Hyperbaric Consultation at Brooks City-Base

Consultations are also available through the Audie Murphy Veterans Hospital for specific patient categories.

VA Referral Procedures:

Doctors from the VA hospital first enter an electronic consult in their system once they determine that the patient needs HBO therapy. The consult will then go to FEE service where the patient's veteran eligibility is verified. The referral is then forwarded to the Scarce Resource Manager at the Chief of Staffs Office, who will turn in the consult the Chief of Staff for final approval. In his absence, the Administrative Officer also has the authority to approve it. Once approved, the FEE office will call or fax approval for the evaluation to Brooks. Most VA doctors are familiar with this process, however, those who have not done it yet, may not and start calling us to set up the evaluation before obtaining approval. Thus, a simple question of whether the patient is approved for HBO treatment to the VA doctors will help. The Brooks hyperbaric medicine physicians are always willing to discuss a potential referral with a VA physician who is uncertain if HBO is warranted in a particular case. Before we can actually schedule the patients evaluation, however, Chief of Staff authorization must be received. Once scheduled, the referring physician must coordinate with the nursing station and with transportation so that the patient can receive breakfast, meds, and get to the van by 0615 AM. See below for other information.

We currently have no mechanism to evaluate patients who are not authorized care in one of the defined military beneficiary categories.

Primary

acute carbon monoxide poisoning
cerebral arterial gas embolism
decompression sickness

Secondary (adjunctive)

acute thermal burns
compromised skin grafts/flaps
clostridial gas gangrene
crush injury/other acute ischemias
intracranial abscess
necrotizing soft tissue infections
refractory osteomyelitis
selected problem wounds-vascular insufficiency-diabetic ulcers
osteoradionecrosis-soft tissue radionecrosis

Emergency referrals (DCS, CO) are made as below during duty hours. After hours, use the Brooks Command Post at 210-536-3278 or DSN 240-3278 and request the Hyperbaric Medicine Physician on-call.

Routine referrals are made on a Physician to Physician basis only. The referring physician should contact our Medical Officer of the Week (MOW) at 536-3281 or DSN 240-3281 to explain the reason for the referral and provide a case synopsis. The MOW will provide a date and time for our next available appointment. We will need the patients name, SSAN, beneficiary status, age, and current diagnoses, the physicians office phone number, FAX number, and pager. Information regarding any known or suspected infection control issues, such as MRSA, VRE, Chronic Hepatitis, or immunocompromise should also be reviewed.

If the patient is over age 60, OR has pulmonary disorders, a recent chest X-Ray report is needed (in the past 12 mos). If the patient has a history of Congestive Heart Failure with exercise intolerance, a recent echo with ejection fraction estimate is required.

On the day of the appointment, the patient must bring: Appropriate identification to pass through Brooks City-Base gate security; X-Ray and/or echocardiogram reports as indicated above; outpatient medical records; copies of recent medical consultations; copies of recent hospital admissions with H&P and discharge summary; copies of any recent vascular studies; List of Current Medications; if mental compromise is present, an adult with a current medical power of attorney must accompany.

Please provide the patient with a map to our facility by expanding and printing those below. Please carefully explain that we are located at Brooks City-Base, NOT Brooke Army Medical Center. The full consultation will take between 2 to three hours, depending on case complexity and whether Transcutaneous Oximetry testing is needed. The patient should take all of his/her usual medications, and need make no alterations in their daily routine. Unless otherwise instructed by the referring physician (or if post-operative dressings have not yet been removed or replaced), we will remove dressings from, inspect, photograph, and re-dress any wounds we have been requested to evaluate.