Version 0 (January 2017) Emergency Responder Health and Safety Manual

5.3 PPE—General Information

PPE provides essential protection to emergency responders if it is properly used. PPE must be used only after other control methods, including engineering controls, work practices, and administrative controls, have been exhausted. For guidance on PPE for CBRN incidents, see Guidance on Emergency Responder Personal Protective Equipment (PPE) for Response to CBRN Terrorism Incidents.

Selection of PPE must be based on the nature of the hazard and conditions known to be present at the response site. As in any HAZMAT response, selected PPE must meet the requirements of OSHA’s PPE standards and HAZWOPER standard. The manual’s Respiratory Protection Program chapter and PPE Program chapter provide detailed information on PPE program requirements that apply to emergency responders, but the information provided below supplements the PPE program information contained in those two chapters.
PPE use in itself poses health and safety hazards, including heat stress, fatigue, and psychological stress, as well as impaired vision, mobility, and communication. PPE that provides a high level of protection is more physically restrictive than less protective ensembles. The selected PPE must match the magnitude of the hazard. Both over-protection and under-protection can be hazardous and must be avoided.
NIOSH Respirator Certification
NIOSH has an ongoing program to test and certify self-contained breathing apparatus (SCBA) and air-purifying respirators (APRs) for use in CBRN environments. Only a limited number of models have been certified to date. To determine if a given SCBA or APR has been NIOSH-certified for use in CBRN environments:

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  Check the NIOSH website for a list of CBRN-certified respirators.
  
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  Look for the label shown below, which will either be attached to the respirator or included in the respirator’s packaging materials.
  

If this CBRN Agent Approved label is not on the SCBA or APR, the device is not approved by NIOSH for use in CBRN environments. Check the label! (Note that about 5 percent of the population will not achieve a good fit with a given respirator brand. This necessitates obtaining a second brand that is certified by NIOSH for use in CBRN environments.)

Additional information is provided in respirators’ instruction manuals. For more information, visit the NIOSH website.

5.3.1 PPE for Chemical Agents

The selection of PPE for use during a response to a chemical agent follows the same principles as PPE selection and use in conventional toxic industrial chemical incidents. Detailed guidance on PPE selection is provided in the manual’s PPE Program chapter, and information on ensembles for selected chemical agents is presented in the Guidelines for PPE Ensemble Selection.

5.3.2 PPE for Biological Agents

During a response to an incident involving a biological agent release, the main function of PPE is to prevent exposures. Exposure to biological agents may occur through any of the following pathways: inhalation, ingestion, ocular, or dermal.

Recommendations for PPE selection are based on the assumption that biological agents occur mainly as fine airborne particles and have the same physical properties in air or on surfaces as inorganic dust particles. This similarity in behavior between organic (biological) particles and inorganic dust has been demonstrated in military research on bioweapons and in civilian research on infection control in hospitals. (See CDC/NIOSH’s “Recommendations for the Selection and Use of Respirators and Protective Clothing for Protection Against Biological Agents.”)

NIOSH recommendations for PPE during a response to a biological agent incident are based on site conditions and, in particular, the dissemination method and nature of the release:

Where the agent is unknown, dissemination with an aerosol-generating device is still occurring, or the event is otherwise uncontrolled, NIOSH recommends that each emergency responder use a Level A protective suit with a NIOSH-approved, CBRN pressure-demand SCBA.

Where the suspected biological aerosol is no longer being generated, but other conditions may present a splash hazard, NIOSH recommends that each emergency responder use a Level B protective suit with a NIOSH-approved, CBRN pressure-demand SCBA.

Where the agent has been identified, and it can be determined that an aerosol-generating device was not used to create high airborne concentrations or dissemination was by a letter or package that can be easily bagged, NIOSH recommends that each responder use a full-facepiece respirator with a P100 filter or powered air-purifying respirator (PAPR) with high-efficiency particulate air (HEPA) filters.
In the event of an incident involving a biological agent, the Onsite Safety Officer (or another designated person) must work closely with public health officials and disease experts to select the PPE that best protects emergency responders from the risk of infection. Also, the use of vaccines and antibiotics may play an integral role in risk management during the incident. Table 3 summarizes the recommended PPE and available types of prophylaxis measures for selected CDC Category A biological agents. The manual’s Medical Surveillance Program chapter provides EPA’s recommendations on vaccinations and antibiotics.
Table 3
CDC’s Category A Biological Agents—Recommended PPE
and Prophylaxis for Emergency Responders

Disease (Agent)	Person-to-Person Transmission?	Persistence/Stability	Recommended PPE^a	Available Types of Prophylaxis for Potentially Exposed
Anthrax (Bacillus anthracis)	No	Spores highly persistent/stable; risk of secondary aerosolization	Level B or Level C (PAPR)	Vaccine; antibiotics
Botulism (Clostridium botulinum toxin)	No	Readily inactivated by sunlight and air	Level C (PAPR)	Vaccine; anti-toxin if exposed
Plague (Yersinia pestis)	Yes; pneumonic, possible bubonic	Readily inactivated by sunlight	Level C	Antibiotics; also treat contacts
Smallpox virus (Variola major)	Yes; up to two months after rash appears	Inactive in about two days outdoors, active for up to two weeks indoors; heat and humidity make less stable	Level B	Vaccine required, no exceptions; treat contacts
Tularemia (Francisella tularensis)	No	Minimally stable; slight risk of secondary aerosolization	Level C	Vaccine; antibiotics

^a The recommended PPE levels are based on the following site conditions: the agent has been identified and controlled; an aerosol-generating device was not used to create high airborne concentrations; dissemination was by a letter or package that can be easily bagged; and the agent is in the form of airborne particles, which will not penetrate the materials of properly assembled and fitted respirators or protective clothing. 
Sources: (1) Rupert, R. 2008. Biological Threat Assessment & Awareness. Presented at the 11^th Annual OSC Readiness Training Program, San Diego. (2) U.S. National Response Team. 2008. NRT Quick Reference Guides for Biological Warfare Agents. (3) U.S. Army Medical Research Institute of Infectious Diseases. 2005. U.S. AMRIID’s Medical Management of Biological Casualties Handbook. 6^th edition. Fort Detrick, MD.