Most of the emergency responders dispatched to a serious incident involving a toxic gas exposure did not use required respirators for breathing protection, according to a NIOSH-funded investigation published in the CDC’s Morbidity and Mortality Weekly Report (MMWR).

The gas, phosphine, forms when pesticides containing aluminum phosphide mix with water. These pesticides are restricted to certified users because short-term exposure can cause respiratory and cardiovascular, or heart and blood vessel, complications, and can be fatal. Federal regulations require emergency crews on the scene with such hazardous substances wear personal protective equipment, including a respirator. Multiple studies, however, show this does not typically happen. Little information is currently available on how to increase emergency responders’ compliance.

The NIOSH-funded Texas Department of State Health Services reviewed this case of phosphine exposure among 51 hazardous materials emergency responders who evacuated and treated residents at an Amarillo, Texas, home after an outdoor pesticide application. The scientists reviewed call records from the Texas Poison Control Network related to the exposure and the results of a standardized health questionnaire completed by the emergency responders afterwards. The questionnaire included information about the responders’ role in the incident, respirator use, previous response training, and possible exposure to phosphine and associated health effects.

More than 78% (40) of the emergency responders did not wear a respirator during the response. Of these, 15 received medical treatment and seven reported new or worse phosphine exposure symptoms within a day after the incident. Their symptoms included eye pain, headaches, dizziness, abdominal cramps, and nausea.

The majority of the 51 emergency responders reported being trained in emergency response and understood standard operating procedures within their agency for handling incidents with hazardous substances. They gave several reasons for not wearing a respirator: being unaware that it was necessary (five), focusing on rescuing people (four), being unaware of the chemical’s presence (four),  feeling it was not required for their task (two), and lacking equipment (one).

These findings show that emergency responder trainings alone do not result in proper use of respirators during incidences with unknown hazardous substances. Few studies exist of behavioral interventions related to the use of respirators and other personal protective equipment among emergency responders. Also, methods for improving compliance with existing guidance and regulations are not well understood. More research is needed to evaluate effective interventions to help ensure that emergency responders comply with current recommendations and regulations for personal protective equipment, according to the scientists.

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