Northstar wrote:
Something I am finding troubling is the large difference between the protocols used for people going in and out of level 4 biohazard areas at the CDC and USAMRID at Ft Derrick and what is advised for healthworkers both here and in Africa.
See The Hot Zone for a detailed description of what's done routinely in a true level 4 research facility. They wear full biohazard suits with HEPA filtered air supply. They shower in decontaminating fluids going in and coming out. They are not allowed to wear their street clothes in under their suit. It is naked in and naked out and showers all around both bleach and regular before and after both naked and wearing the suit after. It does not get touched until it has been showered thoroughly in bleach water for several minutes.
This last is JOT done by healthcare workers -nor is any of the rest, they appear to be dressing out of my personal box of handle a dead body stuff. Really? - and IMO this amateur hour stuff may likely be the source of healthworker infections. I do not even see somebody standing there with a spray bottle of bleach soaking them down before disrobing. Appears to be happening in ordinary rooms, not even a surgical type clean up place or even a shower stall. ???!!!???
Sure thing Northstar! I am qualified for level 4 myself. There is an environmental section of my company's civil engineering firm. Hazmat - first response.
We train out of Atlanta. And many people wash out because of one insurmountable aspect of level 4. Claustrophobia. Many people, size/age/gender/race/ doesn't matter, lose all semblance of control the moment that helmet goes on. I've seen panic in varying degrees and stages. Some panic just looking at the helmet. Some panic after helmet clears their head. Some panic when scba (self contained breathing apparatus) commences. Some say the sound of pulling air from a tank incites panic. And breathing from a tank isn't natural. You must use the muscles of your diaphragm.
Sometimes, underneath that external layer you see - which is a layer of tyvek, even down to tyvek boots - is another layer of nomex. (fire protection). Rubber gloves are duct taped to the sleeves of the suit to close openings of opportunity. Ditto with the tyvek boots and pants. Level 4 participants have to be properly fit tested with a respirator, and you must be able to properly assemble/disassemble the entire unit on your own. A malfunctioning flutter valve could be fatal. One should not wear someone else's respirator because it is useless if it isn't a proper fit. Some things, habits, are only learned with experience. Focus is important, and one can never become complacent. Females have to monitor the length of their nails and a proper manicure is important to prevent ripped gloves and/or tyvek. It's all too easy to become lax undergoing the ritual of dressing and undressing and showering for level 4, time and time again. Distraction can kill.
The military, USAMRIID, Hazmat professionals, are trained and experienced. Therefore, health professionals in Africa may not be able to employ true level 4 protocol because of lack of training. Equipment. Proper fitting. And susceptibility to claustrophobia.
I have read that part of the military contingent is to train while in Africa. But everyone isn't trainable. Claustrophobia. Factor in limited qualified professionals and the picture becomes vivid.
