Seven Mountains EMS Council Air Purifying Respirators, Powered Air Purifying Respirators, and Personal Protective Equipment Seven Mountains EMS Council Introduction of program Instructor / Facilitator should have PPE and PAPR out of containers and lying in front of class room prior to start Ensure batteries that are being used for demonstration are good and that equipment is tested prior to class

Objectives -Determine whether the available PPE and respiratory protective equipment is appropriate for the hazards that have been identified and the tasks that are being assigned  -Don, work in, and doff personal protective equipment These objectives should be an outline for the class. Do = put on Doff = take off You can also discuss the Slime Green PPE bags and show students what chemical protective clothing is available. There will be discussion in coming slides about some hazardous environments. This is a good time to review the primary hazards associated with hazardous materials incidents. Corrosives, Flammables, and Toxic Materials

PPE The Personal Protective Equipment that you select should be based on the activities that you will be expected to participate in at the scene of a hazardous materials incident and the physical and chemical hazards present REMEMBER TOG (fire fighting or rescue) and jump suites are NOT recommended for many chemical spills Chemical and Physical properties should be reviewed. Discuss the ability to predict the materials behavior and exposure potential by understanding information found on Material Safety Data Sheets (MSDS). This information should include: Boiling Point – Temperature at which a liquid changes to a vapor / gas Vapor Pressure – the measurement of a liquid’s ability to evaporate. Remember the higher the vapor pressure the more likely that material is to yield vapor, potentially causing an inhalation exposure potential. (Float in the environment) Lighter than Air <1 = Air = >1 Heavier than Air (seek out low lying areas in the environment) Specific Gravity – measurement of a liquid compared to water (Float on water) Lighter than Water <1 = Water = >1 Heavier than Air (Sink to low areas in water) Toxicity measurements should also be discussed. These include Time Weighted Average (TWA), Permissible Exposure Limits (PEL), Short Term Exposure Limits (STEL), Ceiling (C), Immediately Dangerous to Life and Health (IDLH)

PPE First responders trained to the operational level are permitted to perform defensive actions only, however those activities may require the use of PPE such as Chemical Protective Clothing (CPC). Ask the students to define Defensive Practices. These should include discussions regarding: Decontamination – stress that this area is an opportunity for triage to take place during a hazardous materials event that may involve patients. EMS providers may be asked to assist with the actual decontamination line as well. Medical Surveillance and Rehab is the other responsibility of EMS during a hazardous materials event. Operational level responders do not perform hands on tasks within the Hot Zone. Operational level responders may be required to where chemical protective clothing as well as respiratory protective equipment including APRs, PAPRs, and SCBAs.

PPE In addition to skin protection it may be necessary for you as a responder to wear self-contained breathing apparatus (SCBA), supplied air respirators (SAR), air purifying respirators (APR), or powered air purifying respirators (PAPR). Discuss the need for additional respiratory protection should the hazards present with an inhalation exposure potential. PAPRs and APRs limitations will be presented in coming slides.

PPE Levels of protection (NFPA 473 & EPA) Level D – no protection Are based on Respiratory and Skin Protection Combined Level D – no protection Level C – limited skin and limited respiratory Level B – limited skin and high respiratory Level A – high skin and high respiratory Level D – Street clothes, station wear, rescue and EMS jump suits, and firefighting turn out gear. Level C – Chemical protective clothing with air purifying respirators (Dust Masks, HEPA masks, APRS, and PAPRs) Level B – Chemical protective clothing with atmosphere supplying respirators (Self Contained Breathing Apparatus and Supplied Air Respirators) Level A – Highest level of protection with a totally encapsulating chemical protective suit and an atmosphere supplying respirator (SCBA or SAR). Most EMS operations at a hazardous materials incident where chemical protection is required will be conducted in Level B or Level C

Common Sense Other forms of PPE recommended but not always required are Body Protection (chemical protective clothing) Head protection Eye protection Hearing Protection All safety items should meet OSHA & ANSI standards The needs of these other forms of PPE will be derived from the physical hazards of the scene. Most of the respiratory protective equipment EMS will use provides eye protection with full face or hooded devices. Hearing protection may be necessary for incidents that involve pressurized containers, industrial incidents, and even some transportation related incidents. OSHA – Occupational Safety and Health Administration. Pennsylvania is not an OSHA state however, OSHA can and will investigate accidents, injuries, and illnesses to emergency responders. OSHA will also levy citations for wrong doings and negligent actions.

Respiratory Protection Many hazardous situations require respiratory protection. Hazards include - dust - mist vapors particles - toxic gasses and - oxygen deficient / enriched atmospheres Dusts and particles – solid particles such as asbestos, Anthrax and other weaponized biological agents Mists and Vapors – maybe generated from scene conditions or chemical reactions. Most air purifying respirators will begin to loose their protective characteristics when they get moist or wet. Some of the cartridges for the APRs and HEPA type masks are paper like material that will be affected by humidity. Any air purifying type respirator (Dust Mask, HEPA Mask, APR, or PAPR) in order to be used safely has to have the environment identified as well as quantified. There are more discussion regarding this statement in coming slides. Oxygen Deficient and Oxygen Enriched Environments can and do create an immediately dangerous to life and health (IDLH) atmosphere. The only recommended respiratory protection in an IDLH atmosphere is SCBA or SAR.

Respiratory Protection Selection of respiratory protection should be based on the The chemical hazards present The work being performed The ability, training, and experience of the responder The chemical hazards present – need to know the identity as well as the concentrations or quantities of materials in the environment. Discussion again about the chemical and physical properties to predict the behavior of the hazardous materials may be beneficial for the students. The work being performed – as EMS responders, even when participating in decontamination should expect to have a low potential for exposure. The work that EMS responders perform occurs in the contamination reduction zone (Warm Zone) and the Cold Zone. EMS responders do not enter the Hot Zone or perform any offensive tactics unless additional training to the Hazardous Materials Technician Level is obtained. The ability, training, and experience of the responder – Responses associated with Hazardous Materials Incidents require specialized training and PRACTICE. During a response is not the time to learn how to properly wear chemical protective clothing and respiratory protective equipment. There may also be physical or mental limitations that the responder may have, such as claustrophobia, respiratory ailments like asthma, or emphysema. These conditions can and will cause complications for the responder if not identified.

Respiratory Protection Dust/HEPA Masks- Dust and mold particles, biological agents Pros Lightweight Disposable Little training required Cons Very limited protection Can only be used in safe atmospheres Training required is the proper use, proper fitting, and seal checks, as well as maintenance and inspection. Safe Atmospheres = Oxygen concentrations of 19.5%<O2>23.5% with minimal contamination that has been measured and quantified

Respiratory protection Air Purifying Respirators (APR’s) - Specific types of vapors Pros Lightweight Disposable canisters Little training required Full and half masks Cons Can only be used with certain vapors Can only be used in safe atmospheres Respiratory and fit testing required Cartridges and canisters have information on the label describing the materials that can protect against. Training required is the proper use, proper fitting, and seal checks, as well as maintenance and inspection. Safe Atmospheres = Oxygen concentrations of 19.5%<O2>23.5% with minimal contamination that has been measured and quantified

Respiratory protection Powered Air Purifying Respirators (PAPR’s) - Specific types of vapors, provides a Positive pressure environment inside the wearer’s mask. Pros Lightweight Disposable canisters Respiratory and fit testing not required Cons Can only be used with certain vapors Can only be used in safe atmospheres Operates on Batteries, which must be replaced or recharged. Fit testing requirement is waved because of the loose hood style assembly. The fan motor can provide a “positive pressure” environment inside the hood as long as the exhalation valves are functioning properly and the neck elastic band is still flexible. Cartridges and canisters have information on the label describing the materials that can protect against. Training required is the proper use, proper fitting, and seal checks, as well as maintenance and inspection. Safe Atmospheres = Oxygen concentrations of 19.5%<O2>23.5% with minimal contamination that has been measured and quantified

Respiratory protection Supplied Air Respirators (SAR’s) - Same as SCBA - Limited to 300’ from air source Pros Can be used in any atmosphere Highest level of protection Unlimited time on air Cons Respiratory and fit testing required More training required Higher costs Mental strain Review with students that this form of respiratory protection is not common within the emergency response entities and is usually found within industry or specialized confined space rescue teams.

Respiratory protection SCBA - highest level of protection Pros Can be used in any atmosphere Highest level of protection Cons Respiratory and fit testing required More training required Limited time frame Higher costs Highest level of protection that is most common to the fire and rescue services. Additional training is required prior to use. Again those responders that may have medical or mental limitations should be identified. SCBAs would be worn in the decontamination line should an inhalation type hazard be associated with the materials involved in the incident.

Limitations of the PAPRs Need to know the identity of the contaminant Need to understand the chemical and physical properties of the contaminant Need to quantify the environment that you are in, especially OXYGEN O2 concentrations (19.5% > O2 < 23.5%) Identifying the material – this may and probably will require the assistance of the hazardous materials response team, facility personnel if responding to a fixed facility, as well as markings, labels, and placards on transportation vehicles. Chemical and physical properties will be found on Material Safety Data Sheets as well as other reference materials such as the NIOSH pocket guide for chemical hazards, chemical dictionaries, and other sources, even the world wide web. Oxygen concentrations are measured with multi-gas meters and other monitoring equipment that may be brought to the scene by the fire departments or hazardous materials response teams.

Limitations of the PAPRs Defined usage times (Battery powered fans) Replacement Canisters Dependant on use, environment, and contaminants Compatibility with other forms of Personal Protective Equipment FALSE SENSE OF SECURITY! Battery use – should always use a new set of batteries each response you make. Typically these batteries will provide the user with 6 to 8 hours of operations. Replacement Canisters – canisters should be replaced after each use during any emergency response activity. Also some canisters and cartridges have End of Service Life Indicators (ESLI) that change color when exposed to concentrations of materials that exceed the protective capabilities. Canisters should also be replaced if they become wet during incident response or decontamination or if the seal is noticeably breached. New canisters are vacuum packaged. Compatibility – These PAPRs can be used with hoodless or hooded suits. False Sense of Security – REMIND all students that PAPRs do not have any source of oxygen and the canisters have limited uses against defined materials. There is more discussion regarding concentrations and assigned protection factors on coming slides.

Level of Protection PAPRs provide limited protection from contaminants Assigned protection factor (APF) = 25 Up to 1000 providing evidence of manufacturer testing, documented proof, and extended user training and testing. Example: Chlorine Time Weighted Average (TWA) for Chlorine = 0.5 parts per million ppm) OSHA’s Assigned protection factor (APF) for PAPRs = 25 TWA * APF = maximum concentrations that are safe for the user Chlorine example 0.5ppm * 25 = 12.5 ppm Example: Acetone TWA for OSHA = 1000 ppm TWA for NIOSH = 250 ppm NIOSH = 250ppm * 25 = 6250 ppm OSHA = 1000ppm * 25 = 25000 ppm Understand that 1% on an LEL detector from the fire department equals 10000ppm for the acetone example. FALSE SENSE OF SECURITY

Regulatory Requirements Documented Respiratory Protection Program, in accordance with the Respiratory Protection Standard of OSHA (29 CFR 1910.134) NO FIT TESTING for the PAPRs Individual user training Inspection / testing, cleaning, and maintenance schedules Guidelines for use Limitations of use Remind students that services should have a written respiratory protection program that is compliant with the OSHA Standard. OSHA’s website has template programs as examples. Inspection of the PAPRs include: (follow manufacturers recommendations for frequency) Breathing Tube: The breathing tube should be visually inspected for cracks and tears, the tube is flexible and folded so it should be pulled gently during an inspection. Ensure that both hose clamps are intact and function properly as well. Hood Assembly: The hood is butyl rubber, some of the early PAPRs used a tyvek like material. The hood should be inspected visually as well looking for breaches as well as testing the ratchet strap for fit and the exhalation valves for function. Ensure that the check valve is complete by removing the outer cap and looking as the rubber (latex) flap. The seam around the face piece should be assessed for any cracks or de-lamination. Fan assembly: Ensure a supply of batteries is available but not in the assembly, look for any signs of corrosion in the battery compartment. Also inspect the wire connection between the battery pack and the fan motor. Ensure the thumb screw is available. Place batteries in the unit, plug wire connection together and ensure fan motor runs.

Questions, Comments, Concerns Time to Don and Doff the PAPR Demonstrate the proper assembly of the PAPR, show students how to properly don and doff the equipment, discuss how to secure the assembly to chemical protective clothing. Walk students through a demonstration of an inspection as well. Allow all students the opportunity to assemble the PAPR and don and doff as well. Training kits are available through the regional EMS office by contacting Mark Wolfgang at (814) 355-1474 It is recommended that the kits your service has received be used for training with the exception of the actual canisters. Use training canisters for demonstration and training purposes.