Thomas M. Fox MAS, MS, CHT
The safety of hyperbaric operations has long been one of the field’s defining strengths, built on decades of disciplined practice, engineering controls, and clinical vigilance. That reputation, however, should never be mistaken for invulnerability. The fatal accidents reported in 2025 represent more than isolated tragedies—they are signals. Signals that even mature, highly regulated systems can drift, that latent risks can accumulate quietly, and that success itself can sometimes erode the very caution that created it.
When a field operates for years without major incident, a subtle cultural shift can take hold. Procedures become familiar, routines feel intuitive, and the perceived margin for error widens. In hyperbaric medicine, where patients are treated in oxygen-enriched, pressurized environments, that margin is, in reality, razor thin. Oxygen, while therapeutic, is also a powerful oxidizer. Under pressure, its capacity to accelerate combustion transforms minor oversights into potentially catastrophic events. The environment does not forgive complacency—it amplifies it.
The accidents of 2025 have prompted extensive reflection, and rightly so. Many experienced voices have contributed analyses, each offering pieces of a larger truth. Among the most consistent findings is not a single point of failure, but rather a convergence of vulnerabilities: gaps in training, inconsistencies in procedural adherence, and insufficient emphasis on the physical principles that govern chamber safety. These are not failures of intent—they are failures of system design, reinforcement, and culture.
A modern hyperbaric safety program must therefore evolve beyond static compliance models into something more dynamic and resilient. Borrowing from high-reliability industries such as aviation, a Crew Resource Management (CRM) approach provides a valuable framework. In this context, safety is not the responsibility of a single operator or supervisor, but a shared, continuously active process involving every member of the team. Communication is deliberate, hierarchy is flattened when safety is at stake, and situational awareness is treated as a collective asset rather than an individual skill.