2026 Winter Symposium: Elevating Care Under Pressure: Medicine at the Crossroads of Safety, Compliance, and Performance

2026 Winter Symposium: Elevating Care Under Pressure: Medicine at the Crossroads of Safety, Compliance, and Performance

Originally hosted January 26-28, 2026

www.courses-uhms.org 

Schedule:

Lecture Title - Faculty/Presenter

Alternative care/home use trends- Marc Robins, DO

Mishap report - review of recent events - Richard Barry, PhD

Safe treatment pressure- risk v benefit at different ATA - Scott Gorenstein, MD

Multiple Human Systems Integration Concerns for Spaceflight - Dwight Holland MD, PhD

Potential Risk for Fracture on Long Duration Spaceflight Missions: 
A 2nd Look…An Orthopedist Perspective - James Muccio, MS, MD

Human Performance-- Tying Clinical HBO2 & Aerospace Med.
Michael Harrison, MD

Radiation Considerations for Extreme Environment - Annie Sobel, MD &  Robert Duncan, PhD

Spacesuit design/systems concerns - Bonnie Dunbar, PhD

Computational Concerns for Biomonitoring from Radiation to 
Processing Capacity - Doug Hamilton, MD, PhD

FAA Human-Centered Commercial Spaceflight Regulations - Dwight Holland, MD, PhD

Reimbursement in 2026/ CTPs - Helen Gelly, MD

Emerging Indications - Marc Robins, DO

Immune Dysregulation and Infection Management in Spaceflight: The Potential Role of Hyperbaric Oxygen Therapy - Michael Johnson, MD

Problem wounds and updates on new products- Matthew Kelly, MD

Lecture Descriptions and Objectives:

1. A review of the alarming trend for unsupervised home use of hyperbaric chambers, both soft sided and hard sided as well as reviewing the rise in use among Wellness and Alternative Care centers. This lecture will complement and prepare the audience for the mishap report lecture to highlight a regulatory gap in ensuring safety measures to be applied for all uses of hyperbaric medicine.
2. There is a lack of understanding the role and responsibilities of hyperbaric staff as dictated by national fire codes in the U.S.A. and how to prevent accidents from occurring. Learners will understand their role in preventing hyperbaric accidents.
3. This lecture will review the work of Dr. Shai Efrati and others that have described the hyperoxia-hypoxia paradox. The effect of hyperbaric oxygen on HIF and cell regulation will be the focus of the talk.  A brief discussion regarding two different protocols for radiation cystitis occurs at the end of the lecture.  This will address the gap in knowledge that many hyperbaric clinicians have in understanding this complex paradigm.  
4. Using a blended classic case study and sub-domain specific approach, this presentation will highlight the overall problems of Human Systems Integration (HSI) for Space Flight—especially as this relates to longer duration flights.  Areas touched upon include an overview of space medicine topics, human factors, fatigue, group dynamics and leadership—thus generally covering human-systems integration broadly defined.  A few remarks will also be given about AI/HCI and Robot-teaming interactions and styles.
5. This lecture examines fracture risk during long-duration spaceflight using an orthopedic and biomechanical framework. Osteoporosis is used as a terrestrial analog while emphasizing spaceflight-specific bone microarchitectural deterioration, loading anisotropy, diagnostic limitations, countermeasures, and mission-level implications.
   • Explain how bone microarchitecture and anisotropy influence fracture risk during long-duration spaceflight.
   • Differentiate BMD-based fracture prediction from HR-pQCT-based risk stratification.
   • Describe mechanotransduction changes in normal bone, osteoporosis, and long-duration spaceflight.
   • Identify fracture and stress-fracture mechanisms relevant to microgravity and reloading.
   • Evaluate exercise, pharmacologic, and artificial gravity countermeasures.
6.  The specialties of aerospace and hyperbaric medicine share considerable overlap and clinical practitioners in the field of aerospace medicine benefit greatly from understanding the basic principles of hyperbaric medicine. The physics associated with basic gas laws dictate operational performance and concerns from +Gz-induced atelectasis to altitude decompression illness, influence systems designs and safety policies, and also play a significant role in mishap investigations and data interpretation.  This lecture will discuss many of these aspects with real-world examples for context and reference.
7.  The learner will be able to recommend exposure limits and self-monitoring tools to patients and co-workers. The learner will also understand the difference between EPA radiation guidelines and FAA and NASA crew exposure environments.

8. Describe the functional requirements of spacesuits necessary for safe and effective operation across a range of space environments, including microgravity, vacuum, and planetary surfaces. Explain the engineering and design process of spacesuits, including materials selection, pressure systems, mobility considerations, and life support integration. Analyze the evolution of spacesuit designs, from early programs to modern systems, evaluating their effectiveness, limitations, and performance in mission-specific contexts.

9. This presentation traces the development of a space mission’s concept of operation into operational medicine requirements. Design Reference Missions (DRMs) are conceptual, detailed plans outlining hypothetical mission goals and objectives. The DRM process creates a baseline reference architecture that meets all mission goals by defining the necessary requirements. DRMs are used to assess design impacts, compare strategies, manage hazards, and build consensus among stakeholders. Requirements are prioritized based on the health and performance of the vehicle, the Human System, crew members, and payloads, in that order. Throughout the history of human spaceflight, medical hardware and procedures have not been effectively integrated into the DRMs. This is mainly because medicine takes a preventive care approach to controlling hazards, whereas engineering performs root cause analysis and verifies hazard controls by taking them to failure. The convergence of these two dogmatic approaches occurs in occupational medicine, where the aim is to maintain the health and performance of healthy individuals in unhealthy environments. Keeping humans healthy and performing well in unknown environments where their presence is required to study these hazards poses a major conundrum for flight surgeons. It’s difficult to prove spaceflight is safe when the hazards are not adequately understood. Additionally, healthcare providers struggle to articulate their needs in terms of engineering fault tolerance and precise hazard risk acceptance criteria. This presentation provides some examples of where this process has failed because the DRM medical requirements do not adequately control an occupational hazard, or the hazard is poorly understood. This is further compounded by the additional challenges of supporting medical care for exploration-class missions in deep space.

10.  The FAA Part 460 Regulation for Commercial Spaceflight broadly covers many areas pertinent to Commercial Space Operations. The audience will learn about how the FAA regulates Commercial Space operations in the realms of : Applicability, Crew Qualifications and Training, Operator Training of Crew, Environmental Control and Life Support Systems, and Human Factors. Most people in Medicine don’t understand how the FAA “thinks” about regulations for commercial Spaceflight.
11.  Understand the elements of reimbursement. Familiarization with audits and the implications for practice management and risk assessment. Become conversant with supervision and documentation requirements for hyperbaric oxygen. Gain awareness of the judicial landscape in the use of Cellular Tissue Products.
12.  Review new and emerging Indications and the current available supporting evidence. Understand the current direction for hyperbaric research, problems and unique issues related to research and the process of gathering sufficient evidence for approved Indications.
13. Research shows that spaceflight alters both innate and adaptive immunity, increasing susceptibility to infections. Studies show HBO₂ can suppress resistant strains and enhance antibiotic efficacy. We need more translational research to validate HBO₂ in spaceflight. We will explore how immune dysregulation in spaceflight intersects with infection risk and how hyperbaric oxygen therapy might serve as a novel countermeasure.
14. Briefly discuss the normal wound healing process and then discuss problem wounds and how they vary from normal wound healing.  Case based reports on complex wounds and treatment options. Complex wounds often appear like typical wounds but may not respond to typical wound healing treatments.  Appropriate diagnostics and referrals may be needed for certain types of wounds. Lastly, we discuss the newest wound care products on the market, and what is currently in research

Estimated time to complete this activity: 12 hours

Termination Date: August 6, 2029

Registration: 
Non-Member: $270
Regular UHMS Member: $210.00
Associate UHMS Member: $150.00

Accreditation Statement: The Undersea and Hyperbaric Medical Society is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Designation Statements:

Physician CME: The Undersea and Hyperbaric Medical Society designates this enduring material for a maximum of 12.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nursing/RRT Contact Hours: Approved for 12.00 contact hours. Wound Care Education Partners is a Florida based company and a licensed CE Provider through the Florida State Board of Nursing and the CE is reciprocal for nurses in the United States. Florida nursing credits are reciprocal and approved for nurses within all states. Receiving credit for Florida providers is simple, attend the course and our staff will upload your credits directly to the Florida State database. For out of state credit, we provide the necessary paperwork for you to file with the respective nursing board.

NBDHMT: This live activity is approved for 4.00 Category A and 8.00 Category B credit hours by National Board of Diving and Hyperbaric Medical Technology, P.O. Box 758, Pelion, South Carolina 29123.   
NBDHMT Accreditation Statement: For CHT recertification purposes, the NBDHMT requires a minimum of nine of the minimum 12 required Category A credits relate directly to any combination of hyperbaric operations, related technical aspects and chamber safety.

Full Disclosure Statement: All faculty members and planners participating in continuing medical education activities sponsored by Undersea and Hyperbaric Medical Society are expected to disclose to the participants any relevant financial relationships with ineligible companies. Full disclosure of faculty and planner relevant financial relationships will be made at the activity.

Disclosure: The following individuals have disclosed a relevant financial relationship with ineligible companies. Financial relationships are relevant if the following three conditions are met for the individual who will control content of the education:
A financial relationship, in any amount, exists between the person in control of content and an ineligible company and;

• The content of the education is related to the products of an ineligible company with whom the person has a financial relationship and;
• The financial relationship existed during the past 24 months.
• All of the relevant financial relationships listed for these individuals have been mitigated

None of the individuals in control of content (planners/faculty/reviewers/authors) for this educational activity have relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

No commercial support was received for this activity.

Disclaimer: The information provided at this CME activity is for Continuing Medical Education purposes only. The lecture content, statements or opinions expressed however, do not necessarily represent those of the Undersea and Hyperbaric Medical Society.

CME For MOC Program Guide Designation Statements for ABMS Boards

Required instructions to learners on how to obtain CME for MOC

CME For MOC points are earned through completing a comprehensive evaluation component that assesses individual learner competence, performance, and/or the impact on patient outcomes. Some boards require evaluation feedback that will include a summary of what was discussed and the best next steps for the learner. The evaluation feedback will be provided to you upon submitting the evaluation form.

As an accredited ACCME provider, the UHMS is now responsible to submit physician learner CME credits into the ACCME PARS system. However, it is the physician’s responsibility to submit the necessary information required to match with the ACCME PARS system. It is also the physicians responsibility to check with their respective board(s) to see that the credits were applied accordingly.

American Board of Anesthesiology (ABA)
“This activity contributes to the CME component of the American Board of Anesthesiology’s redesigned Maintenance of Certification in AnesthesiologyTM (MOCA®) program, known as MOCA 2.0®. Please consult the ABA website, www.theABA.org, for a list of all MOCA 2.0 requirements.”

American Board of Internal Medicine (ABIM)***
“Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 12.00 MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.”

American Board of Otolaryngology – Head and Neck Surgery (ABOHNS) ***
“Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn their required annual part II self-assessment credit in the American Board of Otolaryngology – Head and Neck Surgery’s Continuing Certification program (formerly known as MOC). It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of recognizing participation.”

American Board of Orthopaedic Surgery (ABOS) ***
“Successful completion of this CME activity, which includes participation in the evaluation component, enables the learner to earn credit toward the CME of the American Board of Orthopaedic Surgery’s Maintenance of Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABOS credit."

American Board of Pathology (ABPath)
This activity has been registered to offer 12.00 AMA PRA Category 1 CreditsTM towards the American Board of Pathology’s Continuing Certification program Lifelong Learning credits.

American Board of Pediatrics (ABP) ***
“Successful completion of this CME activity, which includes participation in the evaluation component, enables the learner to earn up to 12.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit learner completion information to ACCME for the purpose of granting ABP MOC credit.”

American Board of Surgery (ABS) ***
“Successful completion of this CME activity [which includes participation in the evaluation component], enables the learner to earn credit toward the CME [and Self-Assessment] requirement(s) of the American Board of Surgery’s Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABS credit."

American Board of Thoracic Surgery (ABTS) ***
“Successful completion of this CME activity [which includes participation in the evaluation component,] enables the learner to earn credit toward the CME [and Self-Assessment] of the American Board of Thoracic Surgery’s Maintenance of Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABTS credit."

American Board of Physical Medicine and Rehabilitation (ABPMR)***
“Successful completion of this CME activity [which includes participation in the evaluation component,] enables the learner to earn credit toward the CME [and Self-Assessment / Improving Health and Health Care / Patient Safety] requirements of the American Board of Physical Medicine and Rehabilitation’s Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABPMR credit."

American Board of Preventive Medicine (ABPM)***
"Successful completion of this CME activity, which includes participation in the evaluation component, enables the learner to earn up to 12.00 credits towards the American Board of Preventive Medicine's Continuing Certification Program (CCP). It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABPM CCP credit."

***Will require evaluation feedback