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Personal Protective Equipment (PPE) in a Radiation Emergency


PPE in Radiation Emergencies

Key Information:
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  • In a radiation emergency, the choice of appropriate personal protective equipment (PPE) depends on
    • Response role and specific tasks
    • Risk of contamination
  • PPE can protect against1
  • PPE cannot protect against exposure from high energy, highly penetrating forms of ionizing radiation2 associated with most radiation emergencies.
  • PPE should include a personal radiation dosimeter whenever there is concern about exposure to penetrating ionizing radiation.
    • Direct-reading personal radiation dosimeters may be used to monitor radiation dose and can help workers stay within recommended Dose Limits for Emergency Workers.
    • Direct-reading dosimeters should be worn so that a worker can easily see the read-out and/or hear warning alarms.
  • Recommended respiratory PPE includes a full-face piece air purifying respirator with a P-100 or High Efficiency Particulate Air (HEPA) filter3.
    • Other respiratory protective equipment (e.g., a simple surgical facemask, N-95 respirators), non-fit tested respirators, or ad hoc respiratory protection do not deliver appropriate or sufficient respiratory protection.
    • Environmental testing and hazard assessment by a safety professional can help identify hazards and risk levels and direct choices of permissible PPE.

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Personal Protective Equipment (PPE) Overview


  • Personal protective equipment (PPE): The clothing and/or equipment worn by workers (including first responders and first receivers) to prevent or mitigate serious job-related illness or injury. 4, 5
  • PPE ensembles: prescribed sets of individual PPE elements worn together to protect against chemical, radiological, physical, electrical, mechanical, or other occupational hazards
    • Protection provided by ensembles should be proportional to the anticipated level of risk.
    • When exposures are immediately dangerous to life and health, the most protective PPE ensembles should be worn.
    • In less toxic environments, less restrictive PPE ensembles can be chosen.
  • No combination of PPE elements can protect against all possible hazards
    • Whenever possible, implement administrative and/or engineering controls as the primary means of limiting worker exposure to environmental hazards.
    • PPE should be used only after administrative and/or engineering controls fail to achieve an acceptable level of worker protection and safety.

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PPE Classification Systems

See also: PPE Classifications Systems Table table

Civilian PPE

US Military PPE

  • Mission Oriented Protective (MOPP) gear: six different readiness levels achieved by adding or removing individual MOPP gear ensemble components (See also: table of MOPP readiness levels)4, 11
    • MOPP Ready [lowest level of readiness (i.e., no ensemble elements are worn)]
    • MOPP 0
    • MOPP 1
    • MOPP 2
    • MOPP 3
    • MOPP 4 [highest level of readiness (i.e., all ensemble elements are worn)]

International PPE Systems

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PPE Image Galleries

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Putting on ("Donning") and Taking Off ("Doffing") PPE

Federal Guidance

Other Resources

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First Responder PPE in a Radiation Emergency

Who is a first responder?13

  • In the earliest stages of a mass casualty event or other disaster, first responders are responsible for protecting and preserving
    • Life (e.g., paramedics, emergency medical technicians, ambulance service personnel)
    • Property (e.g., firefighters)
    • Evidence (e.g., law enforcement)
    • Environment (e.g., HAZMAT teams)
  • First responder activities generally occur at the site of the incident
  • First responders expected to enter environments immediately dangerous to life and health must have access to PPE that provides the highest levels of skin and respiratory protection

Important considerations when selecting first responder PPE in a radiation emergency

  • Choice of PPE in a radiation emergency
    • Is made by incident commanders or other on-scene safety officials
    • Is determined by level of risk which is based on
      • Anticipated response role
      • Impact of anticipated on-scene hazards (radioactive and environmental) on response role9, 14
      • Risk of contamination (internal, external) with radioactive material

Recommended PPE and practices in a radiation emergency

First Responder: Recommended PPE and practices in a radiation emergency
Emergency TypeRecommended PPE*
Radiation plus chemical and/or biological hazard: "combined hazard" event
  • Before combined hazard(s) are well characterized: first responders should be instructed to wear PPE ensembles that protect against anticipated (potentially multiple) hazards15
  • After combined hazards are confirmed: first responders should be instructed to wear PPE ensembles that protect against identified hazards15
Radiation only event with high risk of contamination (and non-radiation hazards have been excluded): e.g., Radiological Dispersal Device (RDD) Level C PPE usually provides sufficient respiratory and dermal protection16
Radiation only event with high risk of exposure (and non-radiation hazards have been excluded): e.g., Radiological Exposure Device (RED)
  • PPE confers no protection against high energy, highly penetrating forms of ionizing radiation
  • Factors that help decrease radiation dose from exposure
    • Minimizing time spent near a radiation source
    • Maximizing distance from a radiation source
    • Increasing the physical shielding between a person and a radiation source
* In all cases where radiation is suspected, first responders should also wear personal radiation dosimeters that enable them to read dose rate and/or accumulated dose in real time

Additional sources of information for first responder PPE in a radiation emergency

Federal Guidance - HHS Collaborations
  • OSHA/NIOSH Interim Guidance - August 30, 2004: Chemical - Biological - Radiological - Nuclear Personal Protective Equipment Selection Matrix for Emergency Responders: Radiological Dispersal Device (RDD); (See Overview)
  • OSHA/ NIOSH Interim Guidance (April 2005): Chemical - Biological - Radiological - Nuclear (CBRN) Personal Protective Equipment Selection Matrix for Emergency Responders; (See Overview)
Other Federal Guidance Other Resources
  • Key Elements of Preparing Emergency Responders for Nuclear and Radiological Terrorism (NCRP Commentary No. 19), National Council on Radiation Protection and Measurements, Bethesda, MD, December 2005. (See Notes on Recommended PPE Guidance)

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First Receiver (Hospital Healthcare Worker) PPE in a Radiation Emergency

Who is a first receiver?17

  • A healthcare worker in a hospital or other facility where victims arrive for treatment
  • First receivers provide medical care at locations remote from the incident and not at the site of a hazardous material release

Important considerations when selecting first receiver PPE in a radiation emergency

  • Since victims may arrive for treatment contaminated with hazardous materials, first receivers need to protect themselves against secondary contamination by putting on appropriate PPE before delivering medical care
  • What is secondary contamination?
  • PPE should restrict performance of duties as little as possible
    • Workers are more likely to comply with proper PPE if they are comfortable wearing the ensemble and it allows them to perform required tasks15
    • Operational impact and requirements increase with use of higher levels of PPE (Level A, B, and C)
    • Wearing higher levels of PPE makes sustained delivery of medical care difficult
    • Putting on and wearing of PPE should not delay delivery of care
    • Gloves providing adequate protection should not reduce manual dexterity
    • Double gloving and frequent glove changes are encouraged, especially when working with patients who may not have been fully decontaminated (e.g., those who self-refer to the emergency department [ED] or who arrive by transport with life- and limb-threatening injuries)
      • Taping the inner glove to the sleeve facilitates an easier removal of the outer glove
      • Frequent glove changes help minimize the risk of inadvertent, iatrogenic spread of contamination to uncontaminated areas of a patient, to other patients, to staff members, or to other areas of the ED

Recommended PPE and practices in a radiation emergency

First Receiver: Recommended PPE and practices in a radiation emergency
Emergency TypeResponse RoleRecommended PPE*Notes, Caveats, & Concerns
Radiation plus chemical and/or biological hazard: "combined hazard" event First receivers delivering care to contaminated victims
  • Before incident hazard(s) are well characterized: first receivers should be instructed to wear PPE ensembles that protect against anticipated hazards15
  • First receivers may need to wear a higher level of PPE than they are accustomed to wearing until hazard characterization is complete
  • After combined hazards are confirmed: first receivers should be instructed to wear PPE ensembles that protect against identified hazards15
  • Higher level PPE ensembles are generally not available in most hospitals18
Radiation only event with high risk of contamination (and non-radiation hazards have been excluded): e.g., Radiological Dispersal Device (RDD) First receivers delivering care to victims more likely to be externally contaminated: i.e., healthcare providers working in pre-decontamination (triage) and decontamination areas15, 16, 19
  • Level C PPE usually provides sufficient level of respiratory and skin protection
  • Level C PPE should be worn until risk characterization determines that Level D PPE provides sufficient protection
  • Recommended respiratory PPE includes a full-face piece air purifying respirator with a P-100 or High Efficiency Particulate Air (HEPA) filter.3
  • Other respiratory protective equipment (e.g., a simple surgical facemask, N-95 respirators), non-fit tested respirators, or ad hoc respiratory protection do not deliver appropriate or sufficient respiratory protection; environmental testing and hazard assessment by a safety professional can help identify hazards and risk levels and direct choices of permissible PPE.
  • Lead aprons are cumbersome and do not protect against exposure from high-energy, highly penetrating ionizing radiation
First receivers delivering care to victims less likely to be externally contaminated: i.e., healthcare providers working in post-decontamination areas of the hospital
  • Level D PPE provides sufficient respiratory and skin protection for first receivers working in post-decontamination areas of the hospital; this includes those delivering care to persons who may not yet be decontaminated (e.g., patients who self-refer or who arrive by transport with life- and limb-threatening injuries)
  • Level D PPE also protects skin and personal clothing against possible splashes of contaminated blood and body fluids (urine, feces, wound drainage, etc.)
  • Level D PPE is equivalent to Standard Precautions PPE worn in medical facilities as protection against transmission of biohazards from patients to providers
  • Do not delay stabilization of any patient to first perform decontamination
  • Perform life- and limb-saving tasks before managing radiation problems
First receivers delivering care to victims with suspected or confirmed internal contamination: i.e., healthcare providers working in post-decontamination areas of the hospital
  • Level D PPE also protects skin and personal clothing against possible contamination from blood and body fluids (urine, feces, wound drainage, etc.)
  • Level D PPE is equivalent to Standard Precautions PPE worn in medical facilities as protection against transmission of biohazards from patients to providers
  • Hospital radiation safety officer or health physicist will routinely monitor work areas and patient blood and body fluids for radioactive contamination or elevated radiation levels
Radiation only event with high risk of exposure (and non-radiation hazards have been excluded): e.g., Radiological Exposure Device (RED) First receivers delivering care to victims in all areas of the hospital
  • Level D (Standard Precautions) PPE should be used by healthcare workers when caring for victims of radiation exposure
  • Patients exposed to radiation but not contaminated with radioactive material pose no threat of exposure to healthcare providers
* In all cases where radiation is suspected, first receivers should also wear a personal radiation dosimeter to monitor their radiation absorbed dose

Additional sources of information for first receiver PPE in a radiation emergency

Federal Guidance

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References

  1. Rojas-Palma C, Liland A, Jerstad AN, Etherington G, del Rosario Perez M, Rahola T, Smith K (eds.). TMT Handbook: Triage, Monitoring and Treatment of people exposed to ionising radiation following a malevolent act. Norwegian Radiation Protection Authority, 2009.
  2. Key Elements of Preparing Emergency Responders for Nuclear and Radiological Terrorism (NCRP Commentary No. 19), National Council on Radiation Protection and Measurements, Bethesda, MD, December 2005. Purchase required; see Free Overview (PDF - 219 KB).
  3. OSHA/NIOSH Interim Guidance - August 30, 2004. Chemical - Biological - Radiological - Nuclear (CBRN) Personal Protective Equipment Selection Matrix for Emergency Responders: Radiological Dispersal Device (RDD) (OSHA, HHS/CDC/NIOSH)
  4. Personal Protective Equipment (emedicinehealth)
  5. OSHA FACT Sheet: Personal Protective Equipment. (PDF - 286 KB) (OSHA, 2002)
  6. Regulations (Standards - 29 CFR 1910.120 Appendix B) General description and discussion of the levels of protection and protective gear. (OSHA)
  7. Emergency Management: Personal Protective Equipment. (EPA, 2009)
  8. ATTENTION EMERGENCY RESPONDERS: Guidance on Emergency Responder Personal Protective Equipment (PPE) for Response to CBRN Terrorism Incidents. Publication No. 2008-132 (HHS/CDC/NIOSH, June 2008)
  9. Standard on Protective Ensembles for First Responders to CBRN Terrorism Incidents, 2007 Edition. (NFPA, 1994) (Full document may be accessed on-line with free registration)
  10. Standard on Vapor-Protective Ensembles for Hazardous Materials Emergencies, 2005 Edition. (NFPA, 1991) (Full document may be accessed on-line with free registration)
  11. NBC Individual Survival Measures (Course #572), Module 2 - Individual Protective Equipment, Lesson 2.6: Mission Oriented Protective Posture (Marine Corps Institute)
  12. European Committee for Standardization (CEN) Workshop 43 - Personal Protective Equipment (PPE) for chemical, biological, radiological and nuclear (CBRN) hazards (PPE CBRN) (European Committee for Standardization)
  13. Homeland Security Presidential Directive / HSPD-8 (The White House, December 17, 2003)
  14. Occupational Safety and Health Administration (OSHA)/National Institute for Occupational Safety and Health (NIOSH) Interim Guidance: Chemical - Biological - Radiological - Nuclear (CBRN) Personal Protective Equipment (PPE) Selection Matrix for Emergency Responders (OSHA, NIOSH, April 2005)
  15. NYC Hospital Guidance for Responding to a Contaminating Radiation Incident (PDF - 1.95 MB) (New York City Department of Health and Mental Hygiene, Healthcare Emergency Preparedness Program, April 2009)
  16. Stopford BM, Jevitt L, Ledgerwood M, Singleton C, Stolmack M. Development of Models for Emergency Preparedness: Personal Protective Equipment, Decontamination, Isolation/Quarantine, and Laboratory Capacity. (PDF - 4.60 MB) Prepared by SAIC under contract No. 290-00-0023. Agency for Healthcare Research and Quality (AHRQ) Publication No. 05-0099. Rockville, MD, August 2005. (HHS/AHRQ)
  17. 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 2005)
  18. Hospital Preparedness: Most Urban Hospitals Have Emergency Plans but Lack Certain Capacities for Bioterrorism Response. GAO-03-924. (PDF - 2.04 MB) (US Government Accountability Office, August 2003)
  19. Hick JL, Hanfling D, Burstein JL, Markham J, Macintyre AG, Barbera JA. Protective Equipment for Health Care Facility Decontamination Personnel: Regulations, Risks, and Recommendations. Ann Emerg Med. 2003 Sep;42(3):370-80. [PubMed Citation]

Additional References

  1. 2008 Standardized Equipment List (SEL). (PDF - 1.26 MB) (InterAgency Board for Equipment Standardization and Interoperability (IAB), 2008)
  2. Koenig KL. Strip and Shower: The Duck and Cover for the 21st Century. Ann Emerg Med. 2003 Sep;42(3):391-4. [PubMed Citation]
  3. Spotlight: Chemical suits - part 2. Workers in the emergency services can choose different levels of protective clothing to suit the circumstances (SATRA Technology Centre)
 

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