidates must have taken and successfully completed a hyperbaric course at the introductory level that has been approved by the National Board of Diving and Hyperbaric Medical Technology (NBDHMT).

A clinical internship is also required at a minimum of 240 hours working with hyperbaric, undersea or aviation medicine technology; of this at least 50% must have involved specific veterinary hyperbaric medicine experience and training. The internship is designed to strengthen the candidate’s familiarity with chamber equipment; facility orientation; patient assessment; safe chamber operation; and patient preparation, in addition to develop a strong foundation of general knowledge in the field.

Once certification is obtained, recertification is required every two years. In order to recertify, candidates must be able to prove at least 16 continuing education credits have been earned within the two- year time frame, with 50% of this time devoted to safety issues in undersea hyperbaric medicine. In addition, the certificate holder must provide employer verification of at least 100 hours of experience working in hyperbaric or undersea medicine.

The certification exam will ask questions regarding the physiology of gases and how pressure affects hyperbaric medicine. In order to correctly utilize hyperbaric oxygen therapy, practitioners must have a comprehensive understanding of how increasing pressure affects an animal’s body, and the problems that can arise from increased pressure as well as the benefits of using oxygen therapy for disease management.

Successful exam candidates will have reviewed units of measurement used to define diving and hyperbaric oxygen therapy pressure, and how to convert these units. They will also be familiar with the major laws that describe the behaviors of gases under certain circumstances, such as Boyle’s Law, which projects air consumption and volume; Charles’ Law, which is concerned with the interrelatedness between temperature and pressure; and Dalton’s Law, which considers alveolar oxygen concentration and gas pressure at a range of depths. Preparation should include facility with definitions and terms associated with hyperbaric oxygen therapy, and a thorough understanding of barotraumas, both in terms of direct and of indirect pressure change effects. Carbon dioxide and carbon monoxide poisoning; hyperthermic and hypothermic events; hypoxic and anoxic events; and the symptoms of such events on animals might also appear as question content in this exam.

Candidates should be prepared to address issues concerning the neurological, cardiovascular, musculoskeletal, integumentary and respiratory systems of felines, canines, equines, avian, reptiles and other animals, and the effects of pressure changes on them.

A review of contraindications that should alert the veterinarian that hyperbaric oxygen therapy should be avoided is also essential, including untreated diseases and disorders such as pneumothorax, guttural pouch disease, and ear diseases, viral infections, chronic respiratory infections and optic neuritis.

An understanding of chamber operations should also be part of the candidate’s review process. This area of the test might ask questions regarding monoplace and multiplace chambers, how internal chambers are monitored, and the how types of equipment found in hyperbaric systems such as fire suppression equipment, compressors, and oxygen delivery systems operate.