As a practicing physician in hyperbaric medicine, I am alarmed at the insidious expansion of poorly regulated hyperbaric chambers in the United States. These facilities use unsafe chambers and do not conform to industry standard safety practices, tragically leading to two fatal accidents in 2025 and likely countless unreported injuries. It is imperative to know how these facilities differ from reputable hyperbaric programs, the injuries they may cause, and what you can do to help. One of these facilities likely is in your community, you should be aware and ready to respond.

Consider the Case

A 40-year-old male presents to the emergency department complaining of shortness of breath after the “soft” hyperbaric chamber he had used at a wellness center as a treatment to prevent aging failed. Treatment pressure was around 1.3 ATA (about 4 psi above surface). During his treatment, the chamber zipper failed and rapidly decompressed. Along with shortness of breath, he complains about confusion and an inability to move his left side. How would you evaluate and treat this patient?

Defining the Issue

Since 1967, the Undersea and Hyperbaric Medical Society (UHMS) has outlined evidence-based indications for the therapeutic use of hyperbaric oxygen (HBO) and promoted industry safety standards through advocacy and their facility accreditation program. Hyperbaric treatments are not without risk. However, when treatments are conducted in regulated chambers, under physician supervision, with well trained staff, hyperbaric medicine is safe. Over 130 chambers in the U.S. have obtained UHMS accreditation — a voluntary, third-party inspection that verifies a program meets the highest industry standards for safety and patient care.

In recent years we have seen an expansion of poorly managed chambers in wellness centers, chiropractic offices, and even homes. Many use soft or inflatable chambers that are FDA approved only for acute mountain sickness, either in their clinic or at home. They may tout themselves as “mild hyperbarics” by targeting chamber pressures of 1.3 ATA, well below therapeutic standards. Even these “mild” pressures can lead to catastrophic injuries during chamber failure. More difficult to identify are facilities that use standard “hard-sided” chambers capable of reaching 2.0 ATA, a standard pressure used at reputable facilities. Both types of facilities share troubling attributes of minimal physician oversight, questionable prescriptive authority and lax safety standards. They operate afoul of existing U.S. Food and Drug Administration (FDA) and National Fire Protection Association (NFPA) regulations that are poorly enforced and usually left to local fire marshals who may have minimal experience with local chamber practices or required regulations.