Firefighters and other first responders routinely rescue victims suffering from everything from minor injuries to severe trauma. Any such rescue may involve contact with blood or other body fluids that may contain bloodborne pathogens such as Hepatitis and HIV. While the emergency response community is trained to apply “universal precautions” when considering all body fluids as potentially contaminated, protective clothing also provides reliable protection.
Examination gloves are the most common protective clothing item for emergency medical situations. They are regularly used to protect hands from blood exposure, yet they are sufficiently thin and flexible to allow necessary dexterity for patient care. The important characteristics of such gloves include liquid integrity, viral penetration resistance and dexterity. It is also essential that gloves do not break while worn and remain viable for use following a variety of storage conditions (e.g., hot temperatures).
Another type of commonly used item is eye/face protection such as goggles, face shields or surgical masks, some of which have visors. These items are worn to protect the vulnerable parts of the face (eyes, nose, and mouth) from accidental contact with blood and body fluids. If needed, respirator face pieces also provide this protection in addition to preventing respiratory contact with airborne pathogens such as tuberculosis and SARS.
The characteristics for the following devices are less well-defined and selections are often based on personal preferences Garments may be worn routinely or as needed. Some organizations wear reusable garments as part of their everyday medical response functions. Other organizations may deploy disposable gear only when their hazard assessment indicates that blood/body fluid contact is likely. Regardless of the practice, garments like gloves must provide adequate barrier protection as demonstrated by product integrity. Organizations may use other PPE, such as special footwear, footwear covers, cleaning gloves or extrication gloves, depending on their EMS roles and objectives.
NFPA 1999:Standard on Protective Clothing for Emergency Medical Operations defines criteria for PPE used in emergency patient care outside the hospital. The standard was originally developed in the late 1980s after the heightened awareness of bloodborne pathogen exposures and regulations were developed by OSHA. These regulations established first responders as healthcare workers under the provisions of Bloodborne Pathogen rule (29 CFR 1910.1030). In some areas, the industry has responded well to the standard by offering certified, compliant products. There are now more than 50 different styles of examination gloves offered by more than two dozen manufacturers. A similar number of reusable garments that meet NFPA 1999 requirements are also available.
For the other products covered in NFPA 1999, there are significantly fewer certified products. For example, there are only a couple styles of compliant footwear and only one eye/face protection device. Why the industry lacks offerings in these areas is not completely understood; however, it is suspected that in some cases, product criteria do not match user expectations and practices. For example, all the certified garments are considered reusable, yet a substantial amount of disposable clothing is used in emergency medical operations.
To better address end-user needs, the NFPA Technical Committee on Emergency Medical Services PPE, which is responsible for NFPA 1999, is carefully reconsidering emergency responder needs. The standard is being revised to address categories of known PPE use to make product criteria more relevant and consistent with end-user practices. For example, the committee is considering creating distinctions between disposable clothing and reusable clothing. Both types of clothing must still offer the same barrier protection, but the relative strength, durability and ergonomic features are generally different.
It is also important to address adequate face protection. Most medical masks are appropriate in light liquid contact situations, but generally do not offer sufficient barrier properties to protect against severe blood or body fluid contact.
The National Personal Protective Technology Laboratory of the National Institute for Occupational Safety and Health (NIOSH) is sponsoring a project to support the revision the 2008 edition of NFPA 1999. NIOSH is interested in getting industry feedback on end-user preferences and experience with PPE to help define appropriate levels of protection.
It is also important to point out that protection against bloodborne pathogens is built into several other types of protective clothing. As part of NFPA 1971 for structural firefighting, turnout clothing worn by firefighters is bound by some of the same barrier requirements that are outlined in NFPA 1999. This protection must be integrated into firefighting clothing because firefighters do not always have the ability to change their outfits when encountering blood or body fluids. Since 1997, a mainstay of NFPA 1971 has been the viral penetration resistance test and the shower test. These tests affirm the barrier characteristics of the clothing and materials. Multiple cycles of washing are applied to help assure that performance remains beyond its intended service life. Further, technical gear covered in NFPA 1951: Standard on Protective Ensemble for USAR Operations includes similar requirements, as does NFPA 1994 for protection of first responders during CBRN terrorism incidents.
Protection from exposure to contaminated blood and body fluids remains an important concern for first responders. Use of protective clothing that keeps blood and body fluids from reaching the skin or underclothing is one part of a comprehensive program aimed at minimizing bloodborne pathogen exposure. Using clothing and equipment that conforms to NFPA standards is one way to help ensure this level of protection.
