Personal Protection

Clinicians Course/ Version 1

Student Handout
10 June 2009

Terminal Learning Objective. Identify personal protective equipment, protection levels, care
and maintenance of equipment, measures and risk factors to taken during a CBRNE incident.

Enabling Learning Objectives

A. Identify personal and collective protection measures that can be taken during a CBRNE
incident so that responders can initiate appropriate actions to protect self and others. IAW FM 3-
11.3, 3-11.4, 3-11.5, 3-11.22, 3-11.9, OSHA 3151-12r Regulations (Standards - 29 CFR).
.
B. State the proper employment of assigned protective equipment. IAW FM 3-11.3, 3-11.4, 3-
11.5, 3-11.22, 3-11.9, OSHA 3151-12r Regulations (Standards - 29 CFR).

C. Select the proper protective equipment for use in a CBRNE incident. IAW FM 3-11.3, 3-
11.4, 3-11.5, 3-11.22, 3-11.9, OSHA 3151-12r Regulations (Standards - 29 CFR).

D. Identify the risks of operating in protective clothing during a CBRNE incident.

IAW FM 3-11.3, 3-11.4, 3-11.5, 3-11.22, 3-11.9, OSHA 3151-12r Regulations (Standards - 29
CFR).

ELO A Identify civilian and military self protective respiratory equipment to protect personnel
in a CBRNE environment.

1. Time, Distance and Shielding

a. Protective measures of time, distance, and shielding should be implemented immediately at

a contaminated scene, specifically;

1) We must minimize the time spent in the hazard area and the time of exposure to the
hazard. Use rapid entries/exits to execute reconnaissance or rescue.

2) The greater the distance from the source of harm, the less the potential exposure we will
face. The rule should always be to maintain a safe distance from the hazard area or projected
hazard area whenever possible.

3) Shielding ourselves and maintaining significant physical barriers increases the chances of
a safe and successful mission. We can shield ourselves by using vehicles, buildings, PPE, etc.

NOTE: See slide 4.

2. Types of Protective Equipment

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 a. Protective equipment is the key to survival for emergency responders and for hospital
personnel treating victims who may be contaminated with a CBRNE agent. In many cases
hazardous substances and concentrations may not be known, this is a major reason for needing
protective equipment.

b. We define protective equipment as either respiratory or protective.

NOTE: See slide 5.

3. Respiratory Protection

a. Many types of PPE are currently available, ranging from maximum protection with a
positive pressure respirator and total body encapsulation to minimum protection with a simple
surgical mask and a pair of latex gloves. We’ll discuss various types of protective respiratory
devices and clothing, however, there are two basic types of respiratory protection we will discuss
today. They are the Atmosphere-Supplying Respirators (ASRs) and Air-Purifying Respirators
(APRs).

b. The basic function of a respirator is to reduce the risk of respiratory injury due to
breathing airborne contaminants. A respirator provides protection by either removing the
contaminants from surrounding air (air-purifying respirators) or by supplying the wearer with an
alternate source of clean breathing air (air-supplying respirators).

NOTE: See slide 6.

4. Respiratory Protection: Air-Purifying Respirators (APRs)

a. When using air-purifying respirators (APRs), air is passed through air-purifying elements,
which removes aerosols, vapors, gases, or a combination of these contaminants. When using
negative-pressure type respirators breathing air is drawn through the air-purifying element
creating a negative pressure inside the facemask. This type of respirator is also known as tight-
fitting.

b. Disposable APRs usually are half masks, which do not provide adequate eye protection.
This type of APR depends on a filter, which traps particulates. The use of a high-efficiency
particulate air (HEPA) filter or use in combination with a chemical cartridge enhances disposable
APRs.

c. APRs essentially remove contaminants by passing ambient air through an air purifying
filter, cartridge or canister allowing great mobility.

d. APRs cannot be used against unknown substances, when the ambient dose could be lethal,
or if the agent has a low warning threshold.

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 e All APRs are limited by the adequacy of their face seals. Accordingly, APRs do not
provide adequate respiratory protection in environments immediately dangerous to life or health.

NOTE: See slide 7.

5. Respiratory Protection: Air-Purifying Respirators (APRs)

a. Powered air-purifying respirators (PAPR) contain a blower that pulls surrounding air
across the air-purifying element and blows the purified air into the wearer’s face-piece. The
powered type is equipped with a tight-fitting face-piece or a loose-fitting face-piece, helmet,
hood, or suit. They also provide the greatest degree of respiratory protection.

1) Only protects against chemicals and specific concentrations.

2) Uses a battery-powered motor-driven blower good for up to 6 hours.

3) Provides high mobility.

4) Cannot be used in immediately dangerous to life and health atmospheres.

5) Cannot be used in oxygen deficient atmospheres.

6) Requires monitoring of contaminant and oxygen levels.

NOTE: See slide 8.

6. Respiratory Protection: Atmosphere Supplying Respirators (ASRs)

a. Atmosphere (air)-supplying respirators (ASR) provide a substitute source of clean

breathing air. This air is supplied to the worker from either a stationary source through a supply
hose or from a portable container independent of the surrounding air. ASR must be used in
oxygen deficient atmospheres and those atmospheres containing hazardous chemicals that cannot
be purified by cartridges and cassettes for APRs.

b. Suplied-Air Respirators (SAR) (SAR consists of a full face-piece connected to an air

source away from the contaminated area like the airlines have. SARs are less bulky than the Self-
Contained l. Breathing Apparatus SCBA, they can be used for longer periods. SARs also are
easier for most hospital personnel to use. Although negative-pressure SARs exist, positive-
pressure SARs are recommended for HAZMAT incidents. SARs, like SCBA, provide the highest
level of respiratory protection.

NOTE: See slide 9.

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7. Respiratory Protection: Atmosphere Supplying Respirators (ASRs)

a. The (SCBA) consists of a full face-piece connected by a hose to a portable source of

compressed air. The open-circuit, positive-pressure SCBA is the most common type. This SCBA
provides clean air under positive pressure from a cylinder; the air then is exhaled into the
environment. Negative-pressure SCBAs are prohibited by Occupational Safety and Health
Administration (OSHA) regulations for
hazardous materials (HAZMAT) incidents.

1) SCBAs are expensive, heavy, and bulky. They also contain contain limited air
supplies.

2) Users must be fit-tested and have a high level of training and there is a requirement for
a physical evaluation prior to using the SCBA.

NOTE See slide 10.

8. Military Masks
a. Types Military Protective Masks include: the M40/M42, M45, and MCU-2P.

1) Military protective masks protect against field concentrations of all known

chemical and biological agents in vapor or aerosol form.

2) Military masks utilize canisters to protect from biological and chemical

Agents however; they are not designed for radiological protection, but will provide added alpha
and
beta dust inhalation protection.

NOTE: See slide 11

9. Newer Military PPE Joint Service - Lightweight Integrated Suit Technology (JS-LIST)

a.. Military PPE Joint Service - Lightweight Integrated Suit Technology (JS-LIST)

1) Features state-of-the-art chemical protective lining technology, which provides

increased chemical protection while allowing more mobility and easier donning and
doffing.

2) Can be laundered up to six times.

3) Components include an over-garment and protective over-boots.

4) Provides protection up to 24 hours in a contaminated environment.

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 Conduct a check on learning and summarize the learning activity.
NOTE:
1. Military masks utilize canisters to protect from biological and chemical agents?
True

2. Military mask are not designed for radiological protection, but will provide
added alpha and beta dust inhalation protection.

3. The JS-List provides protection up to how many hours in a contaminated

environment.
24 Hours

ELO B. State the proper employment of assigned protective equipment.

NOTE: See slide 12

1. Civilian Chemical Protective Levels.

a) Military PPE, designed for the combat environment, has not been fully tested for
noncombatant use. In the U.S., equipment and training standards and utilization guidelines for
civilian PPE are set by the Occupational Safety and Health Administration (OSHA) and the
National Institute for Occupational Safety and Health (NIOSH). While military PPE has not been
NIOSH certified and OSHA approved, there may be circumstances in which it is the only
available protective equipment.

b) OSHA provides guidelines for selecting appropriate PPE for civilian responders and
categorizes equipment ensembles into four levels, A through D. Many different products exist
for civilian PPE. Equipment should have NIOSH certification and OSHA approval. This ensures
the equipment has been tested and approved for protection against CBRNE hazards.

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NOTE: See slide 13

2. Civilian Chemical Protective Levels.

a) Level A is used when:

b) Hazardous substances have been identified and the highest level of protection is required
for skin, eyes, and respiratory system.

c) In any conditions in which the hazardous substance is unknown.

3. Level B is used when:

a) Type and atmospheric concentration of substance have been

Identified.

a) The highest level of respiratory protection is necessary.

b) A lesser level of skin protection is needed.

c) There is less than 19.5% oxygen.

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 d) The HAZMAT is unknown and there is no direct skin contact or splash
Hazard.

NOTE: See slide 14

4. Civilian Chemical Protective Levels. Level C is used when:

a) Types of contaminants are identified.

b) Substances will not adversely affect or be absorbed through any exposed skin.

c) Air Purifying Respirator (APR) is available that can remove the

contaminants.

d) All criteria for use of APR are met.

e) There is more than 19.5% oxygen.

5. Level D is used when the atmosphere contains no hazard and when there is no potential for
splashes, immersion, or unexpected inhalation of, or contact with, hazardous levels of any
chemicals. Level D is generally considered a work uniform offering minimal protection.

NOTE: See slide 15

6. Military Chemical Protective Levels

a. The military uses a five-level personal protection system called Mission Oriented
Protective Posture (MOPP). The local commander determines MOPP levels based on
assessment of available data. Standardized MOPP levels allow commanders to easily increase or
decrease levels of protection without providing long explanations.

b. MOPP levels are based on the amount of protective clothing and equipment to be
worn. Levels were devised because of the risks involved with prolonged use of
military PPE and its degradation of job performance. Mask only is an another
protective posture used for riot-control agents and blood or cyanide.

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 a.

NOTE: See slide 16

7. Military Chemical Protective Levels.

a) Level 0 - Highly vulnerable to persistent agent attacks. Automatic upgrade to MOPP 1 is

given when notification that chemical weapons have been used or that the threat for use has
risen.

b) Level I - This level is automatically assumed when chemical weapons have been
employed in an area of operations or when directed by higher commands.

c) Level II - As with MOPP 1, the overgarment jacket may be left unbuttoned, but trousers
remain closed.

NOTE: See slide 17

8. Military Chemical Protective Levels

a. Military Chemical Protective Levels

1) Level III - Flexibility is built into the system to allow relief in hot weather. Soldiers
can open the over-garment jacket and roll the protective mask hood for ventilation,
but trousers remain closed.

2) Level IV - Provides the highest degree of chemical protection, but also has the
most negative impact on an individual's performance. Always used when hazardous
agent is unknown.

NOTE: See slide 18

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9. Protection Levels for Healthcare Personnel.

a. Healthcare personnel may be exposed to a variety of environmental hazards, regardless of

their discipline or location of work. If a contaminated patient enters the healthcare facility,
secondary contamination potential exists for facility, staff, other patients, and visitors.

1) To lessen the risk of secondary contamination, the following protection levels are
suggested by medical planners.

2) Level B for personnel involved in performing decontamination (waterproof garments

should be worn over the chemically resistant clothing).

3) Level C for healthcare personnel providing initial medical treatment but not involved
with decontamination (some recommend Level B protection).

NOTE: See slide 19

10. Protection Levels for Healthcare Personnel

a. Level C for emergency management service personnel not involved in tactical operations
inside the "hot zone" (area of contamination).

b. Level D for hospital personnel working in laboratories or in-patient services

(OSHA does no consider clinical attire as Level D protection).

NOTE: Conduct a check on learning and summarize the learning activity.

1. If medical personnel are not involved with decontaminating and initial patient
care what is the recommended protection level? Level C, but some recommend
Level B.

ELO C. Select the proper protective equipment for use in a CBRNE incident.

NOTE: See slide 20

1. Protect Against Contamination Spread of Contamination

a. Select the shortest route with the least contamination: Permits the fastest travel based on
mission, enemy, terrain, troops, time available, and civilian considerations.

1) Delay entry into the area by implementing the concept of time, distance, and shielding.

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 2) Avoid low laying areas.

3) Select the shortest route with the least amount of contamination.

4) Avoid contact with surface.

5) Perform immediate decontamination if contaminated.

6) Decontaminate personnel and equipment by washing them thoroughly with warm soapy
water.

NOTE: See slide 21

2. Care and Maintenance

a) To ensure survivability in an incident requiring PPE, strict adherence to PPE maintenance

schedules are necessary. Respirators need to be cleaned, sanitized, and put back in working
order after each use. All respiratory protection equipment should be inspected regularly.

b) Maintenance checks are appropriate:

1) Upon receipt of equipment from a vendor

2) After each use, whether training or actual incident

3) During periodic inspections or whenever questions may arise on key issues

NOTE: Conduct a check on learning and summarize the learning activity.

1. When are maintenance checks appropriate? a) Upon receipt of equipment

From a vendor b) After each use, whether training or actual incident and c)
During periodic inspections or whenever questions may arise on key issues

ELO D Identify the risks of operating in protective clothing during a CBRNE incident.

NOTE: See slide 22

1. Limitations for Wearer

a. Delay entry into the area by implementing the concept of time, distance, and shielding.

1) Avoid low laying areas.

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 2) Select the shortest route with the least amount of contamination.

3) Avoid contact with surface.

4) Perform immediate decontamination if contaminated.

5) Decontaminate personnel and equipment by washing them thoroughly with warm soapy
water.

NOTE: See slide 23

2. Limitations for Wearer: Preventive Measures

a. Physical Requirements

1) Good physical condition, as profiled by baseline and regular medical exams.

2) Good motor coordination.

3) Adequate muscular and skeletal condition (size and strength) to wear protective
equipment.

4) Agility (ability to balance breathing apparatus with air cylinder or backpack).

5) Cardiovascular conditioning to help maximize air supply.

NOTE: See slide 24

3. Limitations for Wearer: Preventive Measures

a. Physical Requirements (continued)

1) Good mental condition, as profiled by baseline and regular medical exams.

2) Emotional stability (including ability to deal with psychological stresses such as

(claustrophobia).

3) Ability to handle emergency situations.

NOTE: See slide 25

4. Limitations for Wearer

d. Psychological Limitations

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 1) Claustrophobia.
2) Apprehension.
3) Distorted bodily sensations.
4) Confusion and panic.
5) Hallucinations.
6) Disorientation.
7) Paranoia.

NOTE: See slide 26

5. MOPP Gear Work/Rest Cycles

a) Military work is categorized as very light, light, moderate, or heavy. Hundreds of military
tasks have been tested to determine the degradation from wearing MOPP gear.

b) Work intensity is a major contributing factor to heat stress than can be managed by
leaders.

c) Adding layers to the uniform reduces mobility, agility, coordination, and dexterity and will
add 10 degrees to the body temperature.

d) Soldiers wearing MOPP4 will take about 1.5 times longer to perform most tasks.

e) Wearing of MOPP gear increases the risk of heat stress, even at moderate environmental
temperatures and work intensities.

f) The incidence of heat casualties can be reduced if soldiers are allowed to lower their work
intensity and/or take more frequent rest breaks.

NOTE: See slide 27

6. Personal Protection

a. Military work is categorized as very light, light, moderate, or heavy. Hundreds of military
tasks
have been tested to determine the degradation from wearing MOPP gear

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NOTE: See slide 28 Questions

1. Questions / Summary

A. Identify personal and collective protection measures that can be taken during a CBRNE
incident so that responders can initiate appropriate actions to protect self and others.
.
B. State the proper employment of assigned protective equipment.

C. Select the proper protective equipment for use in a CBRNE incident

D. Identify the risks of operating in protective clothing during a CBRNE incident.

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SECTION V. STUDENT EVALUATION

Testing NOTE: Describe how the student must demonstrate accomplishment of the
Requirement TLO. Refer student to the Student Evaluation Plan.
s

Feedback NOTE: Feedback is essential to effective learning. Schedule and provide

Requirement feedback on the evaluation and any information to help answer students'
s questions about the test. Provide remedial training as needed.

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