ABSTRACT
I. Introduction to Personal Protective Equipment ................................................................... 550 A. Need for Protection and Routes of Exposure .............................................................. 550 B. Anatomical and Physiological Considerations ............................................................ 551 C. Key Terms and Definitions.......................................................................................... 551 D. Atmosphere (Air)-Supplied Respirator ........................................................................ 552 E. Self-Contained Breathing Apparatus ........................................................................... 553 F. Air-Purifying Respirators............................................................................................. 555 G. Respirator Nosecup...................................................................................................... 555 H. Respirator Hood........................................................................................................... 556
II. Physiological Consequences of Personal Protective Equipment Usage.............................. 556 A. Heat Stress ................................................................................................................... 556 B. Pathophysiology of Heat Accumulation...................................................................... 557 C. Clothing Worn during PPE Usage............................................................................... 557 D. Physiological Consequences of Respirator Usage....................................................... 558 E. Physical Limitations of Personal Protective Equipment Usage .................................. 559
III. Levels of Civilian Personal Protective Equipment .............................................................. 560 A. Criteria Employed for Selection of an Appropriate Level of Personal
Protective Equipment................................................................................................... 560 B. Level A ........................................................................................................................ 560 C. Level B......................................................................................................................... 562 D. Level C......................................................................................................................... 563
1. Activated Carbon .................................................................................................. 564 2. Example of the Construction of an Air-Purifying Respirator Filter..................... 564 3. Powered Air-Purifying Respirators....................................................................... 567 4. Hooded Powered Air-Purifying Respirators ......................................................... 568 5. Negative-Pressure Air-Purifying Respirators........................................................ 569 6. Respirator Facepiece Construction ....................................................................... 570 7. Protective Suit Construction ................................................................................. 572
E. Level D ........................................................................................................................ 573 F. Boots ............................................................................................................................ 573 G. Gloves .......................................................................................................................... 574 H. Toxicological Protective Aprons ................................................................................. 574 I. Cooling Vests............................................................................................................... 574 J. Vision-Assisting Devices............................................................................................. 574
K. Miscellaneous Equipment ............................................................................................ 575 1. Head Harness ........................................................................................................ 575 2. Outserts ................................................................................................................. 575 3. Reversed Faceseal ................................................................................................. 576 4. Voicemitter............................................................................................................ 576 5. Voice Amplifiers ................................................................................................... 576
IV. Miscellaneous Topics Related to Personal Protective Equipment ...................................... 577 A. Skin Exposure Reduction Paste Against Chemical Warfare Agents .......................... 577 B. Alternate (Nontraditional) Forms of Personal Protective Equipment
for a Large-Scale Chemical Event ............................................................................... 577 C. Wet Bulb Globe Temperature Index ........................................................................... 578 D. Conversion of Parts Per Million or Parts Per Billion to Milligrams
Per Cubic Meter ........................................................................................................... 578 E. Respirator Storage........................................................................................................ 578 F. Shelf and Service Lives of Personal Protective Equipment ........................................ 579
V. Governmental Oversight and Regulations ............................................................................ 580 A. Respirator Protection Program for Workers ................................................................ 580 B. Fit Testing of Respirators ............................................................................................ 580 C. Federal Chemical, Biological, Radiological, or Nuclear Standards
for Personal Protective Equipment .............................................................................. 581 D. Code of Federal Regulation and Other Governmental Regulations............................ 582
Photographic Acknowledgments .................................................................................................. 582 Photos............................................................................................................................................ 583 References ..................................................................................................................................... 606
Prehospital Setting. The most important care that the casualty receives is the care that is given within the first several minutes of a chemical attack. The conduct of the care given immediately after toxic chemical agent exposure, including the administration of antidotes, can literally mean the difference between life and death. This is not an overstatement (United States Army Medical Research Institute of Chemical Defense, June 2001). Since this care will be rendered in a warm zone, personal protective equipment (PPE) must be employed by the responder.
