Implementing the Response: Personal Protective Equipment

Respiratory Protection at Hazardous Materials Incidents

• Respiratory protection prevents the inhalation of hazardous substances.
• Inhalation is the most significant route of entry for hazardous materials.
• SCBA should be worn during emergency operations until air monitoring determines otherwise.
• Each type of respiratory equipment has limits and may need pairing with another respiratory protection piece.

Types of Protective Breathing Equipment

• Self-Contained Breathing Apparatus (SCBA)
  • Closed circuit SCBA
  • Open circuit SCBA
• Supplied Air Respirators (SARs)
• Air-Purifying Respirators (APRs)
  • Particulate-removing
  • Vapor-and-gas-removing
  • Combination particulate-and-vapor-and-gas-removing
• Powered Air-Purifying Respirators (PAPRs)

Self-Contained Breathing Apparatus (SCBA)

• Classified as either closed- or open-circuit.
• Two manufactured types:
  • Pressure-demand
  • Positive-pressure
• High-pressure type and Low-pressure type SCBAs also exist.

Supplied Air Respirators (SARs)

• Atmosphere-supplying respirators consisting of:
  • Facepiece
  • Belt- or facepiece-mounted regulator
  • Voice communications system
  • Up to 300 feet (90 m) of air supply hose
  • Emergency escape pack or emergency breathing support system (EBSS)
  • Breathing air source that the user does not carry
• Not certified for fire fighting operations due to potential airline damage from heat, fire, and debris.
• Approved Type 2 respirators can be used at hazmat and CBR incidents with limitations.

SAR Advantages:

• Reduces physical stress by removing SCBA weight.

SAR Limitations:

• Potential for damage to the air-supply line.
• The short airline (no more than 300 feet [90 m]) restricts mobility.
• Issues with hose entanglement.
• Restricted vision and communications.

Air-Purifying Respirators (APRs) and Powered APRs (PAPRs)

• Use specific purifying elements to filter air.

Three types of air-purifying elements:

• Particulate-removing
• Vapor-and-gas-removing
• Combination particulate-removing and vapor-and-gas-removing
• APRs have either full or half facepieces.
  • Full and half facepieces provide a complete seal to the face
  • Full facepieces also provide eye protection
  • Half facepieces do NOT protect against CBR materials that can be absorbed through the skin or eyes. Not recommended for use at hazmat/WMD incidents except in very specific situations
• APRs should not be used where unknown atmospheric conditions exist.
• APR facepiece has disposable filters, canisters, or cartridges that remove specific contaminants from the air.
• Air enters APR through facepiece either from external atmosphere or through user exhalation
• Air passed through facepiece into filter, sorbent, catalyst, or a combination of the three; specific contaminants are removed

Determining factors for APR canister, filter, or cartridge use:

• What is the hazard?
• What is the oxygen level?
• Is the hazard a vapor or a gas?
• Is the hazard a particle or dust?
• Is there some combination of dust and vapors present?
• What concentrations are present?
• Does the material have a taste or smell?

APR Limitations:

• No protection against oxygen-deficient, oxygen-enriched, or IDLH atmospheres.
• Limited life of its filters and canisters.
• Need for constant monitoring of the contaminated atmosphere.

Precautions for using APRs:

• Know what and how much of the chemicals/air contaminants are in the air.
• Ensure that the oxygen level is between 19.5 and 23.5 percent.
• Ensure that atmospheric hazards are below IDLH conditions.
• APRs may be used in several types of hazardous incidents or situations.
  • Hazmat/WMD incidents after scene hazards have been properly identified
  • CBRN situations
  • Law enforcement
  • EMS/medical personnel
  • Escape situations; utilize a combination organic vapor/high efficiency particulate air (OV/HEPA) cartridge
• High-efficiency particulate air (HEPA) filters are used for medical emergencies. Must be 99.97 percent efficient; 95 and 99 percent effective filters may be used depending on health risk hazard
• Particle masks, or dust masks, are classified as particulate-removing air-purifying filters. These disposable masks protect the respiratory system from large-sized particulates, provide very limited protection and should not be used to protect against chemicals or small particles
• Vapor- and gas-removing APRs use a sorbent material to filter vapor and gases from the air.

Powered Air-Purifying Respirators (PAPRs)

• Supply air under positive pressure.
• PAPRs remove contaminants and supply purified air to full facepiece through a blower.
• Positive pressure system offers greater safety than standard APRs in case of leaks or poor facial seals.
• Air flow makes PAPRs more comfortable to wear.
• PAPRs can be used at decontamination operations and long-term operations during hazmat/WMD incidents.

Limitations of Respiratory Equipment:

• Limited visibility
• Decreased ability to communicate
• Increased weight
• Decreased mobility
• Inadequate oxygen levels
• Chemical specific
• Psychological stress

Protective Clothing at Hazardous Materials Incidents

• Protective clothing must be worn whenever a responder faces potential hazards such as:
  • Thermal
  • Chemical
  • Biological
  • Radiological
  • Ballistic
• No single combination or ensemble of protective equipment can protect against all hazards.

Limitations of Fire Fighting Turnout Gear:

• Fumes and chemical vapors can penetrate.
• Offers no protection from fires.
• Structural fire fighting protective clothing will provide limited protection against some hazardous materials but is NOT a substitute for CPC.
• Protects user from some chemicals found in the atmosphere of burning buildings.
• SCBA protects against toxic gases.
• Multiple layers of coat and pants may provide short-term protection from liquid chemicals. However, structural fire fighting clothing is not an effective chemical barrier.
  • Neither corrosive-resistant nor vapor-tight
  • Liquids can soak through
  • Acids and bases can dissolve or deteriorate outer layers
  • Gases and vapors can penetrate garment
• Gaps in structural fire fighting clothing allow for penetration of chemicals at the neck, wrists, waist, and at points where pants and boots overlap.
• Some hazardous materials can permeate and remain in structural fire fighting clothing, causing repeated exposure or later reaction with another chemical.
• Some jurisdictions allow the use of structural fire fighting protective clothing and SCBA to perform short-term duration operations.

Advantages of Structural Fire Fighting Clothing with SCBA:

• Protection against thermal damage during an explosive attack.
• May protect the user from biological agents that are strictly respiratory.

Limitations of Structural Fire Fighting Clothing with SCBA:

• Limited or no protection against projectiles, shrapnel, and other mechanical effects from an explosive blast.
• Limited protection against radiological materials.
• Inadequate protection against skin contact with hazardous material.
• High-temperature protective clothing is used for short-term high temperature situations. Can withstand heat levels structural fire fighting clothing cannot but has limited use against chemicals.

Proximity Suits vs. Fire-Entry Suits:

• Proximity suits: Permit close approach to fires (Frequently used in aircraft rescue and fire fighting).
• Fire-entry suits: Allows the user to walk into a total flame environment for short periods of time; provides protection at radiant heat temperature as high as $2,000°F (1 100°C)$
• Flame-resistant clothing will not ignite or melt when exposed to fire or radiant heat. Designed for minimal exposure to hot or molten materials, hot surfaces, radiant heat, flash fires, flame, electrical arc discharge.

Chemical-Protective Clothing (CPC):

• Designed to protect against specific chemical hazards.
• Made of a variety of materials; each material protects the user from specific chemicals or products.
• CPC is not is intended for fire fighting activities, nor for protection from hot liquids, steam, molten metals, welding, electrical arc, flammable atmospheres, explosive environments or thermal radiation.
• No single type of CPC protects against all chemical hazards. You must have sufficient training to operate in conditions requiring the use of chemical-protective clothing.
• There are two types of liquid-splash protection clothing:
  • Encapsulating - One-piece suit with boots and gloves that are sometimes attached to the suit. Protects users from splashes or vapors and gases and includes the Totally-Encapsulating Chemical Protective suit (TECP).
  • Nonencapsulating - One-piece overall, but can also be composed of individual pieces. Gaps between pants cuff and boots and between cuff and gloves are taped.
• An encapsulating suit covers the entire body and SCBA.
• Liquid-splash protective clothing, a type of CPC, is not designed to be completely gas- and vapor-tight.

Nonencapsulating Suit Limitations:

• Protects against splashes and dusts but not against gases and vapors.
• Does not provide full body coverage; parts of the head and neck are often exposed.
• Vapor-protective clothing offers better protection from toxic vapors and gases than liquid splash-protective clothing.
• NFPA 1991 sets performance requirements for vapor-tight, totally encapsulating chemical protective suits.
  • Minimum protection level for responders facing a specific chemical exposure.
    • Chemical-resistance
    • Flame resistance
    • Twenty-one chemical permeation tests

Limitations of Vapor-Protective Clothing:

• Melt and burn when exposed to fire.
• Cannot be used in potentially flammable atmospheres.
• Do not protect the user against all chemical hazards.
• Impairs mobility, vision, communication.
• Do not allow body heat to escape and can contribute to heat stress; may require the use of a cooling vest

Additional Considerations When Choosing PPE:

• Besides the known hazards at an incident, CPC's effectiveness can be reduced by three actions:
  • Permeation
  • Degradation
  • Penetration

Permeation:

• Occurs when a chemical passes through fabric or material on a molecular level.
• In most cases, there is no visible evidence of chemicals permeating material.
• Permeation data is provided by most CPC manufacturers.

Permeation metrics:

• Breakthrough time: Time it takes for a chemical to permeate CPC material.
• Permeation rate: Speed at which a chemical moves through CPC material after it has permeated.
• Decontamination will not stop permeation from occurring.

Degradation:

• Chemical degradation occurs when the characteristics of a material are altered by contact with chemicals.

Penetration:

• Occurs when a hazardous material enters an opening or a puncture in protective material.
• The service life of CPC affects user protection level.
• Each piece of CPC has a specific service life, or expiration date.
• If CPC is contaminated, its service life is over and cannot be used again.
  *Never use CPC that is beyond its expiration date and/or has exceeded its service life.

PPE Ensembles

*An adequate PPE ensemble requires respiratory protection, clothing, and consideration of the operation.

*Hazards present + actions needed to be preformed = PPE ensemble.

*No single type of PPE protects against all hazards.

*Regulatory agencies have established sets of PPE ensembles that provide specific levels of protection.

EPA Chemical-Protective PPE Ensembles:

• Used by fire and emergency service organizations but other organizations have PPE ensembles appropriate to the hazards of their mission and SOPs.

*Always follow your agency's SOP/Gs in determining the level of PPE necessary to perform a task.

*The four levels of EPA protective ensembles are used at hazmat/WMD incidents:

Levels Of Protection:

• Level A
• Level B
• Level C
• Level D

*Levels are the starting point to creating protective ensembles.

*Just having the right ensemble components is not enough, PPE ensembles need to be tailored for each specific incident based on known hazards.

Level A Ensembles:

• Provide the highest level of chemical protection, protecting against hazardous vapors, gases, mist, particles.
• Components:
  • Positive-pressure, full facepiece, SCBA, or positive-pressure airline respirator with escape SCBA approved by NIOSH
  • Vapor-protective suit: Totally-Encapsulated Chemical Protective (TECP) suit
  • Optional coveralls, long underwear, hard hat
  • Chemical-resistant inner and outer gloves
  • Chemical-resistant boots with steel toe and shank
  • Disposable protective suit, gloves, and boots (can be worn over totally encapsulating suit, depending on suit construction)
  • Two-way radios (worn inside encapsulating suit)

Level B Ensembles:

• Protect users against splashes from hazardous chemicals.
• Level B CPC ensemble may be encapsulating or nonencapsulating.
• Level B ensembles have a lower level of skin protection, but the same level of respiratory protection as Level A.

Appropriate use of Level B ensembles:

• Hazards have been identified but require less skin protection and a high level of respiratory protection
• Atmosphere contains less than 19.5% oxygen or more than 23.5% oxygen
  *Direct-reading organic vapor detection instrument detects an incompletely identified vapor but not chemicals harmful to or capable of being absorbed through intact skin
  *Presence of liquids or particulates indicated, but they are not known to be harmful to or capable of being absorbed through intact skin

Level C Ensembles:

• Protect users from hazardous chemical splashes.
• Level C respiratory equipment includes all the various levels of APRS and PARPS.
• Level C protection is only used under specific conditions:
  • Specific material is known
  • Specific material has been measured
  • Protection level approved by IC after all qualifying conditions for APRS and PAPRS have been met
  • Atmospheric oxygen concentration is between 19.5 to 23.5 percent
  • Atmosphere is not IDLH
  • Product is known
  • Appropriate filter available
    *Level C ensembles have a lower level of respiratory protection but the same level of skin protection as Level B.
    *Level C protection ensembles can be used in environments safe for APR use. The following conditions should be satisfied:

*Atmospheric contaminants, liquid splashes, or other direct contact will not adversely affect or be absorbed through exposed skin.

*Types of air contaminants have been identified, concentrations have been measured.

*APR is available that can remove the contaminants.

*Atmospheric concentration of chemicals does not exceed IDLH levels.

*Atmosphere must contain between 19.5 and 23.5 percent oxygen.

Level D Ensembles:

• Consist of typical work uniforms, street clothing, or coveralls.
• Components:
  • Coveralls
  • Chemical-resistant boots/shoes with steel toe and shank
  • Safety glasses or chemical splash goggles
  • Hard hat
  • Optional gloves, disposable chemical-resistant outer boot covers, escape device in case of accidental release and need to immediately escape area, face shield
• Level D ensembles are typically not worn in hot zones or hazmat responses above the Awareness level.
  • Atmosphere contains no hazards
    *Work functions preclude splashes, immersion, or potential for unexpected inhalation of or contact with hazardous levels of any chemicals

Responder sources for PPE selection include Allied professionals, Hazmat technicians, Emergency response plan, SOP/Gs, IAP/Site Safety Plan.

PPE Selection

*All responders should understand how to select appropriate PPE.

*Generally, the higher the level of PPE, the greater the hazard.

*Overprotection, as well as underprotection, can be hazardous and should be avoided.

*Selecting operational PPE is a shared responsibility as it is ultimately chosen by IC but responders should understand the selection process.

*PPE choice is dependent on both chemical and physical hazards.

Effectiveness of Typical Fire Service PPE Ensembles for Specific Hazards

*Responders can consult resources to aid in PPE selection.

Factors to consider while choosing protective clothing:

• Chemical and physical hazards
• Physical environment
• Exposure duration
• Available protective clothing or equipment
• Monitoring and detection readings
• Compliance with regulations
• Exposure effects PPE choice
• Exposure levels
• Material chemical-resistance
• Air supply
  *Assume worst-case exposure so that appropriate safety margins can be added to ensemble wear times

While taking Protective clothing selection into account, factors include:

• Clothing design
• Material chemical-resistance
• Physical properties
• Ease of decontamination
• Ease of maintenance and service
• Interoperability with other types of equipment
• Cost

*Initially, most firefighters will be wearing structural fire fighting protective clothing ensembles (turn-out gear). Turnout gear has limited protection against hazmat/WMD hazards, May be appropriate for some operations at hazmat/WMD incidents with protective measures.

PPE Related Stresses

• Wearing PPE can cause extreme stress on the user. Increased risk for heat and cold related disorders for PPE/CPC wearer
• Most PPE prevents body from releasing heat and moisture; CPC Does not provide insulation.
• Medical monitoring is required when environmental factors put you at risk.
• Heat emergencies while wearing PPE can be fatal.

Heat related effects include:-

• Heat stroke
• Heat exhaustion
• Heat cramps
• Heat rashes

Heat-exposure while wearing PPE can be prevented or reduced by:

• Fluid consumption before and during operations involving PPE
• Air cooling by fans or by wearing undergarments that provide natural ventilation
• Ice cooling
• Water cooling by misters or mobile showers
• Cooling vests worn underneath PPE are bulky and impair movement
• Rest/rehab areas in shady areas or areas with misters or air conditioning
• Work rotation with other responders
• Proper liquids - Before working avoid alcohol and caffeinated drinks
• Physical fitness of PPE user
  *Some agencies may use cooling vests to combat heat illness when using CPC .Rehab can help prevent heat stress by allowing responders to cool off and rest.

PPE also heightens the risk for cold emergencies:

• Caused by exposure to cold weather or to cryogenic liquids
  *Can result in serious health conditions, such as:

• Trench foot

• Frostbite

• Hypothermia

Cold emergencies can be prevented by:

• Being active
• Rehabbing in a warm area
• Wearing warm clothing/layers
• Dressing appropriately
• Avoiding cold beverages

PPE and psychological effects

• CPC may cause claustrophobia

• Chemical hazards that responders face could cause anxiety, which can be debilitating

• CPC and other types of encapsulating PPE are confining

• Training will build confidence; if a responder is still uncomfortable, emergency response CPC may not be suitable for her/him

• Pre- and post-entry evaluations directed by AHJ should be conducted before and after entering the warm or hot zones.
  *AHJ requires exposure records be kept with medical records for personnel who work near any hazardous chemicals. Exposure records include

• Type of exposure

• Length of exposure

• Description of PPE used

• Type of decon used and any decon solutions

• On scene and follow-up medical attention and/or assistance

Procedures for Safely Using PPE

*Learning how to safely use PPE will increase the responder's comfort and proficiency.

Before donning PPE, it is necessary to conduct a pre-entry inspection:

• Confirm pressure test completion dates & Complete visual inspection
• Operational check of PPE components:
  • Breathing apparatus
  • All zippers and closures
  • Valves
  • Communications equipment
    *Any equipment taken or used in the hot zone

Remember emergency and safety procedures when entering an IDLH atmosphere:

• Use the "buddy system"
• Work in teams of two inside an IDLH area
• Operate within accountability systems, and know evacuation and escape procedures
  *Ensure at least two equally trained and equipped responders (backup personnel) are outside the IDLH area in case of need for rescue

Before entering the hot zone, responders will receive a safety briefing that entail:

• Incident status
• Identified hazards
• Description of site
• Tasks to be performed
• Expected duration of tasks
• Escape route or area of refuge
• PPE and health monitoring requirements
• Incident monitoring requirements
• Notification of identified risks
  *Communication procedures, including hand signals

When wearing a limited air supply, the PPE user must know the estimated time for each task to remain safe.

Contamination and exposure are two separate hazards common in hazmat incidents.

Contamination - A condition of impurity resulting from contact or mixture with a foreign substance

Exposure - A hazardous material entered or potentially entered the body via routes of entry

Avoid contamination as best as possible as it increases the risk of exposure. It is best to:

• Always try to reduce any contact with a product
• Avoid walking through and touching any product
• Avoid kneeling or sitting on the ground in CPC, as this may cause suit chafing or abrasion which allows for faster degradation
  *Protect monitoring instruments as best as possible If avoidance is not possible and you need to protect the suit from damage, put something between your suit and the ground contamination. Options include: thick cardboard; rug; visqueen; absorbent pillows, pigs, booms, socks, and pads; knee pads).

Some level of communicative capabilities is required for all levels of PPE.

Communication devices may be integrated into PPE or may also use predesignated hand signals, motions, gestures

Planned emergency communication is vital and includes Signals sent to safety personnel on designated radio channels + predesignated Hand signals, Motions or Gestures.

If radio communication is lost, backup communication through hand signals may be used.

Follow hand signals specified by the AHJ.

Backup hand signals should be simple, easy to remember, and distinguishable from a distance.

Hand Signals:

• Loss of air supply
• Loss of suit integrity
• Responder down from injury or illness
• Loss of Radio Communications

*I am okay, or situation okay

The donning of PPE can be time-consuming and confusing & You should always train with the protective clothing that you will be using in field.

*Manufacturer and department recommendations for donning PPE must be followed.

Know the generic PPE donning procedures:

• Preselect clearly delineated area in cold zone close to entry point Ensure area is isolated from distractions, sheltered from elements
• Select area large enough to accommodate all personnel
• Entry, backup team members medically evaluated based on AHJ procedures Continue hydration per AHJ procedures
• Conduct mission briefing
• Deploy chemical-protective clothing in an organized manner Check all equipment visually and operationally
• Ensure removal of personal effects
• Don appropriate undergarments

*Entry and backup team should be donned at the same time so both teams are ready for the entry order.

*Upon exit from the hot zone, the entry team is attended to by doffing personnel.

*Entry teams need decontamination prior to doffing & the Entry team will be hot, tired, anxious to remove PPE
Doffing personnel may wear a lower level CPC & Doffing personnel should watch for signs and symptoms of heat stress

There is a generic guide to doffing PPE:

• Personnel wearing PPE should allow assisting personnel to perform work
• To avoid cross contamination, entry team members only touch inside of PPE; assisting personnel only touch outside of PPE
• Once PPE is removed, zip or store so that inside and outside surfaces cannot touch
• All entry PPE is placed in a marked containment
• Respirator facepiece is the last item removed by user
• Breathing apparatus should be isolated and marked for decontamination
  *All entry team and support team members must report immediately to rehab

Follow a standard program of inspecting PPE on initial receipt, before and after each use and periodic inspections by personnel. Inspect respiratory equipment each use, Daily or weekly, Monthly and Annually

Follow a standard program of maintaining PPE according to:

• Manufacturer's recommendations
• NFPA standards
  *OSHA requirements

Store PPE to prevent damage from:

• Dust
• Extreme temperatures
• Moisture
• Sunlight
• Chemicals
  *Impact

Proper documentation of PPE maintenance and use is important and entails:

• Review inspection, testing, and maintenance logs that can show patterns about equipment
• AHJ requires documentation after PPE use at an incident, which may include PPE inspection forms, contaminated gear forms, deprovisioning forms