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PPE Classification System from OSHA and EPA

Level A PPE Ensemble Elements

See also: PPE Image Gallery - Civilian: Level A Equivalent
   
Respiratory Protection Positive-pressure, full-face piece self-contained breathing apparatus (SCBA)
OR
Positive pressure supplied air respirator (SAR) with SCBA-type auxiliary escape respirator
Clothing Totally encapsulating chemical- and vapor-protective suit
Chemical-resistant inner suit (e.g., Tyvek coveralls)1
Long underwear1
Hard hat (worn under suit)1
Gloves Inner and outer chemical-resistant gloves
Boots Chemical-resistant boots, with steel toe and shank
Advantages Maximum available skin, respiratory, eye protection
Disadvantages

(Operational impact and requirements)
  • Shortest length of time in a protective garment due to heat, other physical and psychological stressors, limited air supply
  • Restricted mobility
  • May exceed protection level necessary for healthcare workers working in healthcare facilities
  • Requires highest level of:
    • Ongoing training
    • Suit acclimatization
    • Medical monitoring
1Optional. To be worn as indicated following an assessment of environmental hazards and responder need.

 

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Level B PPE Ensemble Elements

See also: PPE Image Gallery - Civilian: Level B Equivalent
   
Respiratory Protection Positive-pressure, full-face piece self-contained breathing apparatus (SCBA)
OR
Positive pressure supplied air respirator (SAR) with SCBA-type auxiliary escape respirator
Clothing Hooded chemical-resistant clothing
  • Overalls and long-sleeved jacket
  • Coveralls
  • One or two-piece chemical splash suit
  • Disposable chemical-resistant overalls
Chemical-resistant inner suit (e.g., Tyvek coveralls)1
Face shield1
Hard hat (worn under suit)1
Gloves Inner and outer chemical-resistant gloves
Boots Chemical-resistant boots, with steel toe and shank
OR
Disposable, chemical-resistant outer boot covers1
Advantages
  • High level of protection
  • Less restriction of mobility than Level A PPE
Disadvantages

(Operational impact and requirements) 		Compared to Level A PPE
  • Requires same degree of user training and medical monitoring
  • Equipment has same sustainability issues
1Optional. To be worn as indicated following an assessment of environmental hazards and responder need.

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Level C PPE Ensemble Elements

See also: PPE Image Gallery - Civilian: Level C Equivalent
   
Respiratory Protection Full-face or half-mask, negative pressure air purifying respirator (APR)

Escape Mask1
Clothing Hooded chemical-resistant clothing
  • Overalls
  • Two-piece chemical splash suit
  • Disposable chemical-resistant overalls
Chemical-resistant inner suit (e.g., Tyvek coveralls)1
Face shield1
Hard hat1
Gloves Inner and outer chemical-resistant gloves1
Boots Chemical-resistant boots, with steel toe and shank
OR
Disposable, chemical-resistant outer boot covers1
Advantages
  • Increased mobility as compared to Level A or Level B PPE
  • Much less physical, psychological stress
  • Extended operation time without air supply limitations
  • No fit testing required for hooded respirators
Disadvantages

(Operational impact and requirements)
  • Cannot be used
  • Requirements
    • User enrollment in medical monitoring program
    • Potential fit testing of respirators before they are issued and worn
    • Ongoing competency-based training and exercise
    • Equipment procurement
    • Ongoing equipment maintenance
    • Presence of a safety officer during wearing of PPE
1Optional. To be worn as indicated following an assessment of environmental hazards and responder need.

 

NOTES on Level C PPE
  • Level C PPE is the ensemble of choice for first responders and first receivers caring for victims highly suspected to be contaminated with radiological material
  • Level C PPE Respiratory Protection
    • Hooded NIOSH-certified CBRN powered air-purifying respirators (PAPRs) ("all-hazards PPE") with Assigned Protection Factor (APF) of ≥1000 including
      • Appropriate breathing filters based on hazard vulnerability analysis
      • Combination organic vapor/acid gas/High Efficiency Particulate Air (HEPA) filter (aka "WMD" cartridges) OR
      • Filters appropriate to identified agents such as radioactive particles or chemicals not filtered by "WMD" cartridges
  • A non-powered air-purifying respirator (APR) may be worn when
    • Hazardous substance(s) has/have been identified and quantified and
    • Data confirm that a negative pressure respirator will adequately protect users from identified inhalation hazards
  • For extended or sustained operations, a hooded, powered air-purifying respirator (PAPR) is more comfortable and easier to use.

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Level D PPE Ensemble Elements

See also: PPE Image Gallery - Civilian: Level D Equivalent
   
Respiratory Protection Escape Mask1
Clothing Water-repellent surgical gowns or coveralls1
Scrub suits
Safety glasses, face shield or goggles (for personnel who may get wet with potentially contaminated liquids)
Hard hat1
Gloves1 Surgical gloves
  • Double gloving with frequent changes of outer pair to reduce spread of contamination to other providers, other parts of the patient
  • Tape inner pair of gloves to surgical gown arm cuff; outer pair is then more easily replaced while minimizing risk of self-contamination
Boots/Footwear Chemical-resistant boots, with steel toe and shank1
OR
Disposable, chemical-resistant outer boot covers1
OR
Waterproof shoe covers (for personnel who may get wet with potentially contaminated liquids)
Advantages
  • Provides sufficient level of protection when work operations preclude splashes, immersion, or potential for unexpected inhalation or contact with hazardous levels of chemicals
  • Equivalent to everyday uniforms worn by first receivers
  • Providers caring for patients admitted to hospital wards and floor beds should tailor PPE to anticipated level of patient interaction
Disadvantages

(Operational impact and requirements)
  • Offers the minimum protection against infectious agents or contaminants
  • Requires
    • Regular surveillance for radiation contamination
    • Staff members to conduct frequent self-surveys or to be surveyed by co-workers to identify possible contamination
    • Surveys to be conducted at completion of tour of duty or before exiting radiation controlled areas for clean areas
    • Consultation with hospital radiation safety officer for guidance
1Optional. To be worn as indicated following an assessment of environmental hazards and responder need.

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References:
  1. ATTENTION EMERGENCY RESPONDERS: Guidance on Emergency Responder Personal Protective Equipment (PPE) for Response to CBRN Terrorism Incidents. (PDF - 281 KB) (NIOSH Publication No. 2008-132, June 2008. Page 5) (HHS/CDC/NIOSH, June 2008)
  2. OSHA Best Practices for Hospital-Based First Receivers of Victims from Mass Casualty Incidents Involving the Release of Hazardous Substances (PDF - 1.93 MB) (OSHA, January 2005)
  3. Personal Protective Equipment (EPA)
  4. Stopford BM, Jevitt L, Ledgerwood M, Singleton C, Stolmack M. Development of Models for Emergency Preparedness: Personal Protective Equipment, Decontamination, Isolation/Quarantine, and Laboratory Capacity. (PDF - 4.60 MB) Prepared by SAIC under contract No. 290-00-0023. Agency for Healthcare Research and Quality (AHRQ) Publication No. 05-0099. Rockville, MD, August 2005. (HHS/AHRQ)
  5. OSHA Best Practices for Protecting EMS Responders during Treatment and Transport of Victims of Hazardous Substance Releases. (PDF - 1.47 MB) (OSHA 3370-11. OSHA, 2009)