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Fourth Generation AgentsProtective Equip. / Clothing![]() Rescuer Protection
![]() Protective Equipment
PPE Protection Levels
[1] NFPA 1992 Standard on Liquid Splash-Protective Ensembles and Clothing for Hazardous Materials Emergencies may not provide an appropriate level of vapor protection. ![]() Rescuer ProtectionFGAs present a significant risk of secondary exposure if responders come into contact with agent on patients, their clothing, personal effects, or contaminated surfaces. Just as importantly, patient decontamination is a medical intervention because FGAs can deposit on and in skin and absorption can continue until the patient is fully decontaminated. As long as FGAs are on or in the skin, they pose a medical risk to the exposed individual even if that individual does not yet look or feel sick. Personal Protective EquipmentPainstaking attention to protective zones, decontamination protocols, and donning and doffing of personal protective equipment (PPE) is essential to prevent secondary exposure and spread of agent in the environment. Employers must comply with Occupational Safety and Health Administration (OSHA) standards on PPE (29 CFR 1910.132): https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.132, Respiratory Protection (29 CFR 1910.134): https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.134, Hazardous Waste Operations and Emergency Response (29 CFR 1910.120): https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.120, and other requirements, including state regulations, whenever such requirements apply. The Occupational Safety and Health Administration (OSHA) provides general guidance for EMS and hospitals that receive and treat victims of hazardous substance releases in the following documents:
Key Safe Work Practices include:
Managing Patients Before they are Decontaminated: Responders and hospital personnel providing or assisting with patient care before and during decontamination should select PPE based on the employer’s standard operating procedures, the job task, and the potential for exposure to hazards. The PPE section of the FGA Reference Guide (https://chemm.nlm.nih.gov/nerveagents/FGAReferenceGuide.htm) outlines recommendations for PPE selection. Managing Patients After they are Decontaminated: Limited data are available on the risk of post-decontamination handling of patients who have been exposed to FGAs, but there are concerns that FGAs can persist in body fluids, posing a potential hazard to personnel. Due to a depot effect in the skin, repeated decontamination over a course of days may be beneficial. For these reasons, the following specific PPE recommendations provide a precautionary approach to worker protection measures. This guidance will be updated as more evidence becomes available. Because of the concerns that FGAs can persist in body fluids, the following guidance provides a precautionary approach to protect EMS and hospital personnel from exposure when treating a patient, following decontamination, who was suspected or confirmed to have been exposed to FGAs:
When it is not possible to implement the precautionary approach above, EMS and hospital personnel at a minimum should wear appropriate PPE and take blood and body fluid precautions, including:
It should be recognized that this level of PPE may not provide sufficient exposure reduction. Therefore, gloves should be changed every 15 minutes, or when they become soiled, or between patients if possible, whichever occurs soonest, and gowns should be changed when they become soiled. Limited real world experience in the U.K. demonstrated this approach was adequate to protect workers given the specifics associated with the March and June 2018 incidents. Responders and hospital personnel should report any potential exposure and be medically evaluated immediately per your department or agency’s procedures. Symptoms may occur up to 3 days post exposure. In order to determine when it is appropriate to downgrade PPE, employers are encouraged to perform a risk and hazard assessment, taking into account patient status. See the FGA Reference Guide (https://chemm.nlm.nih.gov/nerveagents/FGAReferenceGuide.htm) for information necessary to conduct the risk and hazard assessment. General recommendations for handling PPE include:
PPE, linens, and other waste that have come into contact with the patient should be segregated from other waste and disposed of properly. Consult with experts for disposal recommendations. Protect YourselfTo Protect Yourself from Exposure
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