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Comparison of powered and conventional air-purifying respirators during simulated resuscitation of casualties contaminated with hazardous substances
  1. J Schumacher1,
  2. S A Gray2,
  3. L Weidelt3,
  4. A Brinker4,
  5. K Prior5,
  6. W M Stratling6
  1. 1
    King’s College, St Thomas’ Campus, London, UK
  2. 2
    London Ambulance Service NHS Trust, UK
  3. 3
    Luebeck University Hospital, Germany
  4. 4
    Department of Anaesthetics, Medway Maritime Hospital, Gillingham, UK
  5. 5
    Royal Navy, Shock Trauma Center, University of Maryland, Baltimore, USA
  6. 6
    University Hospital of Wales, Cardiff, UK
  1. Dr J Schumacher, GKT School of Medicine, King’s College London, St Thomas’ Campus, Department of Anaesthetics, London SE1 7EH, UK; jan.schumacher{at}


Background: Advanced life support of patients contaminated with chemical, biological, radiological or nuclear (CBRN) substances requires adequate respiratory protection for medical first responders. Conventional and powered air-purifying respirators may exert a different impact during resuscitation and therefore require evaluation. This will help to improve major incident planning and measures for protecting medical staff.

Methods: A randomised crossover study was undertaken to investigate the influence of conventional negative pressure and powered air-purifying respirators on the simulated resuscitation of casualties contaminated with hazardous substances. Fourteen UK paramedics carried out a standardised resuscitation algorithm inside an ambulance vehicle, either unprotected or wearing a conventional or a powered respirator. Treatment times, wearer mobility, ease of communication and ease of breathing were determined and compared.

Results: In the questionnaire, volunteers stated that communication and mobility were similar in both respirator groups while breathing resistance was significantly lower in the powered respirator group. There was no difference in mean (SD) treatment times between the groups wearing respiratory protection and the controls (245 (19) s for controls, 247 (17) s for conventional respirators and 250 (12) s for powered respirators).

Conclusions: Powered air-purifying respirators improve the ease of breathing and do not appear to reduce mobility or delay treatment during a simulated resuscitation scenario inside an ambulance vehicle with a single CBRN casualty.

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  • Funding: Funding was provided by departmental support.

  • Competing interests: None.

  • Ethics approval: The study received Trust Research and Development approval from the London Ambulance Service NHS Trust. All compliant subjects gave written and informed consent after having been given a detailed explanation of the treatment protocol and the respiratory protection devices.