# CBRNe Personal Protective Equipment Is Not a Hindrance to Lifesaving Procedures in Prehospital Settings: A Prospective, Repeated-Measures Observational Study

## TL;DR

This study shows that wearing protective gear for hazardous materials does not significantly hinder most lifesaving procedures by emergency responders, though some tasks like intubation are affected.

## Contribution

The study provides empirical evidence on the effectiveness of lifesaving procedures while wearing CBRNe PPE, highlighting minimal impact despite physical demands.

## Key findings

- Procedure success rates remained high overall, with only minor drops in video-assisted intubation and intravenous access timing.
- Success rates and timings improved in subsequent trials, suggesting a learning effect with practice.
- Only 61% of participants completed the entire drill due to equipment tolerance limits.

## Abstract

Objectives: The primary objective was to compare the usage of Hazardous Materials (HazMat) Protective Personal Equipment (PPE) and ordinary PPE when performing basic and advanced health care support maneuvers in a prehospital setting, evaluating the effectiveness of several procedures, defined as the mean success rate of each. The secondary objective was to evaluate the presence of a learning effect, with improvements in the success rate and/or procedure timing. Methods: This was a prospective within-subjects (repeated-measures) study conducted on Emergency Medical Services (EMS) responders within their Chemical-Biological-Radiological-Nuclear-Explosive (CBRNe) training institutional programme. Volunteers performed a trial sequence of eight lifesaving procedures four times. During the first trial sequence, they wore standard clothing; during the three successive trials, they wore full HazMat PPE equipment. The primary outcomes were changes in success rate and time interval across the four trials. Results: A total of 146 EMS responders volunteered for the experiment. Procedure success rates remained high overall, with the most notable initial drop observed for video-assisted intubation (≈−10%). The only statistically significant delay in the first HazMat trial compared with baseline was for intravenous access (median +30 s; p < 0.001). In the two successive HazMat trials, success rates and timings improved, with median values coming close to baseline. However, only 61% of participants completed the entire drill due to tolerance limits of the equipment. Conclusions: HazMat PPE, while physically and ergonomically demanding, has minimal impact on most lifesaving procedures, though it may reduce intubation success and delay intravenous access. Tolerance to prolonged use is a key limitation, but dexterity improves rapidly with brief practice. EMS responders can benefit from continuous training practice, while manufacturers could explore ergonomic and tolerance improvements in their PPE equipment.