An explosion in Lehi revealed gaps in how Utah regulates hyperbaric oxygen chambers

Businesses on either side of Revive Infrared Spa in Lehi thought a car had crashed into their building on the May afternoon when a loud explosion shook their walls.

Instead, a hard-sided hyperbaric oxygen chamber had exploded — with two people inside, according to a report from Lehi Fire Department. A glass window on the chamber burst, sending hand-sized shards of glass into the air and driving some into the ceiling.

The explosion caused “serious injuries” to the people inside the chamber, according to the report; one was unconscious when first responders arrived and had to be taken to a hospital. Revive owner Shane Smith was knocked to the ground.

Hyperbaric chambers allow users to breathe pure oxygen — the air we breathe is roughly 21% oxygen — in a highly pressurized environment. The combination floods blood and then tissues with oxygen, doctors say, which can help bodies and brains heal from infections or injuries.

It worked for Josh White. The 48-year-old Utah attorney had tried every other treatment available for long COVID, he said, as he experienced brain fog, tremors and extreme nerve pain after his initial COVID-19 infection in October 2021. After more than 100 hyperbaric oxygen treatments, split between LDS Hospital and the Aviv Clinic in Florida, White said his symptoms have substantially improved — and he’s experienced new levels of energy and creativity.

The potential for hyperbaric chambers to help with long COVID is one of latest possibilities to bring them to the public eye — and to capture the attention of the wellness community. In addition to treating carbon monoxide poisoning, slow-to-heal wounds and certain infections at medical centers, hyperbaric oxygen therapy is now offered at “medical spas,” massage centers and physical therapists’ offices.

But the explosion in Lehi has exposed gaps in how hyperbaric chambers are regulated outside health care facilities.

Hyperbaric chambers in wellness centers exist in a regulatory “gray area,” said United Fire Authority Fire Marshal Dan DeVoogd, as the state and many local governments haven’t required permits or adopted national safety standards in codes that apply to local businesses. “We’re kind of at a standstill waiting for codes to change.”

Under pressure

After the explosion in Lehi, police Cpl. Nolan Jenkins arrived to find glass shards in the parking lot, smoke in the air and “parts of the ceiling all over the ground,” according to his report.

But Lehi Fire Marshal Garion Rowett wasn’t notified until the next day. By the time he investigated, much of the scene had been tidied up and “a lot of information and evidence” was obscured or unavailable, his report said.

Smith told both police and fire investigators that he was operating the chamber as intended — the chamber was pressurized to 27 psi, and the chamber is advertised to work under pressures of up to 30 psi. Atmospheric pressure at sea level is 14.7 psi, according to NOAA, the National Oceanic and Atmospheric Administration.

But the chamber itself did not comply with at least one of the two industry standards meant to keep such machines safe, Rowett said.

Safety guidelines that describe how a chamber should be built and how to safely operate such a combustible device — pure oxygen is highly combustible and fuels any fire that occurs — have been written by the National Fire Protection Association (NFPA) and the American Society of Mechanical Engineers (ASME).

State and local authorities can include these standards in their requirements. Utah’s state boiler code, for example, says “pressure vessels” located at businesses or “any place where workers or the public may be exposed to risks” from their operation need to meet “the latest applicable provisions” in ASME’s guidelines; ASME-compliant chambers will be marked with a placard.

But unlike boilers, there are no state requirements to get a permit or inspections for hyperbaric chambers. Rick Sturm, chief boiler/pressure vessel inspector, said the state generally focuses on working with inquiring owners to make sure new chambers are safe. If inspectors become aware of a chamber that poses an “imminent danger,” they can condemn it, he said.

Utah’s state code does not specifically reference the NFPA guidelines, known as “NFPA 99,” but state Fire Marshal Ted Black said fire departments have the authority to enforce that standard if their local government has adopted it.

NFPA 99 is specifically written for health care facilities; there are guidelines about emergency protocols, training and the kind of piping needed to expel medical gas. Medical centers are supposed to have a safety director on-site and a “worst-case” scenario fire drill at least once a year.

But Utah County has not adopted NFPA 99 in its code for chambers in any settings, and neither Lehi police nor Lehi fire issued a citation to Revive Infrared Spa. Officials could determine, generally, that using a noncompliant chamber made a business or a building unsafe, but that would be a potential violation of a local government’s building code or licensing rules, DeVoogd said.

“That’s the problem, right?” DeVoogd said. “Health and wellness centers don’t get regulated like a hospital or a medical clinic. … Ultimately, at the end of the day, it would become an insurance issue or a licensing issue.”

The other catch, DeVoogd and Rowett said, is knowing where such chambers are being used.

There’s no permit system or regulatory mechanism to alert fire officials about hyperbaric chambers that are located outside medical facilities. Businesses or individuals can self-disclose, at which point fire departments can evaluate their chambers for compliance. Otherwise, Rowett said, he and his colleagues can only react.

Smith, Revive’s owner, did not respond to requests for comment. Revive’s business license expired in July, according to state records, but the business is still accepting appointments on its website.

The Salt Lake Tribune reached out to the people — a married couple — who were inside the chamber when it exploded. After initially agreeing to an interview, they decided it would bring up “bad memories” and said they would rather leave it in the past.

Different uses, different rules

The couple added they don’t blame Revive and think the business “was just as much a victim as us,” referring to their concerns about the chamber’s manufacturing.

The manufacturer, Classic Hyperbarics, builds single and double-occupancy hard-sided hyperbaric chambers and sells them out of its headquarters in Chino Valley, Ariz. Its chambers are advertised for “affordable, in-home use” — a distinction that exempts them from regulatory scrutiny faced by chambers used in health care settings.

Classic Hyperbarics did not respond to requests for comment. Its website says its chambers are “medical grade” and “designed to exceed industry standards with 1/2″ bullet proof material for the port hole windows, 1/2″ solid steel door and 3/8″ thick chamber shell.”

Rowett confirmed the chamber at Revive was not NFPA compliant. He couldn’t determine whether it was ASME compliant, but photos of the chamber in police and fire records do not show an ASME placard.

Hyperbaric chambers for use in health care facilities also are regulated by the Food and Drug Administration, classified as “class II medical devices,” said Tom Workman, a now-retired Texas aerospace physiologist who has worked in hyperbaric safety since the 1970s.

And in order for a company to “legally market any chamber for human occupancy for therapeutic purposes,” he said, the chamber “has to be cleared by the FDA.”

Classic Hyperbarics’ chambers are not on the FDA’s list of registered medical devices; nor do they have “501k clearance,” the requisite designation to be considered a medical device, according to the FDA’s database.

Steve Harder, Arizona’s chief of boilers and elevators, visited Classic Hyperbarics’ facility in May, after receiving a report that its chambers are not cleared by the FDA and do not comply with NFPA standards.

But Harder found that that company was “outside of our jurisdiction,” a spokesperson for the state said, as they were being manufactured and marketed for in-home use, and hyperbaric chambers are not considered boilers under Arizona state law.

Utah officials now are dealing with another gap in regulations — as new “mild hyperbaric oxygen therapy” chambers, which are soft-sided “bag” chambers, emerge. These cheaper options operate at much lower pressures than medical chambers, but are still pressurized.

It’s unclear what standards they should meet. The American Medical Association opposes their use until there are clearer safety regulations on the books.

Neither DeVoogd nor Rowett could say how many wellness facilities are operating hyperbaric chambers of any kind in their jurisdictions. DeVoogd said he’s aware of “two or three.” Rowett said he is aware of “a few,” but said Revive is the only one he’s certain was being used.

Through Google and Yelp searches, The Salt Lake Tribune found six Utah businesses — not hospitals, but wellness centers, medical spas or physical therapy offices — that offer some form of hyperbaric oxygen therapy. Some chambers are described as are soft-sided; others are hard, like the one at Revive.

‘Determination to overcome’

White, the attorney who suffered from long COVID, said it left him unable to perform at work, unable to interact with his kids, and paranoid about his future. Every day brought waves of “excruciating nerve pain” in his legs, he said, which he could only treat with ice baths.

It was “torture,” he said, and he was desperate. At one point, he asked if he could be placed in a medically induced coma while his brain healed.

Then he met Dr. Lindell Weaver at Intermountain Health. White sat through 60 sessions in a multiperson chamber — an enclosed room that looks a bit like the cockpit of a spaceship, with airplane-like seats lining two walls and small, round windows offering pools of light.

Nurses go through a 96-item checklist every morning before patients use the chambers, one nurse in the basement clinic said. The environment is controlled down to the fabric of the clothing patients are allowed to wear inside — scrubs made from a static-resistant cotton blend, to avoid any possibility of static electricity. Fires won’t happen, Weaver said, if there is no source of ignition.

Accidents are rare, but catastrophic, Weaver said — and preventable.

The treatment is FDA-approved for a variety of illnesses, including carbon monoxide poisoning, wounds, burns, gas gangrene and, of course, decompression sickness. It has not been approved as a COVID-related treatment, but it’s being studied for COVID and a host of other conditions, and Weaver said doctors can offer it if they think it will help patients.

In White’s case, the pure oxygen is thought to have helped him rebuild neural pathways and repair damaged tissue in his brain, he said. The improvement he saw at Weaver’s clinic was just the beginning of his recovery.

At the Aviv Clinic in Florida, his treatment included dozens of daily two-hour sessions in a multiperson chamber, plus counseling, physical therapy and dietary guidance. Every detail of his life was documented, measured, and evaluated, he said.

It wasn’t a miracle that saved him, White said, it was 12 weeks of constant, rigorous care.

“It’s really, really important … what hyperbaric is being offered and where,” White said. “I’m speaking in hyperbole, but if people want to run down to the nearest hair salon, or barber, or chiropractor, or whatever it may be, to get access to hyperbarics, that’s not what we’re talking about here.”

His brain fog is gone; so are the tremors and nerve pain. His mind is even sharper, in ways, he said, than it was before COVID-19.

“I get huge creative bursts of energy unlike anything I’ve ever experienced,” White said. “There are new connections; enhancements I feel like are really quite amazing.”

He still gets occasional afternoon “migraine-like” headaches, he said, and is sometimes sensitive to light and sound. But his symptoms continue to improve.

“When I was suffering, there was no way I could backpack, or hike, or do anything in the outdoors that I loved,” White said. At Aviv, “I bought a whole new set of camping and backpacking items to try to exercise some of that determination to overcome, and that I would get better.”

“Having that positive outlook,” he said, “… that was something I couldn’t find for the longest time.”

Correction • 11:10 a.m. Sept. 5, 2023: This story has been updated to reflect that oxygen fuels fires, but is not itself flammable.

Shannon Sollitt is a Report for America corps member covering business accountability and sustainability for The Salt Lake Tribune. Your donation to match our RFA grant helps keep her writing stories like this one; please consider making a tax-deductible gift of any amount today by clicking here.