HBOT Conversations:
Tom Fox (Part 2)
Tom is the Research Physiologist for the Hyperbaric Institute for Research and Training, a division of Island Hyperbaric Centre in Pincourt QC. He has worked in the field of Clinical Hyperbaric Oxygen for the last 30 years, and has been intimately involved with the implementation and the development of the US Army’s Clinical Hyperbaric Service at Dwight David Eisenhower Army Medical Center. Tom is a senior army aviator and flew twelve years as a Medical Evacuation Pilot for the US Army.
Tom joined the Extivita-RTP team in 2022 as the Safety Director, and is joining us in a 2-part series to discuss the history of Hyperbaric Oxygen Therapy and dive into his personal experience healing patients with HBOT.
Watch the Podcast
In Part 2 of Ed di Girolamo’s conversation with Tom Fox, we dive further into the history of hyperbarics and how this all plays a part in where we are today in understanding, administering, and healing patients with HBOT. Part 1 discussed HBOT history up to Cunningham’s ball in the 1920s.
We start our conversation discussing the time when operating rooms were essentially hyperbaric chambers. Tom explains that was before the FDA, and they started using pressurized rooms and oxygen as an alternative method to do heart surgery and replace valves, because if you super-saturate the body during surgery you can extend the length of time that a patient can go without oxygen. The time was upwards of 13 to 15 minutes, allowing the surgeon more time to do valve replacement. This could have been a real game-changer for the HBOT industry, but it was short-lived because the bypass machine replaced hyperbaric operating rooms.
Then in 1963 the HBOT industry had a set-back. President John F. Kennedy had a premature son who had a condition that lead to a hypoxic event (lack of oxygen) following birth. The child was placed in a hyperbaric oxygen chamber at Harvard. Initially, he did very well. But, 60 years ago we didn’t know a lot about the toxic effects and the therapeutic limits of the use of oxygen. He was treated at a much greater pressure than physicians would treat people today, and this little baby was treated for extended time, up to 7 hours! So Hyperbaric Oxygen Therapy was seen in a negative light right after that, because as different physicians got involved in it, they said that it was HBOT that killed John F. Kennedy’s baby. That incident made it difficult for the hyperbaric industry to bounce back into a positive light. Yet, there was a saving grace; thankfully around this same time and soon after Europe and the USSR were developing whole systems and procedures to administer HBOT. They had hospitals in a former USSR that was using hyperbarics as their principal treatment; so when physicians here in the US wanted to treat with HBOT, they used a machine to translate a Russian manual, so they could get it right.
Moving forward, a lot of the physicians that were fostering and having great success treating with HBOT came out of the military. Tom explains that he has been in the HBOT industry for a long time, 31 years and he has been in the presence of some of the true pioneers in hyperbarics.
And then the Undersea Medical Society enters the picture…..
Tom explains, “Now in 1967, that’s kind of when the Undersea Medical Society came around, you know, what they did was they go, ‘Okay, this is the Wild West. We need to rein this in and we need to identify the rationale, why we’re doing this so that we can structure this into an offering in medicine, a therapeutic offering into medicine.’ And you had doctors like Dr. Kindwall, Dr. Hart, these are pioneers at the time that were instrumental in the formation of the new Medical Society. You know, that was both a curse and it had a lot of positive effects, too. But the thing was they put hyperbarics and undersea medicine together, and that’s been a problem. It certainly prevents the thought of clinical hyperbarics progressing independently of diving medicine.
Next, the FDA worked together with the Undersea & Hyperbaric Medical Society, and together they produced a committee report that looked at the indications. The indications were a lot more than what we have today, and since then it’s been refined.
Tom stresses that there’s an art to properly using Hyperbaric Oxygen Therapy, and he states the following —
“In the right hands, hyperbarics can do wonderful things. In the wrong hands, most often it won’t do bad things, but it will not have the desired results.”
di Girolamo and Tom Fox further dive into the art of using hyperbarics properly, and even how incorporating things like a good diet and exercise will play just as much of an important part in a person’s health. Tom stresses that HBOT is not a cure in most cases, but it can be an extremely useful tool to help someone get closer to their baseline.
The one thing that has stood the test of time is that no one can deny that HBOT is effective for hypoxia and inflammation. Any indication that has those two conditions associated with it, can be positively affected by using Hyperbaric Oxygen Therapy. He ends this segment encouraging everyone to keep an open mind about the god-given miracle of combining oxygen and pressure.
“I think you’re going to find that whether you’re dealing with something currently or you may be having, you know, something going on that you’re not even aware of, HBOT is not going to hurt you. It’s a good option.”
Guests

Thomas M. Fox, MAS,MS, CHT - Safety Director at Extivita RTP & Research Physiologist for the Hyperbaric Institute for Research and Training
Tom is the Research Physiologist for the Hyperbaric Institute for Research and Training, a division of Island Hyperbaric Centre in Pincourt QC. He has worked in the field of Clinical Hyperbaric Oxygen for the last 30 years. During this time, he has been intimately involved with the implementation and the development of the US Army’s Clinical Hyperbaric Service at Dwight David Eisenhower Army Medical Center. He has provided contract hyperbaric services since 1997. Prior to accepting his current position in Quebec, Canada, Mr. Fox served as the Chief of the Atmospherics Branch of the U.S. Army School of Aviation Medicine, Fort Rucker Alabama. In this capacity, he was responsible for hyperbaric/ hypobaric operations and training of US and NATO aviators, flight surgeons and flight medics. Mr. Fox is a senior army aviator and flew twelve years as a Medical Evacuation Pilot for the US Army.
Tom joined the Extivita team in 2022 as the Safety Director, helping Extivita to maintain a healthy and safe environment for exceptional patient care.
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Clinical Trial – Tranexamic Acid and Thromboelastography During Cesarean Delivery
The aim of this study is to characterize the coagulation changes, using thromboelastography
(TEG), after prophylactic tranexamic administration during cesarean delivery. Specifically,
TEG values will be compared in patients who receive prophylactic tranexamic acid or placebo
before surgery, during elective cesarean delivery, and 2 hours postpartum.
Postpartum hemorrhage (PPH) is increasing in incidence in the United States, renewing
interest in multimodal approaches to blood conservation during cesarean delivery.
Pharmacologic therapy with the antifibrinolytic agent, tranexamic acid (TA), has been shown
to reduce estimated blood loss (EBL) during cesarean delivery, but its effect on global
coagulation as assessed by TEG, and how this correlates with lowering blood loss, has not
been elucidated.
This study will be conducted as a randomized, double-blind, controlled trial with two study
arms: control (60 patients); and treatment (60 patients).
Subjects will be pre-medicated with routine pre-cesarean delivery medications including oral
sodium citrate 30 mL and intravenous (IV) metoclopramide 10 mg. A peripheral IV and
noninvasive hemoglobin monitor will be placed, and baseline labs sent: type and screen, serum
hemoglobin, platelet count, fibrinogen, activated partial thromboplastin time (aPTT),
prothrombin time (PT), and baseline TEG values (r time, k time, alpha angle, and maximum
amplitude). Patients will have blood pressure, heart rate, and pulse oximetry measured
throughout surgery as per standard of care. Patients will all receive IV lactated Ringers’
(LR) solution prior to surgery and throughout surgery, with volume recorded and a goal of
less than 2 L unless more IV fluid is clinically indicated. All patients will have a spinal
anesthetic as per standard of care, with hyperbaric bupivacaine 12 mg, fentanyl 10 μg, and
hydromorphone 100 μg. If the anesthetic plan is altered (combined spinal-epidural, general
anesthesia conversion, general anesthesia planned), indications and medication doses used
will be noted for analysis.
Immediately following induction of anesthesia and prior to skin incision, infusion of study
solution will be initiated.
Study solutions will consist of:
1. Control group: 100 mL 0.9% normal saline (NS).
2. Treatment group: 100 mL 0.9% NS containing 1g tranexamic acid (TA). Study solution will
be infused via an infusion pump over 10 minutes. Blood loss will be measured by visual
estimate and weight of surgical sponges. Noninvasive hemoglobin will be measured
throughout the study. All routine care lab values will be noted. At minimum, one lab
panel will be sent one hour after study solution initiation (hemoglobin, fibrinogen,
platelet count, aPTT, PT, and TEG).
