Suited up for protection

How much is too much, or too little?


By Terrence K. Cloonan, Retired Physical Scientist, CDC, NIOSH, USA

Welcome to the interactive article. You are about to take a short journey down a situational training lane. By all means, when you are done, take the time to provide perspective or perceptions for further discussion. When I was invited to write this article, I felt honored and stressed at the same time. The positive stress dissipated as I applied my knowledge and outreach capability.

Let’s start with the photograph provided by the US Army CENTCOM—the first lead image here. What do you see? I see three masked operators and one unmasked operator, standing in a desert urban staging area, overseas. But what respirators are they wearing? To the mil-spec trained eye, the image may seem tactically correct. However, to the public safety and NIOSH-CBRN trained eye, one’s attention to detail tells you there are some aspects that are askew.

First perspective…..that is not just a respirator you see in the foreground. For all practical purposes, it appears to be an attempt to make a combination unit respirator (CUR) “hybrid SCBA”, using one brand of facepiece connected to a different brand’s 2nd stage regulator. You need to know this action currently voids the NIOSH public health/safety approvals of each individual respirator and makes the quality assurance programs of each approval holder suspect. On the dermal side, the operators are not in dermal protective suits. The hood you see is just the normal mil-spec hood that is offered with that facepiece. Also note, the unattached respirator hydration tube on the shoulder of the lead operator. As you know, you need to stay hydrated in such protective postures. The SCBA facepiece in use is a FM-53 from an adapted ST-54 SCBA. The other two masked individuals behind him are also in the same respiratory protective posture. No credentialed chemical protective suits are in use here except for the hood, which is only on the user in the foreground. Seeing just the respirator and hood donned, leads one to determine that the “Mask Only posture” of a MOPP-4 regime is in use. Had enough?

Let us look at a second perspective involving respirator fit testing and sizing. Information you can gleam from just inspecting the image. I would say the foreground user was not fit tested to the donned facepiece judging by where his eyes are located in relation to the panoramic semi-bi-ocular opening. The mask could be a large and he looks like he takes a medium or small. Consequently, the integrated nose cup of the facepiece is really not doing its designed job because it is not correctly sized to his oral-nasal region, judging by how high the nose cup area is sitting up on his lower forehead area. Despite the obvious desert heat, you can see the blues of his eyes as he looks situationally capable and physically fit with clear sclera.

Third and final introductory perspective; the infantry blue gloved operator in the background is adjusting his comms that are being worn over a black balaclava, worn over the donned facepiece. And the “OD” on the helmet of the unmasked training assistant, to the far left, stands for operational detachment team and adds to the clarity of the situational training image. The shown training in this Mask-Only protective posture is designed to acclimatize the soldiers and allow for a level of realism, without causing heat casualties. Doing it regularly and correctly is vital to providing the degree of self-confidence necessary to operate efficiently under such protective postures while validating the scientific and engineered protection awarded to the respirator as a true individual and complete system, and not as an individual sub-component. Please watch the following real-world embedded video and read the rest of the article designed to focus your attention to detail on the correct use of personal protective equipment used by medically cleared and trained operators or responders.

Setting the Expectations

Civilian government emergency responders and military soldiers rely on various levels of assigned personal duty uniforms to conduct their mission, ensure unit standardization, build cohesion and recognition, and provide everyday barriers to hard surfaces, ambient air particulates, and universal bloodborne liquid pathogens that the person may encounter over the course of a duty day. When the 911 call dispatches the responder or the proverbial balloon goes up, those same responders don specific tailored protective clothing and locate available respirators offering a capacity to protect the responder against the known or anticipated threats. When the threat is known to exist, but is not characterized in advance, the threat is viewed as being “unknown”.

In the case of “not knowing” the physical state or concentration of the threat, prior to incident size-up, the responder who is trained in industrial hazardous materials containment, chemical, biological, radiological, and nuclear (CBRN) agent defense, or explosive ordnance disposal (EOD), then dons a suite of available protective clothing, gloves, boots, hearing protection, eye wear, and respirators along with hand held weapons, high visibility vests, ballistic vests, helmets, full-up pistol belts, utility belts, communications devices, and hand tools and/or hand held instruments to accomplish the mission. None of this occurs smoothly without prior acclimatization of the responder to the effects of wearing personal protective equipment (PPE) and then completing initial donning, use, and doffing training. Once found acclimated, the responder must maintain that proficiency through sustainment use training and maintenance of the assigned personal protective equipment.

Knowing what suit, garment, coverall, or ensemble to select, what corresponding respirator type to don with that suit, and how long to stay in that protective posture is a series of decisions not to be taken lightly. It involves a risk assessment process done by an authority having jurisdiction and relying on a proven selection logic. Responders can improve their risk assessment knowledge, tactics, techniques, and procedures by conducting repetitive training to a known standard and participating in timely after-action debriefs focused on mission accomplishment outcomes and areas that need improvement or direct-action corrective measures. Remote learning, virtual “Zoom” sessions, YouTube videos, and traditional book reading actions supplement the current in-person training exercises that help sustain the readiness of any emergency responder tasked with reacting to a CBRN incident, unexploded ordnance (UXO), or mine field detonations.

Safety Analysis & Observations of the Close Quarters Battle (CQB) Training Video

When training resources are limited and work time is prioritized by 911 dispatches or locked in training schedules, the wise use of information technology (IT) resources can help a responder dissect and prioritize what individual training they should focus on. The use of do-it-yourself IT videos can be inexpensive, timely, and serve as a working education tool to back brief the responders used as the subjects of such DIY training videos. The adage of “practice makes perfect” still makes sense, but incorrect practice makes no sense. In CBRN incident response, perfect practice makes sense. Repetitive training makes one perfect, or does it? It is a subjective call on what is “perfect”. Incorrect training can be counterproductive, add additional costs, and lead to unsafe practices in the field, or even worse, to the incident response. In contrast, correct repetitive training produces “muscle memory” responses in responders.

Once a responder has graduated from the training academy, training proficiency must be maintained from real-world responses and structured training events. The construction of do-it-yourself indoor training structures allows planned training events to occur at low cost and allows responders to safely train via the use of blue coded simulator munitions, grenades, and marked weapons while engaging paper targets in hallway room environments that replicate select entry mission conditions and protocols.

"Let’s refocus on the video above”. Note that the readers of this article should not be distracted by the realism of the video and the apparent ease-of-use that the outfitted responders demonstrate while conducting the drill. It is a current-day civilian representation of military close quarters battle. But to the trained safety officer observer, there are subtle protective equipment use areas that outwardly indicate responder proficiency in certain techniques, while showing other areas that require improvement. This is to be expected when conducting incoming new officer training. This particular video is of a Tier 1 city acclimatization training drill involving two-man teams outfitted in Class III CBRN and riot control agent (CS chemical agent) protective coveralls and assigned weapons, without full-up certified respiratory protective devices in use. Let us see if you see what I see in the video. You will find that it takes 2-3 times of watching the video at normal speed and then stop-and-go speed to fully appreciate the training objectives accomplished.

The two officers in training negotiate restricted space rooms, attempting to locate pre-positioned paper targets in two different rooms off a single hallway. Their task is to distract, enter, engage, and terminate the identified perpetrator paper target utilizing long rifles/assault rifles and pistols, as necessary, and determine a “clear” status of target acquisition and room threat condition. They are required to operate in a CBRN protective posture that protects their dermal, respiratory, auditory, and ocular routes of exposure. They are required to maintain stealth in the pre-entry phase. Upon flash-bang distraction entry, they are authorized to use voice and hand and arm signals to communicate. Their mission is to successfully use assigned weapons with simulation munitions (sim munitions) to clear marked rooms while under threat from kinetic action weapons and/or chemical agent weapons or atmospheres. There is no to little liquid CBRN threat, and the ambient air atmosphere is known to be less than immediately dangerous to life and health (IDLH). Operators are required to demonstrate and maintain weapon control and to secure/sling/holster individual weapons upon given the end of exercise or “Ok” command. All the while the responders are getting acclimated to the constraints placed on their vision, breathing, hearing, speech, tactile touch, and movement, while using assigned weapons and PPE.

It is evident that the responders have no visible skin eligible for exposure. All skin surface areas appear to be protected by a suit coverall, gloves, boots, or a full face-tight fitting respirator faceblank that is interfacing with a suit front entry zipper closure system of the tan ruggedized non-encapsulating suit coverall. That is not always the case, upon further inspection of the suit interfaces isolated during the stop-and-go review process. For example, the suit’s elastomeric seal with the Avon Protection facepiece on the tallest responder does appear to be unevenly spaced across the top of the respirator faceblank as shown in the last frame of the video at the 1 minute and 5-second mark. Suppose there is a seam gap or opening. This could lead to ambient atmosphere leaking into the operator’s forehead skin area and possibly into the wearer’s breathing zone if the respirator is not correctly sealed on the user’s face. Another observation example is at the 27-31 second time marks where the smaller stature responder shows that his hook and pile closure cover is not fully hooked onto the front entry zipper seal area, vicinity of his top right neck area. It also appears that the rifle sling friction and weight are also causing the front entry flap to move away from the zippered seal area. Under shower test/liquid integrity evaluations of the suits, this is one area of the suit that can allow liquid or gas contaminates to enter if not properly zippered and closed. At video frame time mark of 32 to 35 seconds, the opening is clearly visible as a separation gap on the responder’s lower right neck area, as he is positioning a flash bang simulator for pin pull and release. The intent of the drill was to familiarize the responders with the Class III suit and engage the room targets with sim munitions successfully. That intent was accomplished, but at the risk of not using fully compliant air-purifying respirators. One responder has a full-face tight fitting SCBA face piece on without having an air-purifying respirator adapter affixed that would allow a suitable air-purifying canister to be used. The other responder has a full-face tight-fitting air-purifying respirator (APR) on but has a military specified filter attached, as opposed to the required CBRN Cap 1 type of canister supporting the recognized approval issued by the National Institute for Occupational Safety and Health (NIOSH), deemed appropriate for responders by the U.S. Department of Homeland Security.

Conclusions

If there is one type of mandatory protective equipment needed in real-world CQB entry responses, it is a ballistic vest and a ballistic helmet. Note that neither of the responders have ballistic helmets or vests on during the acclimatization drill. Most likely, that is on purpose. Field experience shows that there can be challenges using chin-neck-head straps on ballistic helmets required to be worn over top of protective clothing hood areas. Wearing an NIJ compliant ballistic vest over top of the protective suit would add weight to the wearer and also serve as a tool to help keep the front entry flap closure secure.

How confident are you when you are suited up for protection? Is it too much or too little? If it is too much, that may be on purpose because the threat may be unknown upon initial entry. If it is too little and you do make a successful entry, you may discover, in yourself or in your visible buddy’s symptoms, that the available respiratory or dermal protection is inadequate in its offered assigned protection factor rating or its inadequately live agent tested swatch material permeation and penetration capacity traits to stop a liquid, vapor aerosol, or gaseous chemical warfare agent. Particulate threat? Use P-100 rating.

Initial and sustainment training acclimates you and hones your skills, but reality checks your confidence and proficiency at the door or out of the door. Being physically fit is a must and being “physically hot” in a protective clothing suit can be a good thing from a qualitative confidence perspective. It is telling you that your body is sealed off from the ambient threat environment. You can then rely on the individual equipment designs to protect you and not distract you from accomplishing the stated mission. Your experience should tell you that when you are suited up for protection, and you suddenly feel that “cool breeze” or sensation, do not dismiss it. Know that it most likely has occurred because your protective clothing is compromised due to visible rip(s), a seam separation, or you have a respirator-to suit seal interface gap/break or respirator malfunction. Foggy respirator eye lens? See the eye lens of your buddy showing water moisture buildup for no reason? That indicates there is likely a respirator faceblank or air pressure boundary seal leak in an APR. Then you have a quick decision to make. Ideally, the compromised user should stop talking, stay calm, stop all movement actions, clear the mask with a positive pressure seal check and then follow that with a negative pressure seal check, preferably egressing to a lower concentration area or to an all-clear area. Bomb suit technicians are challenged with a host of different human factors while wearing bomb disposal protective equipment. First being, how the special EOD breathing apparatus face shield and visor accessory fits correctly with the EOD10 suit helmet. Second, how the same visor then fits over the CBRN SCBA facepiece and regulator, all the while providing rated ballistic protections and no impact to the NIOSH-approved CBRN SCBA/PAPR.

DISCLAIMER: The use of any private industry manufacturer’s name, logo, brand, or representation is not an endorsement of that item. The viewpoints and opinions expressed are solely of the stated author and are not intended to be reproduced or reprinted without the permission of the CBRNe Society and the author.

Terrence K. Cloonan is a combat veteran. A former U.S. Army Major, Chemical Corps-RA, who successfully transitioned to a public health laboratory as a lead physical scientist under the National Institute for Occupational Safety and Health (NIOSH), in the Centers for Disease Control and Prevention (CDC) and ATSDR. Upon retirement from NIOSH in January of 2020, he completed 44 years of work, with 33 years as a federal employee. Mr. Cloonan offers a wealth of ground-truth knowledge concerning toxic chemical agent tests, occupational and military respirator certification requirements, protective equipment user instruction perspectives, and scientific standards development work for emergency responders. His expertise in military nuclear, biological, and chemical operations and private sector occupational safety/industrial hygiene were vital to the City of New York during the 9/11/2001 terrorist attacks. As a federal liaison in the NYC Red Zone for 10 days, Terry Cloonan assisted the New York City Department of Health and the Office of Emergency Management in their safety proclamations during the city’s mutual-aid response to the terrorist attacks. Major Cloonan is a proven leader that offers honest and transparent perspectives with a high level of confidence, day-in and day-out. This guy can help you with scientific insight and vetted overmatch of most, if not all, given threats, workplaces, and/or situations.