Survey of UK Health Care First Responders' Knowledge of Personal Protective Equipment Requirements.

INTRODUCTION: An adequate level of personal protective equipment (PPE) is necessary when treating patients with highly infectious diseases or those contaminated with hazardous substances. METHODS: Following National Institute for Health Research's Research Centre (London, United Kingdom) approval, the authors of this study conducted a survey of specialist registrars' knowledge of the respiratory and skin protection requirements needed during a resuscitation scenario with Advanced Life Support. Participant responses were compared to UK national recommendations and to a previous survey in 2009. RESULTS: A total of 98 specialist registrars (in Anesthesiology, n=51; in Emergency Medicine (EM), n=21; and in Intensive Care Medicine (ICM) n=26) completed hand-delivered surveys. The best knowledge of PPE requirements (76%) was found for severe acute respiratory syndrome (SARS), with less knowledge about PPE requirements for anthrax, plague, Ebola virus disease (EVD), and smallpox (60%). The results show limited knowledge of PPE requirements (20%-30%) for various chemical warfare agents. Personal protective equipment knowledge regarding treatment of sarin-contaminated casualties was over-rated by 80%, and for patients with EVD, it was over-rated by up to 67% of participants. CONCLUSION: The results of the tested cohort indicate that current knowledge regarding PPE for chemical warfare agents remains very limited.

Respiratory protection during simulated emergency pediatric life support: a randomized, controlled, crossover study.

INTRODUCTION: Emergency pediatric life support (EPLS) of children infected with transmissible respiratory diseases requires adequate respiratory protection for medical first responders. Conventional air-purifying respirators (APR) and modern loose-fitting powered air-purifying respirator-hoods (PAPR-hood) may have a different impact during pediatric resuscitation and therefore require evaluation. OBJECTIVE: This study investigated the influence of APRs and PAPR-hoods during simulated pediatric cardiopulmonary resuscitation. METHODS: Study design was a randomized, controlled, crossover study. Sixteen paramedics carried out a standardized EPLS scenario inside an ambulance, either unprotected (control) or wearing a conventional APR or a PAPR-hood. Treatment times and wearer comfort were determined and compared. RESULTS: All paramedics completed the treatment objectives of the study arms without adverse events. Study subjects reported that communication, dexterity and mobility were significantly better in the APR group, whereas the heat-build-up was significantly less in the PAPR-hood group. Treatment times compared to the control group did not significantly differ for the APR group but did with the PAPR-hood group (261±12 seconds for the controls, 275±9 seconds for the conventional APR and 286±13 seconds for the PAPR-hood group, P < .05. CONCLUSIONS: APRs showed a trend to better treatment times compared to PAPR-hoods during simulated pediatric cardiopulmonary resuscitation. Study participants rated mobility, ease of communication and dexterity with the tight-fitting APR system significantly better compared to the loose-fitting PAPR-hood.

Personal protection during resuscitation of casualties contaminated with chemical or biological warfare agents--a survey of medical first responders.

INTRODUCTION: The threat of mass casualties caused by an unconventional terrorist attack is a challenge for the public health system, with special implications for emergency medicine, anesthesia, and intensive care. Advanced life support of patients injured by chemical or biological warfare agents requires an adequate level of personal protection. The aim of this study was to evaluate the personal protection knowledge of emergency physicians and anesthetists who would be at the frontline of the initial health response to a chemical/biological warfare agent incident. METHODS: After institutional review board approval, knowledge of personal protection measures among emergency medicine (n = 28) and anesthetics (n = 47) specialty registrars in the South Thames Region of the United Kingdom was surveyed using a standardized questionnaire. Participants were asked for the recommended level of personal protection if a chemical/biological warfare agent(s) casualty required advanced life support in the designated hospital resuscitation area. RESULTS: The best awareness within both groups was regarding severe acute respiratory syndrome, and fair knowledge was found regarding anthrax, plague, Ebola, and smallpox. In both groups, knowledge about personal protection requirements against chemical warfare agents was limited. Knowledge about personal protection measures for biological agents was acceptable, but was limited for chemical warfare agents. CONCLUSIONS: The results highlight the need to improve training and education regarding personal protection measures for medical first receivers.

Evaluation of bag-valve-mask ventilation by paramedics in simulated chemical, biological, radiological, or nuclear environments.

INTRODUCTION: Bag-valve-mask ventilation is a key component of life support, but only one handheld resuscitator is designed to operate in contaminated or toxic atmospheres. METHODS: After Institutional Review Board approval, the efficacy of this device was evaluated. The distal trachea of a Laerdal Airway Management Trainer was connected to a mechanical Draeger Volumeter 3000, to enable determination of the minute volume delivered by BVM ventilation. Nineteen paramedics wearing chemical, biological, radiological, or nuclear (CBRN) protective equipment were asked to ventilate this modified airway trainer, either with or without a CBRN filter attached to the inlet filtration system of the AMBU Mark III Resuscitator. The maximum levels of minute ventilation achieved were compared. Values are given as mean +/-SD. A paired t-test was used to detect any differences between the two groups, p-values of <0.05 were defined to show statistical significance. RESULTS: The described model allowed a reproducible and reliable measurement of the delivered minute ventilation. All paramedics were able to operate the device without prior CBRN training. The maximum minute volume achieved without the filter was 9.5 +/-2.7 l/min. Use of the inlet CBRN filtration system reduced the maximum minute volume to 6.3 +/-2.0 l/min, reduction: 23%. The achieved maximum minute volumes ranged from 15 to 4.9 l/min in the controls and from 9.8 to 1.4 l/min in the CBRN group. Four paramedics were unable to achieve a minute volume >5 l/min in the CBRN group, one participant failed to achieve that value in the control group. The inherent breathing resistance of the CBRN filter appears to reduce the inflow of air into the self-inflatable bag. This delay in refilling may have resulted in a reduced achievable minute volume. CONCLUSIONS: The range of maximum minute volumes observed in both groups highlights the need for continuous BVM ventilator training.

Influence of air-purifying respirators on the simulated first response emergency treatment of CBRN victims.

AIM: Medical first responders and emergency room personnel potentially are threatened by exposure to primary or secondary intoxication by chemical, biological, radiological or nuclear (CBRN) substances. The impact of personal respiratory protection by air-purifying respirators on the performance of resuscitation requires evaluation. This will help to improve major incident planning and measures for protecting medical staff. METHODS: We investigated the influence of two air-purifying respirator designs on the resuscitation of simulated CBRN victims. Fourteen UK paramedics followed a standardised resuscitation algorithm, either unprotected or wearing a bi-ocular and a panoramic visor respirator in a randomised crossover design. Treatment times and wearer comfort was determined and compared. RESULTS: We did not find any difference in treatment times between the groups wearing respiratory protection and the controls (189+/-8.3s for the controls, 191+/-9.5s for the panoramic visor mask and 206+/-9.1s for the bi-ocular respirator [mean+/-S.E.M.]). Tracheal intubation appeared to be the most time consuming task. In a questionnaire, volunteers were of the opinion that orientation whilst wearing the respirator with the panoramic visor was better compared to the bi-ocular one (85% versus 15%). With respect to the fit, the majority (79%) rated the bi-ocular respirator as more comfortable. CONCLUSIONS: Modern personal respiratory protection has only a negligible effect in the delay on the short term treatment during well defined simulated scenarios with a single CBRN casualty. Furthermore, air-purifying respirators with panoramic visors seem to allow a better orientation for medical first responders during simulated resuscitation.