應急反應的個體防護

PaulOlson,Ph.D.3MErikJohnson,CIH3MPersonalProtectionforfirstResponders

應急響應使用的個體防護用品1WhoRespondsinUSA?

在美國誰參與應急響應？

CivilianAgencies民間機構:

Fire,police,ambulanceservices,emergencyclean-upfirms,hospitalemergencyrooms,medicalpersonnel,publichealthpersonnel,environmentalhealthpersonnel消防、警察、醫(yī)療急救、突發(fā)事件現(xiàn)場清理公司、醫(yī)院急救室、醫(yī)護人員、公共衛(wèi)生服務人員、環(huán)境衛(wèi)生服務人員

GovernmentAuthorities政府管理機構

ProvincialEmergencyPreparedness/Managementagencies，F(xiàn)ederalEmergencyPreparednessAgency(recentlyreplacedbyOfficeofCriticalInfrastructureProtectionandEmergencyPreparedness)

州級突發(fā)事件準備/管理機構、聯(lián)邦突發(fā)事件準備機構（目前被“臨界設施防護與突發(fā)事件準備辦公室”代替）2ResponseCo-ordination

協(xié)調應急響應Localauthoritiesareusuallyfirstonthescene(firedepartment,police,ambulanceservices)當?shù)刂鞴墚斁滞ǔ５谝粋€到達現(xiàn)場（消防部門、警察、急救服務）Supportorganizationsgetinvolvedsecond(hospitalemergencyrooms,publichealthpersonnel,environmentalhealthpersonnel)其他援助性組織隨后介入（醫(yī)院急救室、公共衛(wèi)生服務和環(huán)境衛(wèi)生服務）Provincialagenciesmaybenextanddependingonthedegreeofincident,federalagenciescouldbecalledin視事件的嚴峻程度，州級政府機構也會介入Decontaminationandclean-upoperationsmayfollow,involvingcontractedcompanies現(xiàn)場清污作業(yè)最后由簽約清污清理作業(yè)公司承擔Emergencyresponseco-ordinationmustbepractisedandreviewedtoensuretheproceduresaresoundandrunsmoothly正確組織和總結參與應急響應各方的協(xié)同作業(yè)，確保作業(yè)進展徹底和順利。3GeneralResponseEquipment

應急響應使用的通用設備RespiratoryProtectionispartofanensembleofresponseequipmentwhichincludes:除呼吸防護外，應急響應設備通常還包括：ProtectiveClothing防護服Chemical,thermal,radiation防化學物、防高溫、防輻射Glovesandboots手套和防護靴Head,eyeandearprotection頭、眼和聽力防護Detectionequipment現(xiàn)場檢測設備Spillcontainment污染物泄漏處理材料Decontaminationequipment清污凈化設備4WhyRespiratoryProtectionIsNecessary

為何需要呼吸防護Gases有毒氣體Vapors有毒蒸氣Dusts粉塵Mists霧Fumes煙Fibers纖維OxygenDeficiency缺氧IDLH可立即威脅生命和健康5TypesofRespirators

呼吸防護用品的類型AtmosphereSupplying供氣式Airpurifying空氣過濾式6AirPurifying空氣過濾式呼吸器Particles,gasesorvaporspassthroughafilterwhichpurifiestheair利用粉塵、有毒氣體或蒸氣過濾元件凈化空氣Negativeandpositivepressure負壓式和正壓式7ChemicalExposureandequipmentApplicability

化學物暴露水平和防護設備的適用范圍ExposureConcentration暴露濃度OEL職業(yè)暴露濃度None無污染NIOSHDefinedLimitNIOSH確定的界限IDLHIDLH濃度Self-ContainedBreathingApparatus空氣呼吸器SCBACanister濾毒罐Cartridge濾毒盒Nuisance除異味Valuesdefinedintheapprovaldocumentation由認證證書確定的限值Usagesubjecttosatisfactionofprotectionfactorlimitations防護水平應高于危害水平8NIOSHParticulateFilterClassifications

NIOSH防塵濾材分類N-Series:NotforoilN類，不適合油性顆粒物Approvedfornon-oilparticulatecontaminants認證批準用于非油性顆粒物Useuntilincreasedbreathingresistanceordamaged當呼吸阻力增加和壞損時更換R-Series:ResistanttooilR類，阻油Approvedforallparticulatecontaminants認證批準適用于所有顆粒物Timerestrictionof8hourswhenoilsarepresent存在油性顆粒物時，限制使用8小時P-Series:OilProofP類，防油Approvedforallparticulatecontaminants認證批準適用于所有顆粒物Manufacturer’stimeuserestrictionsapply使用時間參見制造商建議HEPAfiltersapprovedwithpoweredairpurifyingrespirators(PAPRs)HEPA濾料認證批準用于電動送風空氣過濾式呼吸器9NIOSH42CFR84ParticleFilterClassifications

NIOSH42CFR84防顆粒物濾料的分級方法Minimum N-Series R-Series P-SeriesEfficiency N類 R類 P類效率95% N95 R95 P9599% N99 R99 P9999.97% N100 R100 P100*OSHAhasspecificstandardsforlead,cadmium,asbestos,arsenicand4,4’-Methylenedianiline(MDA)requiring100levelfilters.對鉛、鎘、石棉、砷和MDA等特殊有害物的防護，OSHA要求使用100級濾料10ColorCodingforChemicalCartridgesandFilters防毒濾盒的色標elastopn.pptOrganicVapor 有機 BlackAcidGases酸性 WhiteOrganicVapor/AcidGases有機/酸性 YellowAmmonia/Methylamine 氨/甲胺 GreenOther 氣體 OliveP100/HEPA(PAPRs) Magenta11HalfFacepieceRespirators(negativepressure)

半面式呼吸器（負壓式）Willreduceexposuresby10timestheairconcentration可將污染物濃度降低到環(huán)境濃度的1/1012FullFacepieceRespirators(negativepressure)全面罩呼吸器（負壓式）Willreduceexposuresby10timestheairconcentration(APFof50ifQNFT)可將污染物濃度降低到環(huán)境濃度的1/50Reducesexposuretoeyes降低眼睛的暴露13PoweredAirPurifyingRespirators(PAPRs)

動力送風空氣過濾式呼吸器（正壓式）Hoods,helmetsandfullfacepieces頭罩、頭盔或全面罩作為送風導入裝置Willreduceexposuresby1000timestheairconcentration最高可將污染物濃度降低到環(huán)境濃度的1/100014AtmosphereSupplying

供氣式呼吸器Suppliedairrespirator(airline)長管供氣式Selfcontainedbreathingapparatus(SCBA)攜氣式Combinationsuppliedair/SCBA復合供氣式（長管供氣配攜氣式逃生）15AtmosphereSupplying

供氣式呼吸器SCBAsandcombinationsuppliedair/SCBAmaybeusedinenvironmentsthatareoxygendeficient,orimmediatelydangeroustolifeorhealth(IDLH)攜氣式和復合供氣式可用于缺氧環(huán)境和IDLH環(huán)境Easiertobreatheinthannegativepressurewithcartridge/filter和負壓式呼吸器相比，呼吸阻力較低Somesystemscooltheworker某些設計還具有空調功能Weight,size,andhosesmaylimitmobility行動受設備重量、體積和供氣管長度限制16PersonalProtectiveEquipment

個人防護用品OSHAHazardousWasteOperationsandEmergencyResponse29CFR1910.120(HAZWOPER)OSHA法規(guī)——（處理）危險廢物作業(yè)和突發(fā)事件響應作業(yè)（簡寫HAZWOPER）LevelA–SCBA,totallyencapsulatingchemicalprotectivesuit,gloves,andbootsA級防護：SCBA、全隔離化學防護服、手套和防護靴LevelB–SCBA,hoodedchemical-resistantclothing,glovesandbootsB級防護：SCBA、頭罩式化學阻隔防護服、手套和防護靴LevelC–airpurifyingrespirator,hoodedchemical-resistantclothing,glovesandbootsC級防護：空氣過濾式呼吸器、頭罩式化學阻隔防護服、手套和防護靴LevelD–workuniformD級防護：一般工作服17PPELevelsA,BandC

A、B、C級全身防護18Biologicalmaterials

微生物Bacteria,virus,fungi,protozoan,toxins細菌、病毒、霉菌、原生物、毒素Mainexposurethroughinhalationandingestion主要通過食道和呼吸道進入人體Nosafeexposurelimits沒有安全暴露限值Particulaterespiratorwillreduceexposure防顆粒物呼吸器能降低暴露水平Testedusing0.3micronparticle需經(jīng)過0.3微米顆粒物過濾效率檢測Maynotknowthatyou’vebeenexposeduntilafterthefact產生癥狀之前無法預知是否受暴露19MostPenetratingParticleSize

最具穿透力的顆粒物粒徑20CDC/OSHA-FirstRespondersandBiologicalAgents

美國CDC/OSHA：對微生物危害的應急響應Unknownagent,disseminationmethod,orconcentration;orstillbeingaerosolized對于未知物、散播方法未知、濃度未知或已經(jīng)成為氣溶膠的情況：SCBAwithlevelAprotectivesuit：A級防護服＋SCBASituationdefinedandnolongerbeinggenerated,butmaybeasplashhazard

對情況已知，有害物的產生或發(fā)散已停止，但仍存在飛濺的危險：SCBAwithlevelBprotectivesuit：B級防護服＋SCBANoaerosolizationdeviceused,disseminationviaaletterorpackagethatcanbeeasilybagged若不存在能借助空氣散播的裝置，只靠信封或包裹散播，可容易地加以封裝：PAPRwithfullfacepieceandHEPAfilter：PAPR配全面罩＋HEPA濾料Unlessvaccinated,wearN95whenexposedtosuspectorconfirmedsmallpoxpatients除非有接種預防措施，在接觸疑似或確診天花病人時，應佩戴N95口罩。21Chemicals化學物Canbesolid,liquid,gasorvapor可為故態(tài)、液態(tài)、氣態(tài)或蒸氣Mainexposurethroughinhalationandskin

主要通過呼吸道和皮膚進入人體Exposurelimitsavailableformanychemicals

對許多化學物都建立有暴露限值NIOSHCertifiedrespiratorswithcartridge/canistershouldbeselectedasappropriate

使用（NIOSH）認證的呼吸器，選用適用的濾毒盒/濾毒罐22ExposureRoute暴露途徑Inhalation吸入Absorption皮膚吸收Ingestion吞咽HealthEffects健康危害HighlyVaried多樣性Respiratory呼吸系統(tǒng)NervousSystem神經(jīng)系統(tǒng)Tissue肌肉Examples舉例:OrganicsandSolvents有機物和溶劑Ketones,Acetates,Alcohols,Acrylates,IsocyanatesAcidsandCaustics酸性和腐蝕性HCl,Cl2,H2SO4Ammonia,NaOHPesticides農藥Malathion,Phosphine磷化氫SignificantNotes警示：Readilyavailable隨處可得ToxicIndustrialChemicals工業(yè)用有毒化學物質23GeneralFirstResponseProcedures

應急響應的一般程序BasedonHazardousWasteOperationsandEmergencyResponse(29CFR1910.120)

根據(jù)OSHA（處理）危險廢物和突發(fā)事件響應法規(guī)Perimetersestablished設置安全警戒線HotZone-zoneofexclusion熱區(qū)：危險排除作業(yè)區(qū)WarmZone-contaminationreductionzone溫區(qū)：污染物降解區(qū)ColdZone-supportzone冷區(qū)：支援區(qū)24GeneralFirstResponseProcedures應急響應的一般程序Exclusion(Hot)Zone危險排除作業(yè)區(qū)LevelALevelBLevelCContaminationReduction(Warm)Zone污染降解區(qū)Support(Cold)Zone支援區(qū)CommandPost指揮部StagingArea人員集結地StagingArea人員集結地CrowdControlLine公眾人群控制線DecontaminationLine污染降解區(qū)控制線HotLine排除區(qū)控制線AccessControlPoints出入關卡Wind風向Drainage排水系統(tǒng)NIOSH/OSHA/USCG/EPARecommendedZones25PersonalProtectiveEquipment

個人防護裝備LevelsAandB(SCBAorcombinationairline/SCBA)A和B級（SCBA或復合供氣式）Agentandconcentrationisunknown有害物和濃度未知ElevatedconcentrationorIDLH極高濃度或IDLHLevelC(airpurifyingrespirators)C級防護（空氣過濾式呼吸器）Concentrationhasbeendeterminedandiswithinlimitsofrespirator濃度已知，未超過呼吸防護限度Appropriatecartridgeandfilter有適用的濾毒罐和顆粒物濾料Nooxygendeficiency不缺氧26Applications應用HAZWOPER:selectPPEbaseduponchemicalandconcentration(levelsA-D)根據(jù)HAZWOPER，選擇級別適用的個體防護裝備（A到D級）Lawenforcementmaintainingcrowdcontroloutsidethecoldzone執(zhí)法機構將公眾人群控制在冷區(qū)以外Zeroexposure?OftenwantatleastlevelC

是否為零暴露？通常采取C級防護Hospitalpersonnel醫(yī)護人員Lowexposureifpatienthasbeensuccessfullydecontaminatedon-siteoroutsideofhospital若患者所受污染在現(xiàn)場或醫(yī)院外已清除，醫(yī)護人員受暴露的風險較低。Exposurefromself-admittingpatient<IDLH對于主動前來診治的患者，醫(yī)護人員的暴露水平低于IDLH27ProperUseofRespiratorsper

OSHA(29CFR1910.134)

依據(jù)OSHA（29CFR1910.134正確使用呼吸器28WrittenRespiratoryProtectionProgram

執(zhí)行書面的呼吸保護計劃1)Proceduresforselectingrespiratorsintheworkplace.對在工作場所使用呼吸器，應遵守的選用程序2)MedicalEvaluationsforemployeesrequiredtowearrespirators.對呼吸器佩戴者（是否適合佩戴呼吸器）進行醫(yī)學評價3)Fittestingproceduresfortight-fittingrespirators.對佩戴密合性面罩的使用者進行適合性檢驗4)Proceduresforproperuseofrespiratorsinroutineandreasonablyforeseeableemergencysituations.日常及預見的應急響應條件下使用的呼吸器，提供正確使用方法5)Procedures/schedulesforcleaning,disinfecting,storing,inspecting,repairingandmaintenanceofrespirators.建立清洗、消毒、檢查、維修和維護的程序和時間表29WrittenRespiratoryProtectionProgram

執(zhí)行書面的呼吸保護計劃6)Procedurestoensureadequateairquality,quantity,andflowofbreathingairforatmosphere-supplyingrespirators.對使用供氣式呼吸器而言，確認氣源空氣質量、供氣量和流量合格的程序7)Trainingofemployeesintherespiratoryhazardstowhichtheyarepotentiallyexposedduringroutine&emergencysituations.

對雇員提供培訓，了解呼吸器使用環(huán)境條件下的呼吸危害。8)Trainingintheproperuseofrespirators,includingdonningandremoval,anylimitationsontheiruse,andtheirmaintenance.

對雇員提供培訓，了解佩戴和摘除呼吸器的方法，呼吸的使用限制和維護方法9)Proceduresforevaluatingtheeffectivenessoftheprogram.

評價呼吸保護計劃有效性的程序30HowtoSelectaRespirator

如何選擇呼吸器1)Measurethecontaminantconcentration檢測空氣污染物濃度水平2)Dividetheairconcentrationbythepermissibleexposurelimit(PEL).Thisisthehazardratio用污染物濃度除以允許的暴露限值，得出危害因數(shù)3)Selectarespiratorwithaprotectionfactorgreaterthanthehazardratio.選擇防護因數(shù)高于危害因數(shù)的呼吸器4)ForIDLHenvironmentsuseSCBAsorcombinationsuppliedair/SCBAIDLH環(huán)境下只能使用SCBA和復合供氣式呼吸器（SCBA逃生＋長管供氣）31MedicalEvaluation醫(yī)學評價1.Requiredforemployeesbeforebeingfittestedorrequiredtouse在進行適合性檢驗和佩戴使用之前，需要對使用者就是否適合使用呼吸器進行醫(yī)學評價2.Mandatoryquestionnaire(AppendixC)OSHA29CFR1910.134(附錄C）提供了必須提問的問卷3.Reviewedbyphysicianorotherlicensedhealthcareprovider;follow-upexaminationifnecessary由醫(yī)生或有執(zhí)照的衛(wèi)生保健服務人員進行，如果必要，還應進行健康檢查。4.Mustobtainwrittenrecommendation必須獲得書面的建議5.Repeatifchangeinworkplaceorrequestedbyemployee,supervisor,programadministrator,orPLHCP.Notrequiredannually當工作場所變更，或當雇員、主管或呼吸保護計劃負責人提出要求時，重新進行，但并非每年一次。32FitTestingofTight-fittingRespirators

密合型面罩的適合性檢驗Purpose:todeterminetherespiratorstyleandsizethatwillprotect目的：確認呼吸器的面型設計和尺寸能提供所需要的防護Qualitativefittesting(QLFT)orquantitativefit-testing(QNFT)分定性適合性檢驗和定量適合性檢驗兩種方法Repeatannually,orearlieriffacialscarring,dentalsurgery,excessiveweightlossorgain每年進行一次，或當面部出現(xiàn)疤痕、牙科手術后、體重明顯減輕或增加時進行Notrequiredforloosefittingrespiratorssuchashelmetsandhoods對松配合式頭罩或頭盔，不需要適合性檢驗33QualitativeFitTesting

定性適合性檢驗34UseofRespirators使用呼吸器1.Prohibitswearingtight-fittingfacepieceswith:以下情況不得使用密合型面罩facialhairbetweenthesealingsurfaceandfaceorthatinterfereswithvalvefunction在面罩密封墊與面部之間有毛發(fā)，防礙密合或防礙閥門工作anyconditionthatinterfereswithfacepiecesealorvalvefunction其他任何可能破壞密合或閥門工作的情況2.Foralltight-fittingrespirators,mustperformausersealcheckeachtimeitisputon對佩戴密合型面罩的使用者而言，每次佩戴后都必須進行佩戴氣密性檢查proceduresinAppendixBOSHA29CFR1910.134附錄B提供具體方法proceduresrecommendedbytherespiratormanufacturerthattheemployerdemonstratesareaseffectiveasthoseinApp.B制造商在使用說明中建議的佩戴氣密性檢查方法35NegativePressureUserSealCheck

面罩的負壓式佩戴氣密性檢查方法Covercartridge

用手蓋住濾盒進氣口Inhale吸氣Checkforairleaks

檢查是否存在漏氣36PositivePressureUserSealCheck

面罩的正壓式佩戴氣密性檢查方法Covervalve

用手蓋住呼氣閥Exhale

呼氣Checkforairleaks檢查是否漏氣37CartridgeChange-outSchedule

濾毒盒更換時間Don’trelysolelyontasteorsmell不應單純依靠使用者的嗅覺和味覺Changecartridgesaccordingto:根據(jù)以下方法更換濾毒盒Change-outschedule(softwareprogramsavailablefrommanufacturers