A pandemic event is one in which disease quickly causes death or illness in a great number of people throughout a fairly large area of the world. A primary action recommended in pre-tested pandemic emergency response preparedness and response plans is that responders ensure they are themselves vaccinated early, and that they have both the training and the equipment needed to control infection and protect the public as well as themselves.
In the United States, 30-50 million people are affected by flu viruses between November and March each year, and influenza epidemics result in about 35,000 deaths per year. Normally, flu viruses undergo some genetic modification each year, which means that some people are resistant or immune to infection, but others are not. The number of people affected increases dramatically when influenza A-type viruses undergo major genetic change; an obvious example is the current swine influenza-A (H1N1), which is a virulent mix of swine, human, and avian influenza viruses. Such viruses cause pandemics because most humans have little or no immunity to this novel virus, so the viruses pose a threat to those who are immuno-compromised as well as to those with healthy immune systems.
Because of the highly contagious nature of influenza viruses, first responders must be equipped with response and equipment training as well as appropriate respiratory protection. In fact, this is required under the respiratory protection standards mandated by both OSHA (the Occupational Safety and Health Administration) and NIOSH (the National Institute of Occupational Safety and Health).
Droplets, Particles, and Magenta Markings
Influenza is spread primarily through contact with respiratory secretions from the coughing and sneezing of an infected person. The viruses are initially airborne, but then settle in as droplets on the surfaces of the upper respiratory tracts of persons in the vicinity. When properly fitted, an appropriate respirator can protect emergency responders from the inhalation of infectious airborne droplets.
What is called the “P-100” respirator provides the highest level of aerosol protection, compared with other particulate (i.e., aerosol) respirators. This type of respirator is known as an air-purifying respirator, because it protects the responder by filtering particles out of the air as he/she breathes. However, these respirators protect the wearer only against particles such as airborne biological agents – e.g., bacteria and viruses – but not against gases or vapors.
The “100” in the respirator’s name indicates that, when tested, the respirator filtered out at least 99.97 percent of the airborne particles present. The “P” in the name indicates that the respirator is strongly resistant to oil – i.e., it is “oil proof,” which is recommended because emergency responders often operate in rugged and unknown environments that may possibly contain filter-destroying oils. At a minimum, therefore, responders in the field should wear P-100 disposable respirators for respiratory protection from influenza. Or they can use a respirator with an even higher level of respiratory protection, including full- or half-facepiece air-purifying respirators (APRs) or powered air purifying respirators (PAPRs) fitted with a HEPA (high-efficiency particulate-absorbing) filter/canister.
These respirators are consistent with the NIOSH and OSHA standards. In addition, they also must be marked with the manufacturer’s name, the part number, and, most important of all, a NIOSH marking. It also is important to note that the rubber/elastic components that seal the respirator to the wearer’s face must be equipped with two or more adjustable suspension straps – lacking those, it would be impossible for the responder to maintain a protective respirator seal in what are sometimes rugged and/or unknown environments. To make the P-100 respirator easily recognizable in the field, NIOSH has designated only that respirator type with magenta color coding and markings.
There are two important points to keep in mind with regard to using respirators during a pandemic. The first is to understand and appreciate that there is never a guarantee of complete protection. With appropriate training, though, along with proper gloves and eye protection, the emergency responder can be reasonably confident that a high level of protection is likely when he/she is wearing the proper equipment. Nonetheless, emergency responders must continue to practice other preventive measures, such as being vaccinated each year, and giving proper attention to respiratory hygiene. Both measures can significantly reduce the influenza death rate among not only first responders but also the people they are helping.
The second point for responders to keep in mind is that the need for disposable respirators during a pandemic may well surpass the supply available. As part of the planning process, therefore, measures must be taken early first to predict the number of respirators needed for a worst-case situation and then to stock up on the quantities likely to be required.
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Note: A list of manufacturers/suppliers and model numbers of P-100 disposable respirators is maintained by NIOSH at “http://www.cdc.gov/niosh/npptl/topics/respirators/disp_part/p100list1.html
Diana Hopkins
Diana Hopkins is the creator of the consulting firm “Solutions for Standards.” She is a 12-year veteran of AOAC INTERNATIONAL and former senior director of AOAC Standards Development. Most of her work since the 2001 terrorist attacks has focused on standards development in the fields of homeland security and emergency management. In addition to being an advocate of ethics and quality in standards development, Hopkins is also a certified first responder and a recognized expert in technical administration, governance, and process development and improvement.
