Within the overall PPE ensemble used by responders at these sites, some equipment performed better than others. While head protection and high-visibility vests functioned relatively well for most responders, protective clothing and respirators exhibited serious shortcomings. Conference participants reported that the available garments did not provide sufficient protection against biological and infectious disease hazards, the heat of fires at the sites, and the demanding physical environment of unstable rubble piles, nor were they light and flexible enough to allow workers to move debris and enter confined spaces. Attendees also indicated that the available eye protection, while protecting well against direct impact injury, provided almost no protection against the persistent dust at the World Trade Center site.

Donna Miles/OSHA News Photo

An OSHA employee instructs a New York Police Department officer in the use of respiratory protection at the site. During the first two months of the recovery effort, OSHA distributed about 110,000 respirators, conducted quantitative fit-testing, and instructed wearers in how to use respirators.

Of all personal protective equipment, respiratory protection elicited the most extended discussion across all of the professional panels. Attendees indicated that under most circumstances, the self-contained breathing apparatus (SCBA) was grossly limited by both the weight of the systems and the short lengths of time (about 15 to 30 minutes) it could be used before the air bottles needed to be refilled. Most participants complained that respirators reduced their field of vision at best, and their facepieces fogged up at worst. Filters for air-purifying respirators (APRs) often did not match available facepieces, and many responders questioned the level of protection they provided, especially during anthrax responses.

The large number of anthrax responses imposed significant burdens on decontamination regimes. Reusable hazmat gear was subject to high rates of wear and tear as suits were constantly put in service, decontaminated, and packed up again. Law-enforcement panelists noted that certain types of boots began cracking over time from being repeatedly soaked in a bleach solution and then dried. "You can't get better protection," a special-operations representative said of standard bunker gear and SCBA. However, because of decontamination problems, these should be worn only when confronting a "real anthrax situation."

	Slideshow
	Bri Rodriguez/ FEMA News Photo
	Many responders suggested that the personal protective equipment (PPE) even impeded their ability to accomplish their missions.

For almost all protective technologies, responders indicated serious problems with equipment not being comfortable enough to allow extended wear during demanding physical labor. It was frequently observed that current technologies require a tradeoff between the amount of protection they provide and the extent to which they are light enough, practical enough, and wearable enough to allow responders to do their jobs. While conference attendees were concerned about having adequate protection, many were even more concerned about equipment hindering them from accomplishing their rescue and recovery missions in an arduous and sustained campaign. Respirators available at the sites were uncomfortable, causing many wearers to use them only intermittently (one participant dubbed them "neck protectors") or to discard them after a short period.

For many firefighters at the conference, PPE availability was as important a concern as PPE performance. Some health-and-safety panelists expressed a similar view. There was an acute shortage of respirators early in the response at the World Trade Center, for example. Subsequently, providing appropriate equipment to the large numbers of workers at these sites was made even more difficult because of the many types and brands of equipment that were being used by the various responder organizations or were being supplied from various sources. The problem was further exacerbated by a lack of interoperability among different types of equipment. These issues, coupled with the very large volume of equipment sent to the World Trade Center site, in particular, made it very difficult to match responders with appropriate equipment and supplies.

Performance
A theme that was repeated frequently throughout the conference was that available PPE technologies worked well at the terrorist-attack sites if they were employed as intended and for the hazards they were designed to protect against. "Everything worked well when it was used for what it was supposed to do," according to one participant.

Larry Lerner/ FEMA News Photo

New York, NY, November 2, 2001--FEMA Safety and Health Managers (left to right) Susan White, Ellen Clas, Raoul Ilaw and Dianne Spiller discuss how to use a P-95 respirator to prevent the inhalation of dust and smoke at the World Trade Center site.

But given the nature of the extended and complex response campaigns that followed the terrorist attacks, scrupulous use of equipment only for tasks for which it was designed proved difficult. Some standard-issue equipment that responders had and used was not designed to work in the types of environments presented by the terrorist incidents. Some equipment simply broke down. Helmet face shields and goggles were designed for impact and splash protection; they provided no protection against dust and particulates. Boots (especially rubber boots) were not fitted properly and melted in the high-heat environment. Some of the available hearing protection was designed for high-impact noise such as sirens, not for the constant lower-frequency noise from heavy-duty equipment to which personnel were exposed. When responding to anthrax incidents, responders did not know whether their respirators were adequate. They reported that such shortcomings, coupled with the perception that marginally effective PPE was hindering their ability to do their jobs--and was even inducing other risks--led them frequently to do without personal protection as they sought to carry out their pressing missions.

Availability and suitability
For many firefighters at the conference, PPE availability (specifically, the ability to obtain or replace gear after the first day of the response) was as important a concern as PPE performance, especially at the World Trade Center. Some health-and-safety panelists expressed a similar view. For example, there was an acute shortage of respirators early on. They felt that PPE supply shortages were less acute at the Pentagon and in the anthrax episodes.

At the World Trade Center, adequate supplies of personal protective equipment became available by the third or fourth day, as commercial air transport resumed and logistics capabilities improved, according to special-operations representatives. Other panelists indicated that adequate supplies of some equipment, including respirators, were not available until later--as much as seven to nine days later. Some responders complained that when equipment, such as boots, arrived, those who needed it were sometimes not able to get it because of a lack of proper inventory control. Also, the equipment that was issued, some observed, could be characterized as "one-size-fits-all," even when it didn't. The broad approach taken was intended to simplify PPE training and reduce interoperability problems, but it was not without drawbacks.

As we have seen, discussion participants in many panels questioned the suitability and quality of PPE--gloves, respirators, masks, goggles, and safety glasses--distributed on-site. One special-operations panelist described being handed a respirator out of a box and just being told, "Here's your respirator," with no other description of its capabilities. It turned out to be a quarter-face respirator with only the bare minimum of particulate filtration, a device that was inappropriate for his activities on the site. Another frequently criticized item was "hardware store variety" paper breathing masks that were available at the World Trade Center. A private-sector representative suggested that many firms sent equipment without considering whether it would be useful or not and, in some cases, sent products that had been sitting in their warehouses not selling. One firefighter at the World Trade Center said, "There was, literally, junk everywhere. Good intentions. . . . People sent crates after crates after crates of stuff they thought would be good to have in there." Although this may have been the PPE that was readily available to ship on short notice, having it on the scene reportedly did not measurably help the responders.

DoD photo by Staff Sgt. Larry A. Simmons, U.S. Air Force

Rescue workers take a breath of fresh air near an entrance to the crash site at the Pentagon on Sept. 14, 2001. Damage to the Pentagon was caused when the hijacked American Airlines flight slammed into the building on Sept. 11th. The terrorist attack caused extensive damage to the west face of the building and followed similar attacks on the twin towers of the World Trade Center in New York City.

Attendees at the conference pointed out that members of different professional groups working side by side at the scene often used markedly different protective equipment because of differences in their professions' standard operations procedures, what was made available to them, or what they customarily wore to do their jobs. For example, law-enforcement panelists noted that there was a rush on all types of equipment, and because most law-enforcement agencies did not allocate enough funding to stockpile PPE, they ran out. A member of the law-enforcement panel working at the Pentagon site ran out of biohazard suits in 24 hours, but he was able to arrange for supplies from other federal agencies.

There are many types of respirators, but few are built with the law-enforcement mission in mind. Many law-enforcement officials wore military masks because they are more compatible with the law-enforcement mission (for instance, when a person is holding a rifle, the canister of a nonmilitary mask can get in the way). Yet, because the National Institute for Occupational Safety and Health (NIOSH) has not certified military masks, panelists indicated that they were uncomfortable issuing the masks to their officers and were concerned that they were violating compliance requirements. A specific brand of mask was referred to as being better because it could be used for four different applications and featured interchangeable parts. U.S. Capitol Police were fitted with these masks to investigate anthrax incidents.

A lack of adequate personal protective equipment was cited as a significant problem for many response organizations dealing with anthrax. Hazmat teams typically had suitable gear, but their personnel often were overtasked, given the large number of hoaxes and false alarms involving powdery substances thought to be anthrax. Firefighters and police officers, on the other hand, usually lacked sufficient PPE and training to respond safely. Of the law-enforcement officials participating in the NIOSH/RAND conference, postal inspectors contended that they had the least protection. A panel member reported that to investigate cases of anthrax, inspectors were issued a pair of latex gloves and a dust mask (which they later found out was completely ineffective) and were also offered the antibiotic Cipro™. At the end of the discussion, they expressed the desire to find out what kind of PPE could be made available to them as they inspect future cases of reported anthrax or other biological/chemical agents.

Given the large number of white-powder events, PPE supply became a problem for many emergency-responder units. At anthrax scenes, law-enforcement officers' standard-issue belts and boots had to be thrown away because their leather and canvas components were too porous and could not be properly decontaminated.

Maintenance and decontamination
Many panel participants commented that personal protective equipment was being used and maintained incorrectly. Law-enforcement panelists noted that overtightening a mask could cause it to crack. At one terrorist attack site, 55-gallon barrels were seen being filled up with cracked masks that had to be thrown away. Safety officers realized that training the officers, even just saying, "It doesn't have to be so tight," could save a lot of masks. Federal and state agency representatives noted that respirator cartridges often were not replaced at the proper intervals. In some cases, cartridges were discarded after less than two hours of use (much less time than is appropriate), while in other cases, "a lot of workers would work for the whole week on one cartridge." This was sometimes due to the unavailability of replacement cartridges, while in other instances it had to do with not receiving or not following instructions on respirator use. By the second day of the responses at the World Trade Center and the Pentagon, firefighters observed that their boots, bunker gear, and gloves had become soaked. Although some panelists reported that their departments quickly issued them duplicate sets of certain equipment, most wore their wet equipment for days.

Firefighters and special-operations panelists expressed their concern that PPE decontamination efforts (the process of removing potentially hazardous material from personnel and equipment as they leave a site) were haphazard and not very effective. At the attack sites themselves, practical concerns got in the way of effective decontamination. Workers at the World Trade Center who had only a single set of protective clothing did not want the clothes wetted (any more) during decontamination, fearing that this would further reduce their comfort and mobility. A firefighter commented, "I had guys running around with the same gear on for three or four weeks before it even started to get cleaned." An emergency medical services (EMS) panel member went further: Some responders did not clean or decontaminate their turnout gear at all in the three months following September 11. "[Decontamination] takes the ensemble away from the employee, who then needs a new replacement ensemble," said another EMS panelist. One participant reported that his organization working at the Pentagon contracted a commercial service to have the work clothes of technical rescue and Urban Search and Rescue (USAR) personnel cleaned and dried while they were off their 12-hour shifts. The arrangement made a "big difference" because it reduced supply burdens, and workers returned to work in fresh gear.

Equipment designed to be reused was often discarded instead. Many noted that respirators were discarded well before the end of their designed service life, in part because users did not know the equipment capabilities. A special-operations panelist argued that, because of the large supply of air-purifying respirators available at the Pentagon, workers treated them as if they were disposable. Another said, "We were throwing respirators away, we didn't know how to clean them right." When workers took off their respirators for a break, they had no way to keep them clean. One special-operations panelist described his air-purifying respirator (APR) as "nothing but a cup sitting there under your chin" collecting dust that he would breathe into his lungs when he put the mask back on.

Andrea Booher/ FEMA News Photo

New York, NY, October 13, 2001--New York Firefighters at the site of the World Trade Center.

The large number of anthrax responses imposed significant burdens on decontamination regimes. Reusable hazmat gear was subject to high rates of wear and tear as suits were constantly put in service, decontaminated, and packed up again. Law-enforcement panelists noted that certain types of boots began cracking over time from being repeatedly soaked in a bleach solution and then dried. "You can't get better protection," a special-operations representative said of standard bunker gear and SCBA. However, because of decontamination problems, these should be worn only when confronting a "real anthrax situation."

Because of the problems of obtaining and decontaminating gear, several special- operations panelists indicated they had to modify the way they dressed for the growing number of anthrax calls. Initially, they responded in basic air-purifying respirators, but they had difficulty decontaminating them fast enough to keep up with the call volume. To solve the problem, they shifted to wearing a full SCBA inside a disposable Tyvek™ suit, since the outer layer could be discarded. One federal-and-state-agency panelist commented that Tyvek™ suits were in such short supply that responders asked if they could be reused. One special-operations panelist said, "The logistics and the number of calls began to drive the whole policy."

Finally, participants on the firefighter and special-operations panels pointed out that communications and other devices that run on specialized batteries that are not readily available, rechargeable, or interchangeable are impractical for extended responses. Many of the flashlights in use by responders, for example, were powered by rechargeable battery packs that could be recharged only in a specialized unit back at the fire station. As a result, after the first 12 hours of response, the flashlights became essentially useless: "When we are on extended scenes, we are not able to recharge on the scene and reuse our gear." In the words of one firefighter, "The only thing that saved us was [a retail firm] coming in with a truckload of lights. I mean crates and crates of lights." Panel members indicated that rechargeable units were preferable to those using specialized batteries. They suggested that it would be better if such devices, whether they were rechargeable or not, accepted readily available disposable batteries such as D-cells. That way, power for a responder's equipment could be cached or would be available through local retail networks.