2. CPC Medical Considerations Chapter # 13

3. CPC Medical Considerations Introduction Stress Programs. Stress Programs. Stresses of Encapsulating Garments. Stresses of Encapsulating Garments. Incident Stressors. Incident Stressors. Physiological Factors. Physiological Factors. Work Tolerance. Work Tolerance. Effects of Cold Exposure. Effects of Cold Exposure. Work Mission Duration. Work Mission Duration. Rest Periods. Rest Periods. Field Monitoring. Field Monitoring. Stress Programs. Stress Programs. Stresses of Encapsulating Garments. Stresses of Encapsulating Garments. Incident Stressors. Incident Stressors. Physiological Factors. Physiological Factors. Work Tolerance. Work Tolerance. Effects of Cold Exposure. Effects of Cold Exposure. Work Mission Duration. Work Mission Duration. Rest Periods. Rest Periods. Field Monitoring. Field Monitoring.

4. CPC Medical Considerations Basic Facts: Basic Facts: CPC impacts physiological & psychological stresses to its wearers. Their medical conditions and influential factors deserve consideration, if a successful hazmat response is desired.CPC impacts physiological & psychological stresses to its wearers. Their medical conditions and influential factors deserve consideration, if a successful hazmat response is desired. Basic Facts: Basic Facts: CPC impacts physiological & psychological stresses to its wearers. Their medical conditions and influential factors deserve consideration, if a successful hazmat response is desired.CPC impacts physiological & psychological stresses to its wearers. Their medical conditions and influential factors deserve consideration, if a successful hazmat response is desired.

5. CPC Medical Considerations Basic Facts, Continued: Basic Facts, Continued: Stress reduction programs should have 3 components:Stress reduction programs should have 3 components: »pre-incident, on-site, & post-incident. Managers tend to underestimate the risks of stresses adversely affecting CPC wearers because the environment and chemical incidents frequently occupy the focus.Managers tend to underestimate the risks of stresses adversely affecting CPC wearers because the environment and chemical incidents frequently occupy the focus. Basic Facts, Continued: Basic Facts, Continued: Stress reduction programs should have 3 components:Stress reduction programs should have 3 components: »pre-incident, on-site, & post-incident. Managers tend to underestimate the risks of stresses adversely affecting CPC wearers because the environment and chemical incidents frequently occupy the focus.Managers tend to underestimate the risks of stresses adversely affecting CPC wearers because the environment and chemical incidents frequently occupy the focus.

6. CPC Medical Considerations Stress Programs: Stress Programs: Workers must be periodically examined.Workers must be periodically examined. Continual practice and training must be provided in using PPE, especially SCBA and CPC.Continual practice and training must be provided in using PPE, especially SCBA and CPC. An effective safety program must be implemented, and concerted efforts made, to protect the worker.An effective safety program must be implemented, and concerted efforts made, to protect the worker. Stress Programs: Stress Programs: Workers must be periodically examined.Workers must be periodically examined. Continual practice and training must be provided in using PPE, especially SCBA and CPC.Continual practice and training must be provided in using PPE, especially SCBA and CPC. An effective safety program must be implemented, and concerted efforts made, to protect the worker.An effective safety program must be implemented, and concerted efforts made, to protect the worker.

7. CPC Medical Considerations Stresses of Encapsulating Garments: Stresses of Encapsulating Garments: Do not underestimate risks involved when personnel are working in CPC.Do not underestimate risks involved when personnel are working in CPC. Do not loose focus on the workers!Do not loose focus on the workers! Technological advances.Technological advances. Must be able to recognize situations which CPC may be breached.Must be able to recognize situations which CPC may be breached. Stresses of Encapsulating Garments: Stresses of Encapsulating Garments: Do not underestimate risks involved when personnel are working in CPC.Do not underestimate risks involved when personnel are working in CPC. Do not loose focus on the workers!Do not loose focus on the workers! Technological advances.Technological advances. Must be able to recognize situations which CPC may be breached.Must be able to recognize situations which CPC may be breached.

8. CPC Medical Considerations Incident Stressors: Incident Stressors: CPC wearers are usually subject to 4 stressors:CPC wearers are usually subject to 4 stressors: »Environmental. »Mechanical. »Physiologic. »Psychological. Incident Stressors: Incident Stressors: CPC wearers are usually subject to 4 stressors:CPC wearers are usually subject to 4 stressors: »Environmental. »Mechanical. »Physiologic. »Psychological.

9. CPC Medical Considerations Environmental Stressors: Environmental Stressors: Temperature.Temperature. Humidity.Humidity. Wind speed.Wind speed. Terrain.Terrain. Confined spaces.Confined spaces. Environmental Stressors: Environmental Stressors: Temperature.Temperature. Humidity.Humidity. Wind speed.Wind speed. Terrain.Terrain. Confined spaces.Confined spaces.

10. CPC Medical Considerations Mechanical Stressors: Mechanical Stressors: Attributed to disadvantages of protective equipment (e.g., objects that damage CPC leading to less protection, inherent limitations in mobility, dexterity, and visibility).Attributed to disadvantages of protective equipment (e.g., objects that damage CPC leading to less protection, inherent limitations in mobility, dexterity, and visibility). Mechanical Stressors: Mechanical Stressors: Attributed to disadvantages of protective equipment (e.g., objects that damage CPC leading to less protection, inherent limitations in mobility, dexterity, and visibility).Attributed to disadvantages of protective equipment (e.g., objects that damage CPC leading to less protection, inherent limitations in mobility, dexterity, and visibility).

11. CPC Medical Considerations Physiologic Stressors: Physiologic Stressors: Fitness.Fitness. Acclimatization to weather.Acclimatization to weather. Familiarity w/equipment.Familiarity w/equipment. Age.Age. Obesity.Obesity. Pre-existing medical conditions.Pre-existing medical conditions. Physiologic Stressors: Physiologic Stressors: Fitness.Fitness. Acclimatization to weather.Acclimatization to weather. Familiarity w/equipment.Familiarity w/equipment. Age.Age. Obesity.Obesity. Pre-existing medical conditions.Pre-existing medical conditions.

12. CPC Medical Considerations Psychological Stressors: Psychological Stressors: Anxiety.Anxiety. Claustrophobia.Claustrophobia. Such effects often require continued care.Such effects often require continued care. Psychological Stressors: Psychological Stressors: Anxiety.Anxiety. Claustrophobia.Claustrophobia. Such effects often require continued care.Such effects often require continued care.

13. CPC Medical Considerations Work Tolerance: Work Tolerance: The amount of work or duration an individual can withstand under a set of environmental conditions. As environmental conditions worsen (e.g., temperature, humidity), work tolerance decreases & CPC wearers work for less time. Level A CPC can reduce work tolerance by 50%.The amount of work or duration an individual can withstand under a set of environmental conditions. As environmental conditions worsen (e.g., temperature, humidity), work tolerance decreases & CPC wearers work for less time. Level A CPC can reduce work tolerance by 50%. Work Tolerance: Work Tolerance: The amount of work or duration an individual can withstand under a set of environmental conditions. As environmental conditions worsen (e.g., temperature, humidity), work tolerance decreases & CPC wearers work for less time. Level A CPC can reduce work tolerance by 50%.The amount of work or duration an individual can withstand under a set of environmental conditions. As environmental conditions worsen (e.g., temperature, humidity), work tolerance decreases & CPC wearers work for less time. Level A CPC can reduce work tolerance by 50%.

14. CPC Medical Considerations Effects of Cold: Effects of Cold: Two factors influence a cold exposure injury:Two factors influence a cold exposure injury: »Air temperature. »Wind speed. Local injury resulting from cold exposure is generally known as frostbite. It occurs most frequently on fingers, toes, and ears. There are 3 categories:Local injury resulting from cold exposure is generally known as frostbite. It occurs most frequently on fingers, toes, and ears. There are 3 categories: »Incident Frostbite - Sudden whitening of skin. »Superficial Frostbite - Waxy or white appearance of skin that has hardened topically, but remains resilient at deeper levels. »Deep Frostbite - Cold, pale skin that is solid to the touch. Effects of Cold: Effects of Cold: Two factors influence a cold exposure injury:Two factors influence a cold exposure injury: »Air temperature. »Wind speed. Local injury resulting from cold exposure is generally known as frostbite. It occurs most frequently on fingers, toes, and ears. There are 3 categories:Local injury resulting from cold exposure is generally known as frostbite. It occurs most frequently on fingers, toes, and ears. There are 3 categories: »Incident Frostbite - Sudden whitening of skin. »Superficial Frostbite - Waxy or white appearance of skin that has hardened topically, but remains resilient at deeper levels. »Deep Frostbite - Cold, pale skin that is solid to the touch.

15. CPC Medical Considerations Effects of Cold, Continued: Effects of Cold, Continued: Systemic Hypothermia:Systemic Hypothermia: »Caused by exposure to freezing (below 32°F) temperatures or those below well below the lower limit of room temperature (65ºF) in water. 5 stages of Hypothermia symptoms:5 stages of Hypothermia symptoms: »Shivering. »Lethargy, apathy, listlessness. »Unconsciousness, slowed pulse and respiratory rate. »Freezing of extremities. »Death. Effects of Cold, Continued: Effects of Cold, Continued: Systemic Hypothermia:Systemic Hypothermia: »Caused by exposure to freezing (below 32°F) temperatures or those below well below the lower limit of room temperature (65ºF) in water. 5 stages of Hypothermia symptoms:5 stages of Hypothermia symptoms: »Shivering. »Lethargy, apathy, listlessness. »Unconsciousness, slowed pulse and respiratory rate. »Freezing of extremities. »Death.

16. CPC Medical Considerations Work Mission Duration: Work Mission Duration: Time management tool used to identify work-rest cycles based on a task analysis.Time management tool used to identify work-rest cycles based on a task analysis. Two important facts to remember:Two important facts to remember: »Wearer w/lowest remaining air supply dictates time left for team. »Return travel time, decontamination time, & safety margin must be considered. »See Student Manual, Page 13.78, Work Mission Duration: Work Mission Duration: Time management tool used to identify work-rest cycles based on a task analysis.Time management tool used to identify work-rest cycles based on a task analysis. Two important facts to remember:Two important facts to remember: »Wearer w/lowest remaining air supply dictates time left for team. »Return travel time, decontamination time, & safety margin must be considered. »See Student Manual, Page 13.78,

17. CPC Medical Considerations Field Monitoring (Pre/Post Assessment): Field Monitoring (Pre/Post Assessment): Continuous measuring and evaluation of environmental and biological parameters to detect dangerous trends, conditions conducive to adverse health effects, or the onset of injury or illness from exposure to the environment.Continuous measuring and evaluation of environmental and biological parameters to detect dangerous trends, conditions conducive to adverse health effects, or the onset of injury or illness from exposure to the environment. Minimum environmental parameters:Minimum environmental parameters: »Temperature, relative humidity, & wind speed. Heat Index - a measure of the body ability to cool itself is determined by a combination of ambient air temperature & relative humidity.Heat Index - a measure of the body ability to cool itself is determined by a combination of ambient air temperature & relative humidity. Field Monitoring (Pre/Post Assessment): Field Monitoring (Pre/Post Assessment): Continuous measuring and evaluation of environmental and biological parameters to detect dangerous trends, conditions conducive to adverse health effects, or the onset of injury or illness from exposure to the environment.Continuous measuring and evaluation of environmental and biological parameters to detect dangerous trends, conditions conducive to adverse health effects, or the onset of injury or illness from exposure to the environment. Minimum environmental parameters:Minimum environmental parameters: »Temperature, relative humidity, & wind speed. Heat Index - a measure of the body ability to cool itself is determined by a combination of ambient air temperature & relative humidity.Heat Index - a measure of the body ability to cool itself is determined by a combination of ambient air temperature & relative humidity.

18. CPC Medical Considerations Field Monitoring (Pre/Post Assessment): Field Monitoring (Pre/Post Assessment): See Activity Sheet #13.2.1, Student manual Page 13.23.See Activity Sheet #13.2.1, Student manual Page 13.23. Field Monitoring (Pre/Post Assessment): Field Monitoring (Pre/Post Assessment): See Activity Sheet #13.2.1, Student manual Page 13.23.See Activity Sheet #13.2.1, Student manual Page 13.23.

19. CPC Medical Considerations The Environment, Moisture, & Evaporation: The Environment, Moisture, & Evaporation: Evaporation - Primary cooling process occurs when your body releases heat through perspiration.Evaporation - Primary cooling process occurs when your body releases heat through perspiration. For evaporation to occur, ambient air must not be saturated w/moisture. The amount of moisture that air can hold is directly related to ambient air temperature.For evaporation to occur, ambient air must not be saturated w/moisture. The amount of moisture that air can hold is directly related to ambient air temperature. Evaporation occurs via the lungs & skin. As ambient moisture content (humidity) increases, exhaled gases in the lungs approach the same humidity & no evaporation can occur. When lung humidity increases, waste gases are not efficiently removed & the O 2 content is decreased.Evaporation occurs via the lungs & skin. As ambient moisture content (humidity) increases, exhaled gases in the lungs approach the same humidity & no evaporation can occur. When lung humidity increases, waste gases are not efficiently removed & the O 2 content is decreased. The Environment, Moisture, & Evaporation: The Environment, Moisture, & Evaporation: Evaporation - Primary cooling process occurs when your body releases heat through perspiration.Evaporation - Primary cooling process occurs when your body releases heat through perspiration. For evaporation to occur, ambient air must not be saturated w/moisture. The amount of moisture that air can hold is directly related to ambient air temperature.For evaporation to occur, ambient air must not be saturated w/moisture. The amount of moisture that air can hold is directly related to ambient air temperature. Evaporation occurs via the lungs & skin. As ambient moisture content (humidity) increases, exhaled gases in the lungs approach the same humidity & no evaporation can occur. When lung humidity increases, waste gases are not efficiently removed & the O 2 content is decreased.Evaporation occurs via the lungs & skin. As ambient moisture content (humidity) increases, exhaled gases in the lungs approach the same humidity & no evaporation can occur. When lung humidity increases, waste gases are not efficiently removed & the O 2 content is decreased.

20. CPC Medical Considerations Heat-Related Injuries: Heat-Related Injuries: Heat Rash.Heat Rash. Heat Cramps.Heat Cramps. Heat Stress.Heat Stress. Heat Exhaustion.Heat Exhaustion. Heat Stroke.Heat Stroke. Heat-Related Injuries: Heat-Related Injuries: Heat Rash.Heat Rash. Heat Cramps.Heat Cramps. Heat Stress.Heat Stress. Heat Exhaustion.Heat Exhaustion. Heat Stroke.Heat Stroke.

21. CPC Medical Considerations Heat-Related Injuries, Continued: Heat-Related Injuries, Continued: Heat Rash - Small blister-like bumps w/pricking sensation on affected areas caused by prolonged exposure to humid heat when the skin remains wet w/unevaporated sweat.Heat Rash - Small blister-like bumps w/pricking sensation on affected areas caused by prolonged exposure to humid heat when the skin remains wet w/unevaporated sweat. Heat Cramps - Painful muscle spasms after prolonged exposure to heat while working due to loss of body salt (electrolytes) in sweat. Usually occurs after drinking large volumes of water w/out replacing salt loss.Heat Cramps - Painful muscle spasms after prolonged exposure to heat while working due to loss of body salt (electrolytes) in sweat. Usually occurs after drinking large volumes of water w/out replacing salt loss. Heat-Related Injuries, Continued: Heat-Related Injuries, Continued: Heat Rash - Small blister-like bumps w/pricking sensation on affected areas caused by prolonged exposure to humid heat when the skin remains wet w/unevaporated sweat.Heat Rash - Small blister-like bumps w/pricking sensation on affected areas caused by prolonged exposure to humid heat when the skin remains wet w/unevaporated sweat. Heat Cramps - Painful muscle spasms after prolonged exposure to heat while working due to loss of body salt (electrolytes) in sweat. Usually occurs after drinking large volumes of water w/out replacing salt loss.Heat Cramps - Painful muscle spasms after prolonged exposure to heat while working due to loss of body salt (electrolytes) in sweat. Usually occurs after drinking large volumes of water w/out replacing salt loss.

22. CPC Medical Considerations Heat-Related Injuries, Continued: Heat-Related Injuries, Continued: Heat Stress - First sign of thermoregulatory failure. Symptoms include fatigue, irritation, altered level of consciousness & dehydration.Heat Stress - First sign of thermoregulatory failure. Symptoms include fatigue, irritation, altered level of consciousness & dehydration. Heat Exhaustion - Second sign of thermoregulatory failure marked by Cardiovascular Insufficiency (when total blood volume is inadequate for vascular system). Symptoms include: shallow breathing, profuse sweating, dizziness, lethargy, temperature 99.5ºF - 101.3ºF.Heat Exhaustion - Second sign of thermoregulatory failure marked by Cardiovascular Insufficiency (when total blood volume is inadequate for vascular system). Symptoms include: shallow breathing, profuse sweating, dizziness, lethargy, temperature 99.5ºF - 101.3ºF. Heat-Related Injuries, Continued: Heat-Related Injuries, Continued: Heat Stress - First sign of thermoregulatory failure. Symptoms include fatigue, irritation, altered level of consciousness & dehydration.Heat Stress - First sign of thermoregulatory failure. Symptoms include fatigue, irritation, altered level of consciousness & dehydration. Heat Exhaustion - Second sign of thermoregulatory failure marked by Cardiovascular Insufficiency (when total blood volume is inadequate for vascular system). Symptoms include: shallow breathing, profuse sweating, dizziness, lethargy, temperature 99.5ºF - 101.3ºF.Heat Exhaustion - Second sign of thermoregulatory failure marked by Cardiovascular Insufficiency (when total blood volume is inadequate for vascular system). Symptoms include: shallow breathing, profuse sweating, dizziness, lethargy, temperature 99.5ºF - 101.3ºF.

23. CPC Medical Considerations Heat-Related Injuries, Continued: Heat-Related Injuries, Continued: Heat Stroke:Heat Stroke: »The last sign of thermoregulatory failure leading to overheating that is potentially fatal. »Symptoms include: n Hot/dry skin, no perspiration, nausea, dizziness, rapid pulse, temperature over 104.9ºF. Heat-Related Injuries, Continued: Heat-Related Injuries, Continued: Heat Stroke:Heat Stroke: »The last sign of thermoregulatory failure leading to overheating that is potentially fatal. »Symptoms include: n Hot/dry skin, no perspiration, nausea, dizziness, rapid pulse, temperature over 104.9ºF.

24. CPC Medical Considerations Heat-Related Injury Treatments: Heat-Related Injury Treatments: Remove to a cooler location (usually shaded).Remove to a cooler location (usually shaded). Re-hydration (cool liquids, not cold liquids).Re-hydration (cool liquids, not cold liquids). Cool patient body w/evaporative or active cooling methods (e.g., cool wraps).Cool patient body w/evaporative or active cooling methods (e.g., cool wraps). Medical monitoring & vital signs maintenance.Medical monitoring & vital signs maintenance. Intravenous therapy (if cardiovascular insufficiency).Intravenous therapy (if cardiovascular insufficiency). Heat-Related Injury Treatments: Heat-Related Injury Treatments: Remove to a cooler location (usually shaded).Remove to a cooler location (usually shaded). Re-hydration (cool liquids, not cold liquids).Re-hydration (cool liquids, not cold liquids). Cool patient body w/evaporative or active cooling methods (e.g., cool wraps).Cool patient body w/evaporative or active cooling methods (e.g., cool wraps). Medical monitoring & vital signs maintenance.Medical monitoring & vital signs maintenance. Intravenous therapy (if cardiovascular insufficiency).Intravenous therapy (if cardiovascular insufficiency).

25. CPC Medical Considerations Medical Monitoring Parameters: Medical Monitoring Parameters: Body Weight:Body Weight: »Comparison of pre & post-entry body weights provide the amount & rate of water loss. »Water loss cannot be made up quickly »Losses can be as great as 3.5 liters/hr. »Post-entry body weights provide an index of the amount of fluid remaining in body tissues. »Post-entry body weights must be collected immediately upon exiting controlled zones & before re-hydration. Medical Monitoring Parameters: Medical Monitoring Parameters: Body Weight:Body Weight: »Comparison of pre & post-entry body weights provide the amount & rate of water loss. »Water loss cannot be made up quickly »Losses can be as great as 3.5 liters/hr. »Post-entry body weights provide an index of the amount of fluid remaining in body tissues. »Post-entry body weights must be collected immediately upon exiting controlled zones & before re-hydration.

26. CPC Medical Considerations Medical Monitoring Parameters, Continued: Medical Monitoring Parameters, Continued: Body Weight, Continued:Body Weight, Continued: Suggested water weight loss parameters:Suggested water weight loss parameters: »Body weight loss should not exceed 1.5%. »Stop work & assess @ 3% loss. »Remove personnel for immediate medical attention @ 5% loss Medical Monitoring Parameters, Continued: Medical Monitoring Parameters, Continued: Body Weight, Continued:Body Weight, Continued: Suggested water weight loss parameters:Suggested water weight loss parameters: »Body weight loss should not exceed 1.5%. »Stop work & assess @ 3% loss. »Remove personnel for immediate medical attention @ 5% loss

27. CPC Medical Considerations Medical Monitoring Parameters, continued: Medical Monitoring Parameters, continued: Body Core Temperature:Body Core Temperature: »Tympanic membrane are most feasible means of measurement. »Determine temperature rise via 2-week baseline. »Max temp rise should not exceed 1.5ºF, upon post-entry exam. »Restrict further work until temperature is within 0.5ºF of baseline. »Obtain temp measurement immediately upon exit. Medical Monitoring Parameters, continued: Medical Monitoring Parameters, continued: Body Core Temperature:Body Core Temperature: »Tympanic membrane are most feasible means of measurement. »Determine temperature rise via 2-week baseline. »Max temp rise should not exceed 1.5ºF, upon post-entry exam. »Restrict further work until temperature is within 0.5ºF of baseline. »Obtain temp measurement immediately upon exit.

28. CPC Medical Considerations Medical Monitoring Parameters, continued: Medical Monitoring Parameters, continued: Pulse (Age Adjusted Maximum Heart Rate):Pulse (Age Adjusted Maximum Heart Rate): »220 - age = Adjusted Heart Rate (beats/min) »Best overall indicator. »Limit to which worker can maintain aerobic exercise for prolonged periods w/out heart damage. »Direct measurement of the rate at which the body attempts to cool itself. Medical Monitoring Parameters, continued: Medical Monitoring Parameters, continued: Pulse (Age Adjusted Maximum Heart Rate):Pulse (Age Adjusted Maximum Heart Rate): »220 - age = Adjusted Heart Rate (beats/min) »Best overall indicator. »Limit to which worker can maintain aerobic exercise for prolonged periods w/out heart damage. »Direct measurement of the rate at which the body attempts to cool itself.

29. CPC Medical Considerations Medical Monitoring Parameters, continued: Medical Monitoring Parameters, continued: Blood Pressure:Blood Pressure: »No suspected correlation to heat stress. »Reflects the quality of rest for heart muscle in between strokes. Medical Monitoring Parameters, continued: Medical Monitoring Parameters, continued: Blood Pressure:Blood Pressure: »No suspected correlation to heat stress. »Reflects the quality of rest for heart muscle in between strokes.

30. CPC Medical Considerations Medical Monitoring Parameters, continued: Medical Monitoring Parameters, continued: Health Guidelines & Recommended Rest/Removal Periods.Health Guidelines & Recommended Rest/Removal Periods. Medical Monitoring Parameters, continued: Medical Monitoring Parameters, continued: Health Guidelines & Recommended Rest/Removal Periods.Health Guidelines & Recommended Rest/Removal Periods.

31. CPC Medical Considerations SUMMARY Stress Programs. Stress Programs. Stresses of Encapsulating Garments. Stresses of Encapsulating Garments. Incident Stressors. Incident Stressors. Physiological Factors. Physiological Factors. Work Tolerance. Work Tolerance. Effects of Cold Exposure. Effects of Cold Exposure. Work Mission Duration. Work Mission Duration. Rest Periods. Rest Periods. Field Monitoring. Field Monitoring. Stress Programs. Stress Programs. Stresses of Encapsulating Garments. Stresses of Encapsulating Garments. Incident Stressors. Incident Stressors. Physiological Factors. Physiological Factors. Work Tolerance. Work Tolerance. Effects of Cold Exposure. Effects of Cold Exposure. Work Mission Duration. Work Mission Duration. Rest Periods. Rest Periods. Field Monitoring. Field Monitoring.

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33. CPC Medical Considerations EXAM TIME