PPE Classification System from OSHA and EPA

• Level A PPE Ensemble Elements
• Level B PPE Ensemble Elements
• Level C PPE Ensemble Elements
• Level D PPE Ensemble Elements

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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 When airborne hazard concentrations are immediately dangerous to life and health In low oxygen environments 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)