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In a world of evolving disease, accidental industrial or commercial contamination, as well as foreign and domestic terrorism, emergency providers must be able to provide safe and efficient resuscitation procedures to victims while wearing personal protective equipment (PPE). Contamination events can take the form of chemical, biological, radiological, or nuclear threats (CBRN) that are often compounded by explosions and trauma (ET). This activity describes resuscitation during contamination and highlights the role of the interprofessional team in the management of these patients. Objectives: Identify the indications for PPE during resuscitation. Describe the PPE equipment used during the resuscitation of contaminated patients. Review the clinical relevance of PPE during resuscitation. Outline interprofessional team strategies for improving care coordination of contaminated patients. Access free multiple choice questions on this topic.

In a world of evolving disease, accidental industrial or commercial contamination, as well as foreign and domestic terrorism, emergency providers must be able to provide safe and efficient resuscitation procedures to victims while wearing personal protective equipment (PPE). Contamination events can take the form of chemical, biological, radiological, or nuclear threats (CBRN) that are often compounded by explosions and trauma (ET). Resuscitation follows the emergency medicine mantra of managing the airway, breathing, and circulation (ABC) to sustain life, and regarding contamination gives preference to antidotes (AABCs). The most common schema for PPE is the United States Occupational Safety and Health Administrations (OSHA) PPE protection levels A, B, C, and D. [1] CBRN threats are common; they have been well documented throughout history. The nature of evolving viruses that cause Ebola, severe acute respiratory syndrome (SARS), and Middle Eastern respiratory syndrome (MERS) has required the use of PPE by emergency providers to avoid natural or nosocomial inoculation from airborne or contact means.[2] In developed countries like the United States, industrial production, transportation, and storage of chemicals can all be potential areas for accidental exposure. In April 2013, Adair Grain Fertilizer Company in Texas had hundreds of tons of ammonium nitrate erupt, which killed 15 people and injured or contaminated 160 others.[1] Foreign terrorists have plagued the globe by causing such acts as the 2013 sarin gas release in Damascus, Syria, where at least 36 persons were required to be evacuated by United Nations emergency providers.[1] Domestic terrorism is also present, for example, in 1984, an Oregon cult released Salmonella typhimurium causing 751 casualties.[3] These historical examples illustrate the ever-present CBR and ET threats worldwide necessitating the need for highly trained and prepared emergency providers.

Those team members selected to don PPE are all at risk of contamination. Contamination can be in the form of a systems error or unforeseeable circumstance. The same complications with resuscitative techniques can also occur. For example, endotracheal intubations can lead to esophageal intubations, tracheal perforations, aspiration, or possibly main stem intubations if done incorrectly. Victim and Responder can endure heat stress or dehydration from the physical demands of egress from a dangerous environment with the taxing strain of PPE equipment as added workload required for protection.

The EMS team requires a chain of command with known protocols in place. Briefing and debriefing allow for improvement from lessons learned from previous operations. Teams should be assessed physically and mentally prior to and after operations. The team is only as strong as the weakest link in the chain. Access to current data in resuscitation through ATLS, ACLS, BCLS, and PALS is necessary. Follow-on training for CBRN+ET is required and necessary. Annual training to keep skillsets sharpened must be addressed. Increased preparatory training will improve success while decreasing complications of operations.