PPE quality improvement: 4 points of focus

Now is the time to focus on inventory control, non-structural PPE, EMS PPE, and PPE policy and procedures


If we've learned anything during the COVID-19 pandemic as firefighters and fire officers, it's that while perfect planning doesn't always guarantee perfect outcomes, poor planning (or lack of planning) pretty much always results in poor outcomes. We've witnessed this at the state and federal levels across the U.S., and perhaps you've seen it in your own department or those near you.

But I'm not here to throw stones because as a young fire officer with the Chesterfield (Virginia) Fire and EMS Department, I was raised on quality improvement. Don’t find fault; find solutions. Mantras like that were common in Chesterfield County's Total Quality Improvement (TQI) movement that the governing Board of Supervisors put in motion in the late 1980s across all 52 county departments, including ours.

Before I go any further, I want to share that I believe as fire service leaders, we must understand that the coronavirus is not going away after the curve of new cases flattens out in the U.S. This novel virus is no longer novel; it's likely mutated hundreds of times since it first moved from the animal world to the human world.

It is incumbent upon fire service leaders to engage in some quality improvement activities regarding PPE for their personnel looking into the future. (Photo/Getty Images)
It is incumbent upon fire service leaders to engage in some quality improvement activities regarding PPE for their personnel looking into the future. (Photo/Getty Images)

It is, therefore, incumbent upon fire service leaders to engage in some quality improvement activities regarding PPE for their personnel looking into the future. A future that’s as close as flu season 2020.

Here’s what I think some of those activities look like:

1. Inventory control and management

Are you and your department using automated inventory control and management (ICM) software and apps? If not, now is the time to get on board. For some insights on managing your consumable PPE stock, check out 4 ways to better manage EMS inventory.

If you’re currently using ICM software, does your software integrate with regional and state emergency management agencies? If we've only learned two things about inventory management during COVID-19, it's that:

  • Many fire departments have had difficulty determining what PPE they had and in what quantities.
  • Regional and state emergency management agencies have had difficulty gathering the same information. And that has made it equally difficult for states to share their PPE needs with the federal government.

2. Non-structural firefighter PPE

Fire departments must develop a range of non-structural firefighter PPE options for their personnel that are hazard-specific. The days of wearing structural PPE for anything other than fighting fires or engaging in live-fire training are over. It should have happened before now, knowing what we know about the increased risk of cancer from exposure to fire smoke and how those hazards can still exist even in properly laundered PPE, albeit in smaller amounts.

So, how can we continue to allow our firefighters to wear their structural PPE or elements of their PPE for EMS calls or other non-fire calls during a pandemic? When the science is telling us that the COVID-19 virus can exist for several days on hard surfaces, we can't allow these exposures to go on unaddressed. How many more times will structural PPE need laundering? And at what costs for cleaning materials, washer/extractors, down time for PPE, and decreased PPE life cycles?

One PPE alternative might be cotton coveralls that can be worn over station uniforms or as standalone garments (e.g., nighttime responses or EMS calls). After all, coveralls are one element of Level D (OSHA and EPA) and Class 4 (NFPA 1994) worker protection, the minimum worker protection required by law.

Note: NFPA 1994: Standard on Protective Ensembles for First Responders to Hazardous Materials Emergencies and CBRN Terrorism Incidents, along with NFPA 1991, 1992 and 1999, are currently being consolidated into a new standard, NFPA 1990: Standards for Protective Ensembles for Hazardous Material and Emergency Medical Operations.

Level D/Class 4 protection may be appropriate when no contaminants are present or work operations preclude splashes, immersion or the potential for unexpected inhalation or contact with hazardous levels of chemicals. Appropriate Level D/Class 4 protective equipment may include gloves, coveralls, safety glasses, face shield, and chemical-resistant, steel-toe boots or shoes.

3. PPE for EMS

During the COVID-19 pandemic we’ve certainly learned a great deal about the PPE our people need to provide patient care safely, effectively and efficiently.

If you missed the webinar COVID-19 EMS Patient Management: Myth vs. Reality, you can catch up on some great insights by Rob Lawrence here. The focus of that March 13 webinar – the fourth in an ongoing series from FirstWatch and Paramedic Chiefs of Canada – was = the shape of things to come, not the COVID-19 outcome specifically, but rather the cooperation and partnerships required for EMS, allied public safety agencies, and public health teams to work as one during a pandemic. Among the key topics discussed were communication, PPE and decontamination strategies.

Sure, it’s important to stay abreast of the latest developments, but don’t forget you’ve probably got a wealth of information within your organization, too. Your people who’ve been operating on the front lines of this pandemic have a lot on their minds right now, particularly when it comes to PPE to protect them during patient contact and other situations. You and your department need to learn what they’re thinking.

Now is a good time to capture useful data from your personnel about their PPE experiences during COVID-19, even as their work continues:

  • What PPE elements (masks, face shields, protective eyewear, disposable gowns) have they used?
  • What was their comfort level using each PPE element?
  • What was their confidence level when wearing each PPE element?
  • What PPE element did they not have that they felt they needed?

Just like providing patient care or trying to extinguish a fire, it’s important to constantly collect and analyze data to determine if your plan is working – and then make adjustments as necessary.

You can conduct an anonymous survey using a free online survey tool like SurveyMonkey.com, which enables you to construct a 10-question (max) and receive up to 100 responses. That’s a great tool for smaller departments. And the cost for paid plans that allow for more questions and more responses are certainly within reach for most larger fire departments.

Once you’ve collected the date, analyze it to learn what PPE you need, what PPE you don't need, and probably most importantly, what's the PPE that your people will use.

4. Update your policies and procedures

You’ve probably heard the adage, “The job’s not finished until the paperwork is done.” You and your team have likely been “managing by memo” (or in the current vernacular, email) due to the speed at which new information comes available or previous information is revised. But looking down the road, it’s crucial that you make sure your operational policies and procedures, particularly for PPE, are current, factually correct and put into effect – and that all the old ones are effectively purged.

Yes, everyone is very busy responding to the rising number of calls. If you and your members cannot work on your policies and procedures for the use of non-firefighting PPE and EMS PPE at this time, make sure this topic is added on the planning calendar as a priority item for the future. Make sure that those policies and procedures match the realities you and your members have learned during COVID-19. After all, I can't imagine a greater test environment than that in which we’re all engaged in right now, can you?

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