应急反应的个体防护

PaulOlson,Ph.D.3MErikJohnson,CIH3MPersonalProtectionforfirstResponders

应急响应使用的个体防护用品1WhoRespondsinUSA?

在美国谁参与应急响应？

CivilianAgencies民间机构:

Fire,police,ambulanceservices,emergencyclean-upfirms,hospitalemergencyrooms,medicalpersonnel,publichealthpersonnel,environmentalhealthpersonnel消防、警察、医疗急救、突发事件现场清理公司、医院急救室、医护人员、公共卫生服务人员、环境卫生服务人员

GovernmentAuthorities政府管理机构

ProvincialEmergencyPreparedness/Managementagencies，FederalEmergencyPreparednessAgency(recentlyreplacedbyOfficeofCriticalInfrastructureProtectionandEmergencyPreparedness)

州级突发事件准备/管理机构、联邦突发事件准备机构（目前被“临界设施防护与突发事件准备办公室”代替）2ResponseCo-ordination

协调应急响应Localauthoritiesareusuallyfirstonthescene(firedepartment,police,ambulanceservices)当地主管当局通常第一个到达现场（消防部门、警察、急救服务）Supportorganizationsgetinvolvedsecond(hospitalemergencyrooms,publichealthpersonnel,environmentalhealthpersonnel)其他援助性组织随后介入（医院急救室、公共卫生服务和环境卫生服务）Provincialagenciesmaybenextanddependingonthedegreeofincident,federalagenciescouldbecalledin视事件的严峻程度，州级政府机构也会介入Decontaminationandclean-upoperationsmayfollow,involvingcontractedcompanies现场清污作业最后由签约清污清理作业公司承担Emergencyresponseco-ordinationmustbepractisedandreviewedtoensuretheproceduresaresoundandrunsmoothly正确组织和总结参与应急响应各方的协同作业，确保作业进展彻底和顺利。3GeneralResponseEquipment

应急响应使用的通用设备RespiratoryProtectionispartofanensembleofresponseequipmentwhichincludes:除呼吸防护外，应急响应设备通常还包括：ProtectiveClothing防护服Chemical,thermal,radiation防化学物、防高温、防辐射Glovesandboots手套和防护靴Head,eyeandearprotection头、眼和听力防护Detectionequipment现场检测设备Spillcontainment污染物泄漏处理材料Decontaminationequipment清污净化设备4WhyRespiratoryProtectionIsNecessary

为何需要呼吸防护Gases有毒气体Vapors有毒蒸气Dusts粉尘Mists雾Fumes烟Fibers纤维OxygenDeficiency缺氧IDLH可立即威胁生命和健康5TypesofRespirators

呼吸防护用品的类型AtmosphereSupplying供气式Airpurifying空气过滤式6AirPurifying空气过滤式呼吸器Particles,gasesorvaporspassthroughafilterwhichpurifiestheair利用粉尘、有毒气体或蒸气过滤元件净化空气Negativeandpositivepressure负压式和正压式7ChemicalExposureandequipmentApplicability

化学物暴露水平和防护设备的适用范围ExposureConcentration暴露浓度OEL职业暴露浓度None无污染NIOSHDefinedLimitNIOSH确定的界限IDLHIDLH浓度Self-ContainedBreathingApparatus空气呼吸器SCBACanister滤毒罐Cartridge滤毒盒Nuisance除异味Valuesdefinedintheapprovaldocumentation由认证证书确定的限值Usagesubjecttosatisfactionofprotectionfactorlimitations防护水平应高于危害水平8NIOSHParticulateFilterClassifications

NIOSH防尘滤材分类N-Series:NotforoilN类，不适合油性颗粒物Approvedfornon-oilparticulatecontaminants认证批准用于非油性颗粒物Useuntilincreasedbreathingresistanceordamaged当呼吸阻力增加和坏损时更换R-Series:ResistanttooilR类，阻油Approvedforallparticulatecontaminants认证批准适用于所有颗粒物Timerestrictionof8hourswhenoilsarepresent存在油性颗粒物时，限制使用8小时P-Series:OilProofP类，防油Approvedforallparticulatecontaminants认证批准适用于所有颗粒物Manufacturer’stimeuserestrictionsapply使用时间参见制造商建议HEPAfiltersapprovedwithpoweredairpurifyingrespirators(PAPRs)HEPA滤料认证批准用于电动送风空气过滤式呼吸器9NIOSH42CFR84ParticleFilterClassifications

NIOSH42CFR84防颗粒物滤料的分级方法Minimum N-Series R-Series P-SeriesEfficiency N类 R类 P类效率95% N95 R95 P9599% N99 R99 P9999.97% N100 R100 P100*OSHAhasspecificstandardsforlead,cadmium,asbestos,arsenicand4,4’-Methylenedianiline(MDA)requiring100levelfilters.对铅、镉、石棉、砷和MDA等特殊有害物的防护，OSHA要求使用100级滤料10ColorCodingforChemicalCartridgesandFilters防毒滤盒的色标elastopn.pptOrganicVapor 有机 BlackAcidGases酸性 WhiteOrganicVapor/AcidGases有机/酸性 YellowAmmonia/Methylamine 氨/甲胺 GreenOther 气体 OliveP100/HEPA(PAPRs) Magenta11HalfFacepieceRespirators(negativepressure)

半面式呼吸器（负压式）Willreduceexposuresby10timestheairconcentration可将污染物浓度降低到环境浓度的1/1012FullFacepieceRespirators(negativepressure)全面罩呼吸器（负压式）Willreduceexposuresby10timestheairconcentration(APFof50ifQNFT)可将污染物浓度降低到环境浓度的1/50Reducesexposuretoeyes降低眼睛的暴露13PoweredAirPurifyingRespirators(PAPRs)

动力送风空气过滤式呼吸器（正压式）Hoods,helmetsandfullfacepieces头罩、头盔或全面罩作为送风导入装置Willreduceexposuresby1000timestheairconcentration最高可将污染物浓度降低到环境浓度的1/100014AtmosphereSupplying

供气式呼吸器Suppliedairrespirator(airline)长管供气式Selfcontainedbreathingapparatus(SCBA)携气式Combinationsuppliedair/SCBA复合供气式（长管供气配携气式逃生）15AtmosphereSupplying

供气式呼吸器SCBAsandcombinationsuppliedair/SCBAmaybeusedinenvironmentsthatareoxygendeficient,orimmediatelydangeroustolifeorhealth(IDLH)携气式和复合供气式可用于缺氧环境和IDLH环境Easiertobreatheinthannegativepressurewithcartridge/filter和负压式呼吸器相比，呼吸阻力较低Somesystemscooltheworker某些设计还具有空调功能Weight,size,andhosesmaylimitmobility行动受设备重量、体积和供气管长度限制16PersonalProtectiveEquipment

个人防护用品OSHAHazardousWasteOperationsandEmergencyResponse29CFR1910.120(HAZWOPER)OSHA法规——（处理）危险废物作业和突发事件响应作业（简写HAZWOPER）LevelA–SCBA,totallyencapsulatingchemicalprotectivesuit,gloves,andbootsA级防护：SCBA、全隔离化学防护服、手套和防护靴LevelB–SCBA,hoodedchemical-resistantclothing,glovesandbootsB级防护：SCBA、头罩式化学阻隔防护服、手套和防护靴LevelC–airpurifyingrespirator,hoodedchemical-resistantclothing,glovesandbootsC级防护：空气过滤式呼吸器、头罩式化学阻隔防护服、手套和防护靴LevelD–workuniformD级防护：一般工作服17PPELevelsA,BandC

A、B、C级全身防护18Biologicalmaterials

微生物Bacteria,virus,fungi,protozoan,toxins细菌、病毒、霉菌、原生物、毒素Mainexposurethroughinhalationandingestion主要通过食道和呼吸道进入人体Nosafeexposurelimits没有安全暴露限值Particulaterespiratorwillreduceexposure防颗粒物呼吸器能降低暴露水平Testedusing0.3micronparticle需经过0.3微米颗粒物过滤效率检测Maynotknowthatyou’vebeenexposeduntilafterthefact产生症状之前无法预知是否受暴露19MostPenetratingParticleSize

最具穿透力的颗粒物粒径20CDC/OSHA-FirstRespondersandBiologicalAgents

美国CDC/OSHA：对微生物危害的应急响应Unknownagent,disseminationmethod,orconcentration;orstillbeingaerosolized对于未知物、散播方法未知、浓度未知或已经成为气溶胶的情况：SCBAwithlevelAprotectivesuit：A级防护服＋SCBASituationdefinedandnolongerbeinggenerated,butmaybeasplashhazard

对情况已知，有害物的产生或发散已停止，但仍存在飞溅的危险：SCBAwithlevelBprotectivesuit：B级防护服＋SCBANoaerosolizationdeviceused,disseminationviaaletterorpackagethatcanbeeasilybagged若不存在能借助空气散播的装置，只靠信封或包裹散播，可容易地加以封装：PAPRwithfullfacepieceandHEPAfilter：PAPR配全面罩＋HEPA滤料Unlessvaccinated,wearN95whenexposedtosuspectorconfirmedsmallpoxpatients除非有接种预防措施，在接触疑似或确诊天花病人时，应佩戴N95口罩。21Chemicals化学物Canbesolid,liquid,gasorvapor可为故态、液态、气态或蒸气Mainexposurethroughinhalationandskin

主要通过呼吸道和皮肤进入人体Exposurelimitsavailableformanychemicals

对许多化学物都建立有暴露限值NIOSHCertifiedrespiratorswithcartridge/canistershouldbeselectedasappropriate

使用（NIOSH）认证的呼吸器，选用适用的滤毒盒/滤毒罐22ExposureRoute暴露途径Inhalation吸入Absorption皮肤吸收Ingestion吞咽HealthEffects健康危害HighlyVaried多样性Respiratory呼吸系统NervousSystem神经系统Tissue肌肉Examples举例:OrganicsandSolvents有机物和溶剂Ketones,Acetates,Alcohols,Acrylates,IsocyanatesAcidsandCaustics酸性和腐蚀性HCl,Cl2,H2SO4Ammonia,NaOHPesticides农药Malathion,Phosphine磷化氢SignificantNotes警示：Readilyavailable随处可得ToxicIndustrialChemicals工业用有毒化学物质23GeneralFirstResponseProcedures

应急响应的一般程序BasedonHazardousWasteOperationsandEmergencyResponse(29CFR1910.120)

根据OSHA（处理）危险废物和突发事件响应法规Perimetersestablished设置安全警戒线HotZone-zoneofexclusion热区：危险排除作业区WarmZone-contaminationreductionzone温区：污染物降解区ColdZone-supportzone冷区：支援区24GeneralFirstResponseProcedures应急响应的一般程序Exclusion(Hot)Zone危险排除作业区LevelALevelBLevelCContaminationReduction(Warm)Zone污染降解区Support(Cold)Zone支援区CommandPost指挥部StagingArea人员集结地StagingArea人员集结地CrowdControlLine公众人群控制线DecontaminationLine污染降解区控制线HotLine排除区控制线AccessControlPoints出入关卡Wind风向Drainage排水系统NIOSH/OSHA/USCG/EPARecommendedZones25PersonalProtectiveEquipment

个人防护装备LevelsAandB(SCBAorcombinationairline/SCBA)A和B级（SCBA或复合供气式）Agentandconcentrationisunknown有害物和浓度未知ElevatedconcentrationorIDLH极高浓度或IDLHLevelC(airpurifyingrespirators)C级防护（空气过滤式呼吸器）Concentrationhasbeendeterminedandiswithinlimitsofrespirator浓度已知，未超过呼吸防护限度Appropriatecartridgeandfilter有适用的滤毒罐和颗粒物滤料Nooxygendeficiency不缺氧26Applications应用HAZWOPER:selectPPEbaseduponchemicalandconcentration(levelsA-D)根据HAZWOPER，选择级别适用的个体防护装备（A到D级）Lawenforcementmaintainingcrowdcontroloutsidethecoldzone执法机构将公众人群控制在冷区以外Zeroexposure?OftenwantatleastlevelC

是否为零暴露？通常采取C级防护Hospitalpersonnel医护人员Lowexposureifpatienthasbeensuccessfullydecontaminatedon-siteoroutsideofhospital若患者所受污染在现场或医院外已清除，医护人员受暴露的风险较低。Exposurefromself-admittingpatient<IDLH对于主动前来诊治的患者，医护人员的暴露水平低于IDLH27ProperUseofRespiratorsper

OSHA(29CFR1910.134)

依据OSHA（29CFR1910.134正确使用呼吸器28WrittenRespiratoryProtectionProgram

执行书面的呼吸保护计划1)Proceduresforselectingrespiratorsintheworkplace.对在工作场所使用呼吸器，应遵守的选用程序2)MedicalEvaluationsforemployeesrequiredtowearrespirators.对呼吸器佩戴者（是否适合佩戴呼吸器）进行医学评价3)Fittestingproceduresfortight-fittingrespirators.对佩戴密合性面罩的使用者进行适合性检验4)Proceduresforproperuseofrespiratorsinroutineandreasonablyforeseeableemergencysituations.日常及预见的应急响应条件下使用的呼吸器，提供正确使用方法5)Procedures/schedulesforcleaning,disinfecting,storing,inspecting,repairingandmaintenanceofrespirators.建立清洗、消毒、检查、维修和维护的程序和时间表29WrittenRespiratoryProtectionProgram

执行书面的呼吸保护计划6)Procedurestoensureadequateairquality,quantity,andflowofbreathingairforatmosphere-supplyingrespirators.对使用供气式呼吸器而言，确认气源空气质量、供气量和流量合格的程序7)Trainingofemployeesintherespiratoryhazardstowhichtheyarepotentiallyexposedduringroutine&emergencysituations.

对雇员提供培训，了解呼吸器使用环境条件下的呼吸危害。8)Trainingintheproperuseofrespirators,includingdonningandremoval,anylimitationsontheiruse,andtheirmaintenance.

对雇员提供培训，了解佩戴和摘除呼吸器的方法，呼吸的使用限制和维护方法9)Proceduresforevaluatingtheeffectivenessoftheprogram.

评价呼吸保护计划有效性的程序30HowtoSelectaRespirator

如何选择呼吸器1)Measurethecontaminantconcentration检测空气污染物浓度水平2)Dividetheairconcentrationbythepermissibleexposurelimit(PEL).Thisisthehazardratio用污染物浓度除以允许的暴露限值，得出危害因数3)Selectarespiratorwithaprotectionfactorgreaterthanthehazardratio.选择防护因数高于危害因数的呼吸器4)ForIDLHenvironmentsuseSCBAsorcombinationsuppliedair/SCBAIDLH环境下只能使用SCBA和复合供气式呼吸器（SCBA逃生＋长管供气）31MedicalEvaluation医学评价1.Requiredforemployeesbeforebeingfittestedorrequiredtouse在进行适合性检验和佩戴使用之前，需要对使用者就是否适合使用呼吸器进行医学评价2.Mandatoryquestionnaire(AppendixC)OSHA29CFR1910.134(附录C）提供了必须提问的问卷3.Reviewedbyphysicianorotherlicensedhealthcareprovider;follow-upexaminationifnecessary由医生或有执照的卫生保健服务人员进行，如果必要，还应进行健康检查。4.Mustobtainwrittenrecommendation必须获得书面的建议5.Repeatifchangeinworkplaceorrequestedbyemployee,supervisor,programadministrator,orPLHCP.Notrequiredannually当工作场所变更，或当雇员、主管或呼吸保护计划负责人提出要求时，重新进行，但并非每年一次。32FitTestingofTight-fittingRespirators

密合型面罩的适合性检验Purpose:todeterminetherespiratorstyleandsizethatwillprotect目的：确认呼吸器的面型设计和尺寸能提供所需要的防护Qualitativefittesting(QLFT)orquantitativefit-testing(QNFT)分定性适合性检验和定量适合性检验两种方法Repeatannually,orearlieriffacialscarring,dentalsurgery,excessiveweightlossorgain每年进行一次，或当面部出现疤痕、牙科手术后、体重明显减轻或增加时进行Notrequiredforloosefittingrespiratorssuchashelmetsandhoods对松配合式头罩或头盔，不需要适合性检验33QualitativeFitTesting

定性适合性检验34UseofRespirators使用呼吸器1.Prohibitswearingtight-fittingfacepieceswith:以下情况不得使用密合型面罩facialhairbetweenthesealingsurfaceandfaceorthatinterfereswithvalvefunction在面罩密封垫与面部之间有毛发，防碍密合或防碍阀门工作anyconditionthatinterfereswithfacepiecesealorvalvefunction其他任何可能破坏密合或阀门工作的情况2.Foralltight-fittingrespirators,mustperformausersealcheckeachtimeitisputon对佩戴密合型面罩的使用者而言，每次佩戴后都必须进行佩戴气密性检查proceduresinAppendixBOSHA29CFR1910.134附录B提供具体方法proceduresrecommendedbytherespiratormanufacturerthattheemployerdemonstratesareaseffectiveasthoseinApp.B制造商在使用说明中建议的佩戴气密性检查方法35NegativePressureUserSealCheck

面罩的负压式佩戴气密性检查方法Covercartridge

用手盖住滤盒进气口Inhale吸气Checkforairleaks

检查是否存在漏气36PositivePressureUserSealCheck

面罩的正压式佩戴气密性检查方法Covervalve

用手盖住呼气阀Exhale

呼气Checkforairleaks检查是否漏气37CartridgeChange-outSchedule

滤毒盒更换时间Don’trelysolelyontasteorsmell不应单纯依靠使用者的嗅觉和味觉Changecartridgesaccordingto:根据以下方法更换滤毒盒Change-outschedule(softwareprogramsavailablefrommanufacturers