|Minimum EMS PPE for first responders includes nonlatex gloves and eye protection with temple splash guards. The waist pack should be worn on all EMS calls to contain extra personal equipment. (Photos by author.)|
|Maximum EMS PPE includes eye protection to prevent against blood splatter, a HEPA mask to protect the EMT’s airway from contagious airborne diseases like tuberculosis, nonlatex gloves, and a gown to protect the EMT from extensive blood splatter and bodily fluids. Note that the cuffs of the gown are tucked into the gloves. Calls like gunshot wounds, trauma, and childbirth require this level of PPE.|
|The Xstream waist pack has pockets as part of the adjustable, quick-release waist strap that can accommodate two pairs of nonlatex gloves on each side. The exterior fluted pockets accommodate scissors and trauma shears, a center punch, numerous pens, and a permanent marker for patient triage and for marking the arms or the forehead of a patient for emergency room personnel.|
I have to admit (and most firefighters would agree) that most emergency medical services (EMS) calls are not as exciting as fighting fires. You can tell by watching the faces of the crew after the fire bell hits. If it’s followed by the fire tone, the adrenalin skyrockets and the crew races to the rig. If the bell is followed by an EMS tone, their faces look like those who missed winning the lottery by one number. The speed to the apparatus is more of a brisk walk. Some EMS calls are quite challenging, requiring all the medical skill and knowledge within you. If they’re combined with a rescue, then it’s just as good as a fire. I don’t expect civilians to understand this mentality. It’s like asking a trauma surgeon to describe a good day at work. Nevertheless, EMS calls make up more than 80 percent of our emergency work. So, in other words, this is what we really do, with an occasional fire.
Personal protective equipment (PPE) doesn’t only apply to firefighting ensembles; it also applies to EMS. The minimum PPE for any EMS call is protective eye wear (EMS goggles or glasses with side temple splash protection) and EMS nonlatex gloves. These medical exam gloves vary in strength, but there must be some level of puncture resistance to them. Because paramedics deal with needles, they use a stronger glove that is more resistant to accidental needle sticks than the average gloves for basic EMTs and first responders. With certain calls like contagious respiratory diseases, firefighters also have to wear high-efficiency particulate air (HEPA) masks to protect their upper airways (mouths and noses). Seattle uses the 3M P100 8293, which meets the NIOSH 42 CFR 84 P100 requirements. Unlike regular particle filter masks, the P100 8293 HEPA mask can filter both oil- and nonoil-based particles down to 0.3 microns with 99.97 percent efficiency. That translates into “filters really small stuff.”
Certain calls involving bodily fluids, such as vomitus and blood, splashing require another level of PPE. Calls like childbirth, trauma, stabbings, shootings, or where the patient is vomiting call for the firefighter/EMT to don a full-frontal disposable gown to protect against bloodborne pathogens. This also protects the uniform from human fluid contamination. This level of PPE is in addition to the gloves, mask, and eye protection.
PPE Equipment Storage
When I joined the fire service, we just grabbed a pair of gloves from the box inside the cab, grabbed the aid kits, and off we went. Now we have to carry all our PPE, the aid kit, O2 kit, an AED, and sometimes even a backboard and C-collar—not to mention the radio and clipboard with the aid form. The new aid forms are on computer, so let’s add a laptop to the equipment. That’s a lot of stuff. How do we carry it all? Carrying it in a waist pack, also called a fanny pack, is a good start.
There are a variety of commercially made waist packs. Seattle uses a local manufacturer, Xstream™. This black heavy CORDURA BRAND™ pack has a reflective stripe across the front for night visibility. The waist belt is adjustable with a quick-release buckle. Inside the belt are two small zippered pockets—one on the left strap and one on the right, for nonlatex gloves or other small objects. Two pairs of gloves fit in each pocket.
The main pouch is divided into two pockets that hold the largest part of the inventory. I carry a gown and a Laerdal pocket mask for emergency CPR. This pocket mask has a one-way valve on the face piece to perform mouth-to-mouth ventilations on an unconscious patient while protecting the firefighter from sputum or vomitus. The pouch also holds a HEPA mask, eye protection, a particle mask with face shield, and our EMS protocols quick-reference spiral notebook. These are all required items per our department’s policy. Anything else is extra, and there’s plenty of room for it.
I also carry a small powerful flashlight. Many times we find the patient in a dark area and someone needs to light the scene to read the blood pressure gauge or provide light for the paramedics, who may have to tube a patient, administer an IV, or light up the jump kit to ensure they are grabbing the right drug packets. It’s also convenient to flag in an incoming ambulance or back it out of a dark driveway in the middle of the night.
Wedges are important. I carry two, along with a large one-inch webbing body loop to wedge or tie open doors and gates. Many houses, apartments, and condos have security doors. If you have additional units coming in like ALS medics or ambulances, locking them out only delays patient care and transport. Provide and maintain access to lobbies, stairways, and hallways for responding personnel. I also carry a stethoscope, a roll of one- and two-inch medical tape, a small bottle of hand sanitizer, and swimming goggles.
The outside of the pack has slim pockets with a protective cover. Here I carry trauma shears, a spring-loaded center punch for breaking windows, a small pen light with a pupil measurement scale, a black permanent marker, and as many black ballpoint pens as I can cram in there. Why pens? As the officer, I have to fill out the form with patient information, medical history, vitals, times, and the amount of drugs administered by paramedics. It seems like I’m always losing or dropping my pens.
I also carry a whistle. Don’t ask me why, but if we ever need one, I have one. I know one firefighter who carries a small jar of Vicks vapor rub—a trick he picked up from the coroner. A dab of vapor rub in each nostril helps tolerate the smell of decay from a deceased patient.
As Important as Bunker Gear
Although we don’t wear these packs on fire calls, wearing EMS PPE should be as common as wearing SCBA into a fire—but, often it is not. The company officer must enforce this. The crew needs to realize this PPE is for their safety, their protection, and their families’ protection. Being exposed to a contagious disease or bloodborne pathogen is a serious matter. One time we had a call to a residential high-rise apartment on the 33rd floor. One of my crew members (not from my station) wasn’t wearing his waist pack. I could only assume that in his regular company this policy wasn’t being enforced. I waited until we were ready to enter the unit and I asked him where his pack was. He replied that it was on the rig, and I told him to go get it. It was a BLS call and I knew we could handle it with three EMTs instead of four. I made him ride the elevator all the way down and go back to the rig. After about 10 minutes, he returned wearing his waist pack. Nothing else was said of the matter.
A Personal Lesson
I had to learn the hard way to take wearing EMS PPE seriously for me and my crew. When I was a lieutenant on Engine 9, we responded “code yellow” (no lights, no siren) to a “man down” call. This type of call usually meant we would go roust an intoxicated person who fell asleep on the sidewalk. When we arrived at the address, it was a residence. Usually such calls are on main streets, in alleys, or in parking lots—not on a residential street. It raised a flag but I ignored it. The crew got off the rig and walked up the stairs. Nobody wore PPE and no one brought any of the EMS kits with them.
As we approached the front porch, I could see the legs of a man down. When we got to the porch, there was an unconscious adult lying in a pool of blood. His throat was cut from ear to ear. I immediately radioed for an “assault with weapons” response, which would bring an additional fire unit, ALS paramedics, a battalion chief, and the police. We couldn’t even assess the patient because no one wore gloves and no one had any equipment. We all ran back to the rig to grab our gear. The battalion chief, who just happened to be in the area, arrived within seconds. It was obvious to him that we were returning to our rig for our EMS equipment. The man down turned out to be a woman who was assaulted and stabbed. She survived the event but we delayed first aid because we were unprepared. I ended up getting disciplinary charges for my lack of preparedness and for not enforcing the EMS PPE policy. I’ve received charges before but this one really bothered me because I was complacent when someone’s life was depending on me to be prepared. That was a personal disappointment that took a long time to get over.
No safe, responsible firefighter would enter a fire without SCBA and bunker gear. We should treat EMS calls with the same concern for personal safety and preparedness.
RAUL A. ANGULO, a veteran of the Seattle (WA) Fire Department and captain of Ladder Company 6, has more than 30 years in the fire service. He is a member of the Fire Apparatus & Emergency Equipment editorial advisory board. He is also on the Board of Directors for the Fellowship of Christian Firefighters. He lectures on fire service leadership, company officer development, and fireground strategy and accountability throughout the United States, Canada, and Mexico.