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Personal Protective Equipment (PPE)

• Need for PPE
• PPE Selection
• Levels of PPE
• Types of Protection
• Elements of a PPE Management Program
• Limitations of PPE
• Medical Management
  • Levels of Clearance
• References and Additional Resources

Need for PPE

Personal protective equipment, or PPE, is designed to provide protection from serious injuries or illnesses resulting from contact with chemical, radiological, physical, electrical, mechanical, or other hazards. Careful selection and use of adequate PPE should protect individuals involved in chemical emergencies from hazards effecting the respiratory system, skin, eyes, face, hands, feet, head, body, and hearing. No single combination of protective equipment and clothing is capable of protecting against all hazards. Thus PPE should be used in conjunction with other protective methods, including exposure control procedures and equipment.

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PPE Selection

The onsite incident commander will define the PPE ensemble required based on the conditions at the scene. For first receivers and hospitals, PPE selection is based on the institution's chemical emergency procedures.

• Guidance used for selecting appropriate PPE for chemical emergencies is available.
  • For First Responder - OSHA/NIOSH Interim Guidance: Chemical - Biological - Radiological - Nuclear (CBRN) Personal Protective Equipment (PPE) Selection Matrix for Emergency Responders (OSHA, NIOSH, April )
  • For Hospital Providers - OSHA Best Practices for Hospital-Based First Receivers of Victims from Mass Casualty Incidents Involving the Release of Hazardous Substances (PDF - 1.93 MB) (OSHA, January )

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Levels of PPE

Personal protective equipment is divided into four categories based on the degree of protection afforded.

• Level A protection should be worn when the highest level of respiratory, skin, eye and mucous membrane protection is needed. A typical Level A ensemble includes:
  • Positive pressure (pressure demand), self contained breathing apparatus (SCBA) (NIOSH approved), or positive-pressure supplied air respirator with escape SCBA.
  • Fully encapsulating chemical protective suit.
  • Gloves, inner, chemical resistant.
  • Gloves, outer, chemical resistant.
  • Boots, chemical resistant, steel toe and shank; (depending on suit boot construction, worn over or under suit boot.)
• Level B protection should be selected when the highest level of respiratory protection is needed, but a lesser level of skin and eye protection is needed. Level B protection is the minimum level recommended on initial site entries until the hazards have been further identified and defined by monitoring, sampling, and other reliable methods of analysis, and equipment corresponding with those findings utilized. A typical Level B ensemble includes:
  • Positive-pressure (pressure-demand), self-contained breathing apparatus (NIOSH approved), or positive-pressure supplied air respirator with escape SCBA.
  • Chemical resistant clothing (overalls and long-sleeved jacket, coveralls, hooded two-piece chemical splash suit, disposable chemical resistant coveralls.)
  • Gloves, outer, chemical resistant.
  • Gloves, inner, chemical resistant.
  • Boots, outer, chemical resistant, steel toe and shank.
• Level C protection should be selected when the type of airborne substance is known, concentration measured, criteria for using air-purifying respirators met, and skin and eye exposure is unlikely. Periodic monitoring of the air must be performed. A typical Level C ensemble includes:
  • Full-face or half-mask, air-purifying respirator (NIOSH approved).
  • Chemical resistant clothing (one piece coverall, hooded two piece chemical splash suit, chemical resistant hood and apron, disposable chemical resistant coveralls.)
  • Gloves, outer, chemical resistant.
  • Gloves, inner, chemical resistant.
  • Boots, steel toe and shank, chemical resistant.
• Level D protection is primarily a work uniform and is used for nuisance contamination only. It requires only coveralls and safety shoes/boots. Other PPE is based upon the situation (types of gloves, etc.). It should not be worn on any site where respiratory or skin hazards exist.

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Types of Protection

There are many types of protective equipment, each with specific applications and use requirements. Information on common elements of the PPE ensemble include:

• Respiratory
  • Responders should use appropriate respirators to protect against adverse health effects caused by breathing contaminated air.
    • NIOSH Respirators Guidance (CDC/NIOSH)
• Eye & Face
  • Eye and face protection should protect responders from the hazards of flying fragments, hot sparks, and chemical splashes.
    • NIOSH Eye Safety Guidance (CDC/NIOSH)
• Skin
  • Skin protection should be used when responders may be exposed to harmful substances.
    • NIOSH Protective Clothing & Ensembles Guidance (CDC/NIOSH)
• Noise
  • Earplugs or earmuffs can help prevent damage to hearing. Exposure to high noise levels can cause irreversible hearing loss or impairment as well as physical and psychological stress.
    • NIOSH Noise and Hearing Loss Prevention Guidance (CDC/NIOSH)

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Elements of a PPE Management Program

PPE use requires the implementation of a management program. Some elements of an effective program include:

• Respirator Use Certification and Fit Testing
  • OSHA respirator fit testing (OSHA)
• Training - OSHA Training Information (OSHA)
  • Proper donning of PPE
  • Limitations of PPE
  • Maintenance and Care of PPE
  • Useful life of PPE, disposal

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Limitations of PPE

Decisions about PPE use must consider its limitations.

• Safety Hazards
  • Restricted movement due to weight
  • Restricted vision due to visual field limitations
  • Difficulty communicating due to face protection
• Physiological/Psychological stressors
  • Psychological stress resulting from confining nature of full suits
  • Heat stress and risk of dehydration
  • The highest levels of PPE generally cannot be worn continuously for more than 30 minutes
• Management Requirements
  • Need for a management program that ensures effective use of PPE
    • Facial hair interferes with proper fit of masks
    • Improper use, penetration/tears are potentially hazardous

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Medical Management

Because of the psychological and physiological stresses involved. PPE use requires medical surveillance and clearance.

• OSHA Medical Clearance Questionnaire (OSHA)
• 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)
• Medical Monitoring for use scenarios
  • Pre-entry
    • Record weight, vital signs
    • Record recent medical history
    • Compare to individuals baseline information per institution policy
    • Report any concerns to physician
    • Place identification tape with name and role on the back of the responder
    • Complete safety check by a second person
    • Record the starting time PPE is put on
  • During the event
    • Monitor staff time in PPE
    • Have second team preparing to relieve first team in PPE
  • Post-entry
    • Decontamination
    • Record amount of time in PPE (general guideline is 30 minutes)
    • Record weight, vital signs
    • Ensure hydration

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References

1. Personal Protective Equipment (Rhode Island Department of Environmental Management)
2. Summary of Policy on Personal Protective Equipment (PPE) (Rhode Island Department of Environmental Management)
3. Emergency Response Plan Section 7: Safety and Health(Rhode Island Department of Environmental Management)
4. Fact Sheet: Personal Protection Equipment (PDF - 52 KB) (OSHA, )
5. Personal Protective Equipment (OSHA)
6. Safety and Health Topics: Personal Protection Equipment (OSHA)

Additional Resources

1. Personal Protective Equipment (OSHA)
2. U.S. Department of Transportation. Emergency Response Guidebook (ERG) (DOT)
3. Additional resources from CDC/NIOSH:
   • Emergency Response Resources - Personal Protective Equipment
   • NIOSH Respirator Selection Logic
   • NIOSH National Personal Protective Technology Laboratory (NIOSH/NPPTL) Guidance Documents for Protecting Emergency Responders
   • Recommendations for Chemical Protective Clothing: A Companion to the NIOSH Pocket Guide to Chemical Hazards: Database

Additional PPE Information from Radiation Emergency Medical Management (REMM)

1. Personal Protective Equipment (PPE) Classification Systems
2. PPE Image Gallery: Respiratory Protective Equipment - Civilian
3. PPE Image Gallery: Dermal Protective Equipment - Civilian
4. PPE Image Gallery: Respiratory Protective Equipment - Military
5. PPE Image Gallery: Dermal Protective Equipment - Military

PDF documents can be viewed with the free Adobe® Reader™

PPE is the last line of defense and least effective method of control against a hazard and does NOT take the place of engineering or administrative controls. Effective use of PPE relies on the user and is only used until better controls can be identified and implemented.

Selection of PPE depends on the potential risk of exposure to a hazard. Examples of PPE by body areas include:

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