Why NFPA 99 Compliance Is Essential for Safe Hyperbaric Programs

Compliance Isn’t a Check-the-Box Exercise — It’s a Safety Imperative

Hospitals and physician practices considering a wound care and hyperbaric oxygen therapy (HBOT) program must prioritize compliance from the very beginning. At the heart of safe design and operations lies NFPA 99: Health Care Facilities Code, specifically Chapter 14, which governs hyperbaric facilities¹.

At Shared Health Services (SHS), we help hospital and physician practice partners align clinical best practices with regulatory compliance. This isn’t just about passing inspections—it’s about building a safety culture, minimizing risk, and supporting long-term program viability and success.

What Is NFPA 99?

Published by the National Fire Protection Association (NFPA), a globally recognized nonprofit organization committed to reducing fire, electrical, and related hazards, NFPA 99 outlines the minimum safety requirements for healthcare facilities¹. Chapter 14 focuses specifically on the design, operation, and maintenance of healthcare facilities utilizing medical grade hyperbaric chambers.

Because HBOT is delivered in oxygen-enriched environments, the risk of combustion is significantly elevated. That’s why NFPA 99 includes highly specific standards aimed at protecting patients, staff, and infrastructure from preventable harm¹. NFPA 99 is also referenced by surveyors and regulators when evaluating safety compliance in hospital-based HBOT programs.

Inside the Standards: What Chapter 14 of NFPA 99 Actually Requires

The fire safety risks in hyperbaric therapy are real. NFPA 99 doesn’t just recommend best practices—it establishes mandatory safety requirements for accreditation, compliance, and survey readiness. Many of these standards also appear on certification exams for hyperbaric professionals², underscoring their real-world importance.

Here are some of the most critical provisions from NFPA 99, Chapter 14¹:

• NFPA 99, 14.3.1.3.2 – Every program must designate a Hyperbaric Safety Coordinator to oversee safety, training, and compliance.

• NFPA 99, 14.3.1.6.4.2 – Only approved garments (100% cotton or specific blends) may be worn in chambers.

• NFPA 99, 14.3.1.6.5.2 – Patients must remove all cosmetics, lotions, and oils before entering the chamber.

• NFPA 99, 14.2.10.4.4.1 – Audible and visual alarms must alert staff when oxygen levels exceed 23.5% in Class A chambers.

• NFPA 99, 14.2.5.1 / 14.2.5.2 – Decompression requirements: Class A (≤ 6 minutes from 3 ATA), Class B (≤ 2 minutes from 3 ATA).

• NFPA 99, 14.2.10.6.2 – Breathing gases must meet USP medical grade standards.

• NFPA 99, 14.2.1.1 – Class A chambers must be protected by 2-hour fire-rated construction.

• NFPA 99, 14.2.1.2 – Hyperbaric rooms must contain sprinkler systems and fire extinguishers.

• NFPA 99, 14.2.4.1.1 / 14.2.4.4.1 – Required ventilation: Class A (3 ft³/min per occupant), Class B (1 ft³/min).

• NFPA 99, 14.2.6.2.4 – Deluge fire suppression systems must activate within 3 seconds of trigger.

• NFPA 99, 14.2.9 – Electrical systems must meet enhanced safety requirements for hyperbaric use, including strict isolation of chamber wiring, backup power for life-safety systems, and oxygen-monitoring for shared spaces.

These standards are not optional—they are the foundation of safe and survey-ready hyperbaric programs.

The Role of the Hyperbaric Safety Coordinator

One of the most essential requirements of NFPA 99 is the designation of a Hyperbaric Safety Coordinator —a role often overlooked but vital to ongoing compliance and patient protection¹.

At SHS, we work directly with our hospital and physician partners to help staff and support this role. A well-trained HSC is more than a technician. They serve as the program’s safety officer, with responsibilities that include:

• Developing and enforcing chamber safety protocols

• Coordinating training and emergency simulations for all HBOT staff

• Overseeing equipment checks, chamber inspections, and documentation

• Reviewing all chamber contents for compliance

• Serving as liaison during surveys, inspections, and accreditations

Simply put, the Hyperbaric Safety Coordinator is the cornerstone of every compliant, high-functioning HBOT program. This role is not only essential for NFPA compliance—it also supports preparedness for regulatory surveys conducted under the CMS State Operations Manual³.

Understanding Chamber Classifications

NFPA 99 also defines hyperbaric chambers by class:

• Class A: Multiplace chambers used to treat multiple patients, often with an attending clinician inside¹.

• Class B: Monoplace chambers used for treating one patient at a time (most common in hospital settings).

• Class C: Research or animal-use chambers; not intended for clinical patient care.

SHS helps partners determine the correct chamber type for their setting and ensures it’s installed and operated according to NFPA 99 Chapter 14 standards¹.

Why This Matters for Your Hospital or Practice

Launching a wound care and HBOT program is a significant investment. Done well, it can improve patient outcomes, expand community impact, and create long-term financial sustainability².

But none of that matters if safety is compromised.

NFPA 99 compliance protects your patients, your staff, and your facility. At SHS, we don’t just support your program’s launch—we help build its foundation around compliance, safety, and success.

Let’s Build It Right—From the Start

Whether you're starting from scratch or evaluating a transition from another provider, Shared Health Services is here to help.

Let’s talk about how a best-in-class, NFPA-compliant HBOT program—built with SHS support—can strengthen your care model, reduce risk, and deliver lasting value to your hospital or physician practice.

References

1. National Fire Protection Association. NFPA 99: Health Care Facilities Code. 2024 ed. Quincy, MA: National Fire Protection Association; 2024. Accessed July 23, 2025. https://www.nfpa.org/codes-and-standards/all-codes-and-standards/list-of-codes-and-standards/detail?code=99

   
   

2. Undersea and Hyperbaric Medical Society. Hyperbaric Oxygen Therapy Indications. 15th ed. UHMS; 2023. Accessed July 23, 2025. https://www.uhms.org/images/indications/UHMS%20Indications%2015th%20Ed%20Front%20Matter%20and%20References.pdf

   
   

3. Centers for Medicare & Medicaid Services. State Operations Manual: Appendix A – Survey Protocol, Regulations and Interpretive Guidelines for Hospitals. Rev. 220; Issued: April 19, 2024. Accessed July 23, 2025. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_a_hospitals.pdf