TREAT NOW: A Summary of the Logic of Using HBOT to arrest the Suicide Epidemic June 2014 The Honorable Martin R. Hoffmann Secretary of the Army, June, 2014 ver.5 The International Hyperbaric Medical Foundation

Bottom Line Up Front:  HBOT is the most promising Treatment to abate The Soldier Suicide Epidemic in the short term  The nation has a responsibility and moral obligation to its veterans and the active force  Leadership must be seen to be dedicated to taking care of the force: walk the talk  DOD needs a reset and recovery plan: the force is not fit to fight with so much brain injury and mistreatment of veterans  Servicemen and women are like elite athletes: an investment to keep them at peak performance is at hand  Civilian HBOT clinics across the US can begin treating and healing the brain injured; the VA and DOD can use $$ from their drug budgets to fund, giving hope and health June, 2014 ver.5 The International Hyperbaric Medical Foundation

June, 2014 ver.5 The International Hyperbaric Medical Foundation

June, 2014 ver.5 The International Hyperbaric Medical Foundation

June, 2014 ver.5 The International Hyperbaric Medical Foundation

June, 2014 ver.5 The International Hyperbaric Medical Foundation

June, 2014 ver.5 The International Hyperbaric Medical Foundation

“Hyperbaric oxygen is a safe, easily used treatment that, in many cases, has resulted in a dramatic improvement in the symptoms of patients with [TBI]. Every day we are…. gathering more data validating its efficacy.… I feel, as do many of my colleagues, that there is sufficient clinical and research evidence to justify the use of [HBOT] as a standard- of-care treatment for [TBI] that should be reimbursed by CMS and Tricare…. I have no doubt that, over the next several years, [HBOT] will be proven beyond a reasonable doubt to be one of the most effective treatments for [TBI]…. There is a preponderance of evidence now to justify the use and funding for the treatment….” George Mychaskiw II, DO, FAAP, FACOP, Professor and Chair, Department of Anesthesiology, Nemours Children’s Hospital, and Editor-in-Chief of the Journal of Undersea and Hyperbaric Medicine, the premier journal of hyperbaric medicine in the world. June, 2014 ver.5 The International Hyperbaric Medical Foundation

Translational Medicine and Bayesian Analysis allows for adjuvant therapies The FDA approved protocol for a clinical trial must use “KISS” principle Too many variables make isolation of independent variable – HBOT – difficult “Arms” to the central test of HBOT can be admitted, but they cost Using Bayesian techniques, we can pay attention to discrete interventions We are already considering some additional therapies during HBOT treatment: A translational medicine approach embraces “learning in action,” but we have to respect the FDA protocol and the limits and restrictions of the scientific method The bottom line is that HBOT treatments are needed to arrest the suicide epidemic, build trust and give hope to the wounded who are told there is no alternative to “the new normal.”  Infrared Light therapy to dilate vessels  Physical therapy  Neuro- and cognitive-psychological brain training in “off-dive” hours  Cranial electrical stimulation (CES) June, 2014 ver.5 The International Hyperbaric Medical Foundation

The arguments for TREAT NOW are compelling. The cost to treat and heal TBI/PTSD wounded warriors with HBOT is less than 2% of the costs to leave them untreated. Non- treatment risks lifetime dependence on drugs and at considerable, additional personal and financial costs and suffering to family, friends and community. Worse, the status quo does nothing to arrest suicides. Omitted from the financial benefits of HBOT treatment is the incalculable value of enabling these disabled TBI/PTSD patients to make new beginnings into the constructive, meaningful post-service lives they had expected to gain prior to receiving their wounds. These heroes clearly are entitled to nothing less. SUMMARY: June, 2014 ver.5 The International Hyperbaric Medical Foundation