Personal Protective Equipment (cont.)
IN THIS ARTICLE
Choosing the Right Protective Equipment
Emergency care personnel who provide medical care to victims of hazardous incidents have the responsibility of first protecting themselves by wearing adequate protective equipment. Whenever possible, they will select the level of equipment based on the known properties of the hazard. When the type of hazard is unknown, they will assume a worst-case exposure and use the highest level of adequate protection.
The primary consideration in selecting appropriate equipment is whether it will be worn in the hot zone (exclusion zone or contaminated area) or in the warm zone (contamination reduction zone or area where decontamination of victims takes place). Because victims and equipment should be decontaminated thoroughly before leaving the warm zone, protective equipment is unnecessary in uncontaminated areas (except as noted here).
Hot and Warm Zone Equipment
The hot zone is immediately dangerous to life or health. Accordingly, level A personal protective equipment with self-contained breathing apparatus or supplied-air respirator is required for first responders or other personnel working inside the hot zone, where contact with hazardous materials is likely, including chemical gas or vapors, biological aerosols, or chemical and/or biological liquid or powder residue. Incidents occurring in enclosed spaces with poor ventilation increase the risk of inhalation.
The warm zone is an uncontaminated environment into which contaminated victims, first responders, and equipment are brought. In classic HAZMAT (hazardous materials) response, the warm zone is adjacent to and upwind from the hot zone. However, experience with previous disasters indicates that contaminated victims capable of fleeing the hot zone are likely to bypass emergency medical services and go directly to the nearest hospital, in which case the warm zone may occur outside the emergency department or even inside the hospital.
Accordingly, the warm zone poses a risk of exposure to contaminated victims and equipment, which in turn depends upon the type and route of exposure. In general, early recognition of the type of exposure is based on the signs and symptoms that the victims show.
The protective equipment required depends on whether victims were exposed to a biological, chemical, radiological agent, or unknown agent or agents. The route of exposure may be inferred from the presence of contaminant on the clothing and skin of victims.
Vapor or aerosol exposure leaves no or minimal contaminant on victims, and material breathed into the lungs is not exhaled to contaminate others. Liquid or powder exposures may leave visible residue. For example, in the Tokyo subway sarin attack in 1995, about 90% of the victims exposed to sarin vapor reported to medical facilities by private or public transportation without contaminating others. Fortunately, secondary injury to hospital staff was minimal (mostly eye irritation) and did not require specific treatment. In a similar manner, handling victims exposed to biological aerosols poses little risk to emergency care personnel outside the hot zone.
Medically Reviewed by a Doctor on 1/28/2016
Jeffrey L Arnold, MD, FACEP
Suzanne White, MD
Francisco Talavera, PharmD, PhD
Raymond J Roberge, MD, MPH, FAAEM, FACMT
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