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Dr. Gary Villines specializes in hyperbaric at St. Vincent in Little Rock.

Dr. Gary Villines didn't set out to be a specialist in hyperbaric therapy, but after a long career in emergency medicine, that's exactly what the Arkansas native has become.

"After we opened up the wound center, it rapidly grew and became more successful," Villines said of the wound care center program at St. Vincent. "It didn't take too long after that and I decided to get out of the ER and come over here."

The change came with some built-in advantages.

"The night shifts were killing me in the ER," Villines admitted. "Those 12-hour shifts … I did that for 25 years. Plus this is actually more interesting than what you might think."

The kinds of patients Villines now sees are different, too.

"To be honest, the emergency room is not the best place to be at three o'clock in the morning," he said. "Really most of the time they don't really want to be there. The patients we see now are nice and appreciative."

Villines described a typical patient as older and diabetic. He said, "The next patient to walk through the door would likely be a 72-year-old diabetic male with a wound on his foot … that's probably the average patient."

Hyperbaric therapy is becoming more popular around the state as wound care centers are popping up all over, but it isn't because of some new advance in the science.

"The technology is not especially advanced," Villines said. "It is what it is, oxygen under pressure. But the technology of the equipment hasn't changed."

But he has seen changes. "We've seen a lot of other developments in wound care like cultured skin for skin grafts."

But how did hyperbaric therapy come to be used for wound care?

"I'm not sure I can answer that," Villines said. "I'm not sure if someone accidentally stumbled upon it, or if somebody reasoned it out that it ought to work. A lot of things in medicine have happened because of serendipity."

Hyperbaric chambers were first used along the coasts for scuba-diving accidents and now are popular for wound care. Villines got interested in the therapy's use in emergency medicine and in cases of carbon monoxide poisoning.

"There's a certain criteria for people who need hyperbaric therapy," he said. "Sometimes it is real sneaky, but sometimes it is real obvious, like when they pull somebody out of a house fire, or off a boat on the Arkansas River when there's been a faulty generator."

Villines described a typical carbon-monoxide-poisoning patient.

"You see people come in complaining of a headache or flu-like symptoms and sometimes they are misdiagnosed as having a migraine headache," he said. "But that is the chief symptom of carbon monoxide poisoning. Especially in the time of year when people are first turning on their heaters."

But just because they have the symptoms doesn't mean that Villines will load them into a hyperbaric chamber.

"Somebody may have the symptoms," he said, "but not as severe and we may have them breathe 100 percent oxygen and let them go home. As a good rule of thumb, anyone who has had loss of consciousness from carbon monoxide poisoning should be treated in a hyperbaric chamber." He added, "Anyone with a carbon monoxide level of over 30 or especially over 40 should be treated."

A carbon monoxide level over 60 is generally lethal.

"Say a person was picked up at a house fire and they were unconscious at the scene," Villines said. "The first responders put them on 100 percent oxygen and by the time they get to the hospital, they are waking up. Even those people should be treated. The reason is that carbon monoxide gets built up in the body, in the brain cells especially, and hyperbaric oxygen helps flush that from the body."

Villines added that it would take 27 minutes in a hyperbaric chamber to treat a case like that.

So how would Villines handle a situation in which several people needed hyperbaric therapy at once, like if several firefighters all had carbon monoxide poisoning.

St. Vincent recently installed a multi-place hyperbaric chamber across the street from the hospital in an outpatient facility that can seat 12 and up to 14 in a pinch, but it isn't that straight forward.

"Well, that gets a little tricky," he said. "We haven't worked out all the technical aspects of how that would work. This is an outpatient facility, and it is against health regulations to transfer someone from an inpatient facility to an outpatient facility. So we could still treat people [in an emergency], but it would have to be in the mono-place chamber."

And the mono-place chamber is just off the emergency room in the hospital and it is OK to use, but the multi-place chamber, the one that could hold more than a dozen is not OK to use, by the virtue of it being about a 100 feet from the front lobby and is actually closer to St. Vincent than the parking deck.

"I'd like for us to come up with some sort of disaster plan, so if we had a mass casualty incident, we could bring all the patients here," Villines said of the multi-place chamber. "The big advantage with this chamber is that we could have a doctor or nurse go with them and monitor the situation, and make changes as needed."

To accomplish that, he said, "I have plans to bring in all the disaster services people, the fire chiefs and go over what we can do here."

What about the local leadership, like the county judge?

"The county judge, sure," Villines said with a laugh — his brother Buddy serves as Pulaski County Judge. "That's right, he needs something do. But really, I'm going to try to put together a seminar for the emergency people, primarily so they know where to send people."

Little Rock has two hospitals with inpatient hyperbaric chambers, St. Vincent and Arkansas Heart Hospital.

"They primarily use it for wound care, but they are in the hospital," Villines said of Arkansas Heart Hospital. "Baptist over in North Little Rock has a couple of chambers as well."

While hyperbaric therapy is popular now, that wasn't always the case.

"We almost got rid of ours," Villines said. "There was a time when the usage dipped … but we decided to keep them as a public service. Somebody had to take up the slack."


March 2007

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