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Rescuer Safety - Personal Protective Equipment

Decision making - When is PPE necessary, PPE types for specific situations

Limitations of PPEs

  • Level As take longer to put on
  • Hard moving while wearing SCBA due to weight
  • Hard to see due to visual field limitations
  • Face piece, full suit make it difficult to communicate
  • Hard to perform life-saving interventions
  • Psychological stress in full suits
  • Can't wear longer than 30 minutes
  • Level As with SCBA are the heaviest PPEs
  • APRs are limited to oxygen-sufficient environment
  • Improper use, penetration/tears are potentially hazardous
  • Doff properly or risk becoming contaminated
  • Fit testing is needed for masks, SCBA
  • Facial hair interferes with proper fir of masks

Levels of PPE

  • Level A - protective clothing is the highest level of protection Level A includes a Self Contained Breathing Apparatus(SCBA) with a fully encapsulating vapor tight suit with gloves and booties attached to the suit (tanks range from ½ hour to 1 hour)
  • Level B - requires the use of SCBA but has lesser skin protection Level Bs are chemical resistant suits that are designed for splashes of liquids but not for gas or vapor hazards. A young soldier can last about 2 hours on a hot day with a external air hose
  • Level C is similar to B with the exception of the type of respiratory protection. The SCBA is replaced with an Air Purifying Respirator
  • Level D protective clothing is utilized when there are no respiratory hazard and no major skin hazard considerations. Level D for hospital personnel includes scrubs, safety glasses, shoe covers, and possibly a face shield

Entry Medical Monitoring

  • Record weight, vital signs (T-P-R-BP)
  • Record recent medical history i.e. - URI, GI sinus problems, review current meds
  • Compare to individuals baseline information per institution policy
  • Report any concerns to ED Charge MD

Exclusion Criteria

  • Blood pressure - diastolic >95
  • Pulse > 70% max HR (220-age) X 0.7
  • New irregular rhythm
  • Resp > 24 breaths/minute
  • Temp < 97F or >99.5F
  • Weight/size inability to fit into suit
  • Skin - open sores, rash, significant sunburn
  • Mental Status - any alteration
  • Recent history - GI within 72 hours, recent heat injury, new prescription within 72 hours
  • Pregnancy
  • If screening criteria is outside baseline - if possible rest 15-30 minutes and re-evaluate
  • If not assign responsibility not requiring PPE

Pre-Donning PPE

  • Place tape on back - include name and role
  • Safety check by second person
  • Note time in PPE commences when leaving dressing area

During the Event

  • Monitor staff time in PPE
  • Have second team preparing to relieve first team in PPE

Post -entry Medical Monitoring

  • Record amount of time in PPE (general guideline is 30 minutes)
  • Record weight, vital signs (T-P-R-B/P)

Staff Recovery

  • Vital signs q10 minutes until return to baseline per institutional protocol
  • Oral rehydration
  • IV hydration if clinically indicated

Sweating and Dehydration

Documentation

  • Completed monitoring forms are forward to occupational health for review and placement in employees permanent record
  • Information is kept 30 years following individual's resignation or retirement

Preparation/Education and Training

  • Proper donning of PPE,
  • Limitations of PPE
  • Maintenance and Care of PPE
  • Useful life of PPE, disposal
  • Skin absorption protection/puncture prevention
  • Hand and foot, eye protection
  • ASTM permeation testing

Medical Clearance

  • Questionnaire
  • Medical Factors

Documentation of training received

  • Initial
  • Annual retraining and re-fitting

Record fit testing results

Levels of PPE Clearance

  • Level 1 - escape devices only
  • Level 2 - Air purifying only (with dermal protection)
    Screening- occupational and medical history, vital signs including (BP), EKG, PE of cardio/pulmonary systems, spirometry, hearing and vision screening
  • Level 3 Full spectrum of PPE
    Screening - Level 2 evaluation plus Exercise tolerance test (dependent upon and CV evaluation)

Use testing

  • Put employee in PPE required for job
  • Observe performance of repetitive tasks
  • Measure vital signs
  • Record subjective complaints and clinical data

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