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Veterinarians Emotional in Wake of Kesmarc Explosion

By Lou Anne Epperley, DVM
For Veterinary Practice News

Posted: April 11, 2012, 3:35 p.m. EDT

Horror, shock and soul-searching gripped a community of equine veterinarians after the death of a horse and his caregiver in the February explosion of a high-pressure oxygen therapy chamber in Florida. Feelings of deep sadness swirled around their firm conviction that pressurized oxygen therapy has helped countless human and veterinary patients, and promises much more.

“The sadness for the loss of life and injury, both human and horse, literally defined the moment that was shared by the veterinary community,” said Scott E. Palmer, VMD, hospital director and staff surgeon at New Jersey Equine Clinic in Millstone Township. “Apart from the emotional response to such a loss, hyperbaric medicine practitioners around the world received this news with a common concern: What could have possibly caused such a catastrophic explosion, and could this happen in my own facility?”

Erica Marshall, 28, and the horse Landmark’s Legendary Affaire were killed Feb. 10, 2012, at Kesmarc Farm and Equine Rehabilitation Center in Ocala, Fla. A second worker, Sorcha Moneley, 33, was injured when the hyperbaric oxygen chamber containing the horse exploded after flames ignited in the highly flammable enclosure.

“There have been many different theories and speculations made about the cause of this accident,“ said Dennis R. Geiser, DVM, equine clinician at the University of Tennessee College of Veterinary Medicine. “The investigations into this accident continue, and until those investigations are completed we are not in a position to report on the cause.”

Tennessee’s veterinary college, which has both large- and small-animal hyperbaric oxygen chambers, may be the only teaching hospital with onsite hyperbaric facilities, said Dr. Geiser, a diplomate of the American Board of Veterinary Practitioners-Equine. “When an accident of this nature occurs, there is always an immediate reaction of disbelief and discomfort that often breeds skepticism and doubt, not to mention the sorrow and sympathy for the people involved,” he said. “Since the resurgence of animal hyperbaric therapy, in particular large-animal hyperbaric oxygen therapy, in the late 1990s, thousands of horses, small animals and a few exotic animals have been successfully and safely treated.”

In hyperbaric oxygen therapy, the patient is placed in a 100-percent oxygen chamber, where high pressure condenses oxygen  molecules and increases blood oxygen levels up to 15 times greater than normal, Geiser said.

“Hyperbaric therapy is able to increase tissue oxygen levels in diseased tissue, which improves and speeds healing, improves the body’s ability to fight infections, and reduces inflammation and swelling,” according to a document from Tennessee’s Center for Veterinary Hyperbaric Medicine. In animals, Geiser said, “Essentially any disease that produces tissue hypoxia has the potential to benefit.”

Hyperbaric therapy is a primary treatment for severe smoke inhalation and burns, clostridial and other anaerobic infections, and compromised wounds. It also is used for treatment of ligament disease, bowed or diseased tendons, fractures, exercise-induced pulmonary hemorrhage, laminitis, colic, joint infections, myositis (tying up), neurologic disease and more.

Wreckage after explosion at Kesmarc Equine Rehabilitation Center
A Marion County evidence technician looks over the wreckage after a deadly explosion at Kesmarc Farm and Equine Rehabilitation Center in Ocala, Fla. Photo by Marion County Sheriff’s Office
“I think those practitioners currently associated with operational HBO units either by ownership or by referral will likely look upon it as a tragic accident similar to a car accident or plane crash,” said Kathleen Anderson, DVM, of Equine Veterinary Care PC in Elkton, Md. She is a partner in Fair Hill HBO Services.

“Our facility has performed over 6,000 treatments in the past four years, and although we are very cognizant that there is an inherent risk in the technology and materials, we believe the benefits far outweigh the risks,” Anderson added.

Dr. Palmer, a diplomate of the ABVP-Equine, said fires within clinical hyperbaric chambers are “extremely rare; explosions, even more so. … The object of hyperbaric chamber fire safety protocols is to ensure that fuel inside the chamber is kept to an absolute minimum, and that ignition sources are not present.

“Prior to the recent incident in Florida, I am aware of only two equine hyperbaric chamber fires,” he said. “In one case, two horses were being treated in a hyperbaric chamber together and began to kick the walls of the chamber, creating sparks that caused a fire. In another case, a horse that was groomed with ShowSheen polish prior to entering the chamber spontaneously ignited during treatment.”

The Florida incident, where the entire chamber exploded, appears to be unique, Palmer said.

Hyperbaric chambers manufactured in the United States are constructed to specifications of the National Fire Protection Association and the American Society of Mechanical Engineers in accordance with safety standards for pressure vessels of human occupancy, Palmer said.

The Veterinary Hyperbaric Medical Society was formed in 2006 to bring science and research together to direct the use of hyperbarics in veterinary medicine with an emphasis on safety, noted Nathan Slovis, DVM, of Hagyard Equine Medical Institute in Lexington, Ky.

Dr. Slovis, a diplomate of the American College of Veterinary Internal Medicine, is certified in both human and veterinary hyperbaric technology.

“Anybody who invests a quarter of a million dollars in a chamber should also invest a week of their time and $3,000 of their money to go through one of these training courses,” he said. “There are a lot of chambers out there being run by lay people—and not under the direction of veterinarians— that are being used for inappropriate applications.”

Geisner, Palmer and Slovis said the veterinary hyperbaric society is partnering with the human National Board of Diving and Hyperbaric Medicine and the Underwater and Hyperbaric Medicine Society  to establish training, certifications and continuous education in hyperbaric medicine.

“At this point, it is appropriate for all veterinary hyperbaric oxygen therapy centers to review the operational parameters of their chambers to ensure that they are operating according to the manufacturer’s specifications,” Palmer said. “They need to re-visit safety protocols and emergency procedures, and dedicate themselves to rigorous adherence to those for each and every treatment session.”

Palmer, a past president of the American Association of Equine Practitioners, added, “Training, experience, vigilance and good judgment are key components to the safe operation of hyperbaric chambers.”


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