Mask safety in the field

Situation

Due to the recent health crisis, emergency deployments may be impacted due to problems sourcing NIOSH/FDA approved masks. Also, there is confusion about the proper care and use of N95 masks. This document’s objective is to describe in detail what a N95 mask protects against and guidelines and alternatives to their use to both to protect emergency responders and to provide aid to the public when it most needs it.

What is a N95 Mask

(From Wikipedia) An N95 mask or N95 respirator is a particulate-filtering face-piece respirator that meets the U.S. National Institute for Occupational Safety and Health (NIOSH) N95 classification of air filtration, meaning that it filters at least 95% of airborne particles.

N95 is the most popular type of face mask. Surgical respirators labeled “N95 surgical” have additional qualities that have additional medical protections. P95 masks do the same but have protections against oil inhalation. Standard dust or Surgical masks do not create a seal which allows contaminants to be breathed around the edges of the mask.

Equivalent Standards

Olathe CERT does not recommend using anything other than N95 rated respirator for hazardous work however if supplies are limited and N95 masks are not available then members may substitute KN95(China) and FFP2(EU) certified masks from a reputable source.

Proper Care and Use of a N95 mask

Storage

Masks should be stored in a sealed, rigid, sterile, dry environment.
 

Use

• If you have a beard trim it back so that the mask is able to get a seal. It is advised that you shave all facial hair for the best possible seal
• Clean your hands and face and sanitize
• Apply medical gloves
• Grasp the mask around the edges
• Fit the base of the N95 mask to your chin, it should ride low on your nose but completely cover your mouth and nose with no gaps
• Move the bottom elastic band around the back of your head beneath your ears
• Move the top most elastic band over your head over your ears
• Using your fingers apply pressure to the nasal band and adjust the edges of the mask so that the mask has a good seal around your face.
• Cup your hands around the mask and exhale sharply to detect leakage
• Re-adjust the mask as needed
• Removal, Storage and Reuse

An N95 mask may be removed and reused up to 5 times unless it has been in contact with aerosolized body substances, or otherwise becomes soiled. When a Mask is removed in order to re-use it, store it in a bag and take care when re-applying it so as not to contaminate the inside of the mask with your fingers. It is also important to not crush or deform the mask. The bag needs to be steryl and semi permeable like paper or have a desiccant packet to remove excess moisture.

• Open the storage bag
• While wearing gloves move the bottom elastic band over your head
• Then grasp the base of the mask with one hand
• Move the top elastic band over the top of your head
• Carefully remove the mask taking care not to touch the insides of the mask
• Place the mask carefully in the storage bag and seal it.

Disposal

Any mask that has been in proximity to body substances or has undergone more than 5 re-uses, been soiled or any other reason is deemed no longer fit to be used; it should be disposed of as medical waste.

On Reuse or Reconditioning

There are no safe and/or practical methods for cleaning a mask in the field. Safety best practices recommend replacing a disposable N95 Mask if it becomes soiled, exceeds its maximum number of uses or after one work day whichever comes first.

Performing Labor When Wearing A Mask

A properly fitted mask restricts airflow, advanced n95 mask systems more so than disposable masks. When working while wearing any mask be sure to pace yourself and take frequent breaks to cool down and to catch your breath. When wearing an N95 mask be sure to avoid removing the mask excessively and to replace the mask very carefully to avoid contamination. If you intend to do heavy work be sure to pack extra masks and plenty of safety supplies, cleaning supplies and water.

Post-Deployment Safety Issues for CERT Volunteers

Post-Deployment Safety Issues for CERT Volunteers

CERT members like emergency any emergency response personnel spend an enormous amount of time training in order to keep their skills sharp for the one and a million chance of deploying to a disaster.  After having deployed the mission does not end.  Volunteers may have witnessed traumatic experiences, been exposed to body substances or hazardous chemicals or other environmental issues.  Volunteers may also have over exerted themselves and may have injuries that didn't present themselves immediately.  In each CERT unit there needs to be a Health and Safety position who's job is to follow up with volunteers looking for these latent issues and to ensure volunteers get proper assistance.

Hazards

Psychological Trauma and Depression

Psychological trauma is just as real and debilitating as any other wound a person might get during a disaster.  Every responder who has undergone extreme stress will likely need to under go some form of counseling to help address this trauma.

• Critical Incident Stress Debriefing
• OSHA  Post-Deployment Guide for Emergency and Disaster Response Workers

Muscular/Skeletal injuries

Overexerting ones self causes all manor of pains, bruises and discomfort.  Most of the time the body simply needs rest and basic treatment such as apply cold and elevating the affected limb.  You may need to consult a physician to make sure lingering and ongoing pain is treated correctly.

Blood Borne Pathogens/Infection Control Plans

Diseases can be spread by direct contact with body fluids.  CERT members who have been in contact with body fluids need to report this to the Health and Safety Liaison and get tested for infections regularly.  CERT members who intend to be in contact with victims or in close proximity of wounds and bodily fluids need to get vaccinated.

• OSHA - Blood Borne Pathogen facts
• OSHA - Blood Borne Pathogen protections
• CDC - Blood Borne Pathogen guidelines

How to Respond

CERT Members:

If you have been deployed and experience any type of illness, pain or psychological trauma, you need to notify the CERT health and Safety Liaison or designated CERT parent agency health and safety contact.  For simple muscular skeletal issues such as sprains, strains and general soreness; applying cold, elevating the limb should be sufficient.  For persistent or more advanced problems contact a physician. 

CERT Health and Safety Officer/Liaison responsibilities: 

• Document volunteer pre and post deployment medical issues.  
• Follow up to see if any post deployment medical issues have become chronic.  
• Report deployment medical issues to the CERT parent agency on a regular basis.  
• Provide medical information (insurance, recommended treatments, local community clinic and medical resources) to assist CERT members with deployment related injuries. 

Health and Safety officer should have medical training as well as having taken FEMA IS-930 training to help understand their role in maintaining the wellness and deploy-ability of their Team.  Some CERT Parent agencies offer insurance coverage for volunteers so its doubly vital to track these issues for insurance reasons.

• IS930 - Emergency Responder Health Monitoring and Surveillance (ERHMS)

Storing and Sharing Medical Records

Storage and sharing of medical records is very important and you need to be aware of who and when you can share records with.

• US Department of Health and Human services HIPAA Guidence

This aspect of managing your CERT team is extremely important. Persons put in charge of this role needs to seek out their CERT parent organization for formal guidance on this topic.  It is recommended that persons in this role are an EMR/First responder or higher medical training.

Pre-Deployment Safety Considerations for CERT Volunteers

Pre-Deployment Safety Considerations for CERT Volunteers

Regular Medical Screenings or Physicals

Even younger responders should get a yearly screening or physical to catch problems before they become major issues.  For older responders this is even more critical to detect and treat illnesses.  Responding to a disaster causes great stress on the body and can exacerbate existing medical issues.

Vaccinations 

The CDC recommends two types of vaccinations when responding to a disaster in the US.

• Tetanus: In accordance with the current CDC guidelines, responders should receive a tetanus booster if they have not been vaccinated for tetanus during the past 10 years. Td (tetanus/diphtheria) or Tdap (tetanus/diphtheria/pertussis) can be used; getting the Tdap formula for one tetanus booster during adulthood is recommended to maintain protection against pertussis. While documentation of vaccination is preferred, it should not be a prerequisite to work.
• Hepatitis B: Hepatitis B vaccine series for persons who will be performing direct patient care or otherwise expected to have contact with bodily fluids.

When traveling outside of the US you should consult the CDC immunization website.

Response Equipment: Emergency Response Drills

Emergency responders need to participate in regular training drills in order to identify any equipment needing repair or replacement. 

Policy Discussion:CERT members and weapons

Policy Discussion:CERT members and weapons

When CERT is deployed with a mission to respond to an impacted area they are doing so as non-combatants.  A non-combatant is defined "as one that does not engage in combat: such as
a : a member (such as a chaplain) of the armed forces whose duties do not include fighting
b : civilian."(Merriam Webster Dictionary) 

Every piece of equipment that a CERT team brings when responding should be:

• A tool that is intended to serve the CERT mission of Fire suppression, disaster medical or search and rescue.
• Supplies to support the team in dispensing their duties
• Personal supplies to sustain the CERT member in service with their unit.
• Something you are trained and certified to use in the service of CERT.

If you are carrying something which does not sustain you, cannot be used in a normal way to serve CERT's mission and is conspicuous and considered to be a device which causes harm with no other legitimate purpose then that damages your credibility as an emergency responder.  Moreover you have placed yourself and your team in jeopardy.

In CERT training we learn that when CERT is entering an impacted area they should first evaluate if it is safe.  If it is not safe we should not enter the area.  If there is a question of responder safety then requesting a police chaperone to provide security would be a good idea.  If during a deployment the situation changes and it is no longer safe then your team needs to re-evaluate their situation and if necessary leave.

You need to understand when you deploy as a non-combatant that you are walking into an abnormal situation and danger is always present.  If you cant handle the possibility of danger then you probably should request a non-field role.

An example of how to deal with this potential danger as a non-combatant would be when the Salvation Army deploys teams to dispense supplies into an impacted area.  If the area's safety is in question the Salvation Army requests a local police escort.  Local police have a sworn duty to serve and protect and carry with them the mandate of that community to ensure that the peace is kept fairly.

Part 5 - Logistics Series - Taming the Supply Closet - Storage Safety

Part 5 - Logistics Series - Taming the Supply Closet - Storage Safety

Storage Safety

Storing things correctly is important, storing things SAFELY is even more important.

Long story short, go to OSHA's Health and Safety website and do what it says.

Weight limits

Weigh your equipment when you get it and document it.  When the time comes to deploy your team you will have weight limits when packing cargo.  A car with three occupants only has room for two hundred pounds of equipment.  Shelves and other furniture should come with signage that states the maximum weight capacity of the shelf or furniture piece.  This needs to be displayed on the shelf or documented some where so that equipment can be safely stored.  

Replacing Damaged Equipment

Damaged equipment which can no longer be safely used should never be stored with deployment supplies.  If it needs to be stored it should be labeled as being damaged to prevent some one from being hurt.  An example is storing damaged power extension cords (OSHA CFR 1910.334(a)(2)(ii)).

OSHA requires that damaged power cords be removed from service if it becomes damaged.  Electric tools also need to be inspected regularly and removed from service if damage is found.

Storing fuel

According to OSHA fuel storage needs to be done in an approved container located in an approved storage cabinet.

Shelf and Container placement and condition

Any containers or boxes need to be documented and fully closed when stored.  Boxes or containers need to fit neatly on the shelf and not hang over the edge in any way.  Damaged boxes, bent shelves or other containers with abnormal signs of wear should be replaced.  Shelves need to be placed on secure level ground and a security anchor needs to be attached to the wall or the shelf bolted to the floor to prevent the shelf from falling over.  Heavier boxes and equipment needs to be on lower shelves, and lighter equipment needs to be on higher shelves.

Working safely in the storage area

Make sure, work gloves, safety goggles and safe lifting practices are used to prevent injuries.
Safe lifting means using your legs to lift a heavy object, keeping the object close to your center of gravity and not using your back. Ladder storage and use need to as per OSHA requirements.

Part 4 - Logistics Series - Taming the Supply Closet - Storage Areas and Shelf Life

Logistics Series - Part 4 - Taming the Supply Closet - Storage Areas and Shelf Life

Getting people to document processes is like herding cats.  Keeping your disaster and training supplies tidy is a key factor in being able to deploy your team quickly.

Storage areas

Control access to the storage area

The process is easier when you can control access to the equipment storage area.  A simple door lock or padlock should suffice.  If access to the storage area cannot be controlled then using sturdy stack-able/lockable containers or lockable storage cabinets.

Identify the reasons people use the storage area

Either by using forms, asking questions or just observing what items are first to be placed in disarray, identify what are the most commonly used items and move those closest to entrance.  If people can find what they want they will tend not to dig deeper and make a mess.  Also, consumable items which expire quickly should be placed in an accessible area so it can be easily maintained.

Identify, document, standardize and group supplies needed to deploy and bind together

If you need medical bags, develop a list of supplies then tape, zip tie or otherwise make it easy to detect if some one has opened the package to pilfer supplies.   One way of accomplishing this is using an industrial size roll of plastic food wrap to wrap a shelf.  If holes appear in the wrap that means the shelf needs to be re-inventoried and re-sealed. 

Inventory everything at least yearly

If supplies go missing, expire or are broken, that needs to be documented and the items replaced or removed.

Storage conditions

When storing equipment you need to ensure the storage area is humidity and temperature controlled.

Extremes of both temperature and humidity will cause your equipment to degrade faster.

Everything has a shelf-life

Every item needs to be documented when it was added and removed on a regular basis.

• Materials decay over time so 10 year old never been used rope may become brittle and dangerous to use if stored incorrectly
• Freeze and thaw cycles, mold, fungus, bacteria , bugs, and other vermin can ruin your emergency food supply if not stored correctly
• Paint and other chemicals can deteriorate if stored incorrectly
• Water bottles may freeze/thaw then may spring a leak and cause water damage to your other supplies
• Hand tools may rust if stored incorrectly
• Insects may eat your non-synthetic blankets and clothing
• Many CERT teams rely on a trailer or vehicle to store and transport their supplies.  Trailers and vehicles require yearly maintenance in the form of greasing bearings, pressurizing tires, watching for rust and weather damage
• Electrical systems also need to be tested regularly
• Small engines (generators, chain saws ..etc) require testing and regular maintenance
• Fuel and oil will go bad over time and may need stabilizer to be added
• Batteries will deteriorate over time and need to be replaced on a regular basis
• Alkaline batteries can leak chemicals which will destroy electronics and flashlights if the batteries are not removed for storage

A lot can happen over a year and you need to catch things before they become a problem.

Part 3 - Logistics Series - Getting electricity in an impacted area

Logistics Series Part 3 :

Getting electricity in an impacted area

A while back I attended a talk given by a Salvation Army volunteer who related her experiences volunteering in Puerto Rico in 2017.  She noted that the salvation army thought ahead and built a network of disaster recovery centers each of which with backup power and resources so that they could continue response activities.  Even with backup power it wasn't consistent.  

As an individual responder you need to plan ahead for the devices you need to do your work.

Individual responder device use time:

• Hand held 2 way radio's (8 to 14 hours or less)
• Cellular telephones (11 to 16 hours or less)
• Laptop computer (4 to 6 hours or less)

*These are estimates for ideal conditions and equipment, it should go with out saying that your mileage will vary.

Factors that affect battery efficiency

• Temperature - Warm temperatures can affect battery life up to a 25% loss in efficiency.  Sub zero temperatures will also negatively affect battery efficiency.
• Battery Chemistry - Different battery chemistry will affect the batteries use time.  Most rechargeable batteries are NiMH, Lithium ION or Lithium Polymer.  Lithium batteries having the most efficiency and capacity.
• Amount of use and energy efficiency - enabling energy efficiency features on cell phones and laptops will make a big difference in battery efficiency.  Radios are typically idle 95% of the time and only actively used 5% of the time.  Heavier the active use, the more power will be used.

Power consumption:

• Radio - 5Watts @ 12v, ~410 milliamps per hour
• Cell phone - ~130 milliamps per hour
• Laptop  - ~3Amp or more per hour

Battery ratings

Batteries are often rated in Amp hours or Milliamp hours.  

A cell phone charger is about 1 or 2 amp hours, a vehicle sized 12v gel cell is rated around 50 Amp hours.

Recharging your devices:

• Hand-crank generator
• Solar Cellphone charger
• Portable Solar charging system with storage battery
• Fuel Cell - Hydrogen fuel cells allow for power generation when it isn't sunny
• A large storage battery or lots of little batteries 
• A large LiPO storage battery capable of charging multiple devices of different voltages
• A large amount of standard AA batteries
• Multiple small LiPO battery chargers
• A deep cycle or gel cell marine battery
• A thermo-electric generation system (ex. Biolite)
• Vehicle charger cord
• Portable wind turbine generator
• Gasoline electric generator

The fine print

Lithium Ion and Lithium Polymer batteries are very sensitive to temperature and charging conditions.

Only use the charging cable and cords for your device, using any other charging devices may cause the battery to be damaged, catch fire or explode.  

Different types of battery cells have different voltages.  Nickel Metal Hydride (NiMH) AA rechargeable batteries are 1.2 Volts which is slightly less than a standard AA Alkaline Battery.  Most devices can handle slight differences in voltage but abnormal voltages can cause the a device to behave abnormally.  

When using large gel cells or car batteries, be extremely careful not to accidentally connect the two terminals together causing a short circuit.    Short circuits can cause a fire and chemicals in batteries if released are toxic.  Also since large batteries carry larger amounts of power be careful not to electrocute yourself by touching bare leeds or broken wires.

Generators and fuel cells use flammable liquids or gas which can explode when exposed to heat and fire.  Generators often release carbon monoxide which can be poisonous in confined areas.  Always run generators outdoors and away from work spaces.  Always store fuel away from heat and fire sources.  Gasoline and other fuels are bad for you so when handling fuel or any other chemicals use due care and wear appropriate personal protective equipment.