Covid transports - PPE

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I work for an aeromedical program where we do very long distance fixed wing covid-19 transports. We are transporting covid-19 patients in an Isopod, but for standard PPE for these patients we use N95/goggles/gown.

Wondering if any programs are flying with PAPR's for either flight operations or ground operations. Also wondering if any programs have installed HEPA filtration in aircraft, like Boston Medflight has done in their rotor program.

Thanks.
 

Akulahawk

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PAPR systems are nice, I used one very frequently last night at work. That wasn't a transport gig... One of the issues with a PAPR system is they might not work well with aircraft comm systems. Another issue is flight gear compatibility. If a program uses a flight helmet, is the PAPR system compatible with that helmet? I'm not at all saying that one shouldn't use a PAPR system while in flight, but you might want to look at what mask styles that Firefighters use with their helmets and see if those can be adapted to PAPR use and if those would work with helmets (if used by the crew). A related problem/issue would be if you could use a PAPR hood/facepiece setup under a headset. Next issue is how long one needs to have the units run. The units should allow a run-time probably 1-2 hours longer that your expected time in contact with patients.
 
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PAPR systems are nice, I used one very frequently last night at work. That wasn't a transport gig... One of the issues with a PAPR system is they might not work well with aircraft comm systems. Another issue is flight gear compatibility. If a program uses a flight helmet, is the PAPR system compatible with that helmet? I'm not at all saying that one shouldn't use a PAPR system while in flight, but you might want to look at what mask styles that Firefighters use with their helmets and see if those can be adapted to PAPR use and if those would work with helmets (if used by the crew). A related problem/issue would be if you could use a PAPR hood/facepiece setup under a headset. Next issue is how long one needs to have the units run. The units should allow a run-time probably 1-2 hours longer that your expected time in contact with patients.

They run for 8-12 hours, are rated for use at altitude, and work fine in fixed wing environments without headsets. I’m approaching this topic from the fixed wing side of things where helmets are not used.
 

silver

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They run for 8-12 hours, are rated for use at altitude, and work fine in fixed wing environments without headsets. I’m approaching this topic from the fixed wing side of things where helmets are not used.
Communication in PAPRs is actually one of the challenges that limits its use without added noise of a fixed wing.

The only additional point I want to add from Akulahawk's comment, the risk of self contamination is generally higher with PAPR than N95 usage as doffing a PAPR correctly is much more difficult. Many places rely on utilizing an additional person to assist/coach in correct doffing.
 
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Communication in PAPRs is actually one of the challenges that limits its use without added noise of a fixed wing.

The only additional point I want to add from Akulahawk's comment, the risk of self contamination is generally higher with PAPR than N95 usage as doffing a PAPR correctly is much more difficult. Many places rely on utilizing an additional person to assist/coach in correct doffing.
Yes, valid points.

We are doing 2.5-4 hour fixed wing transports (flight time) with an additional 2+ hours of patient contact time to complete these flights. We are flying spontaneously breathing patients who can deteriorate during our extended flight times and can require intubation during flight. Obviously the flight environment lends itself to high-risk for aerosol generating procedures given the confines of the aircraft, airflow, etc.

I wore one on an entire flight while in the aircraft with N95 as back recently with a spontaneously breathing, non-vented patient and found communication only slightly inhibited with no headset. Then the argument becomes, should you be donning and doffing a headset during flight? We have to frequently in our jets and turboprops to complete our work tasks. So you set headset where? Then it's contaminated and you put it back on your ears. Not the best solution and similar to contamination when doffing a PAPR.
 

VFlutter

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PAPRs may be a hard sell given the cost and relative complexity compared to other style respirators.

There are companies that make various styles of half-faced respirators designed to work with helmets and communication headsets. They are not as comfortable as a PAPR but way above a standard N95 for long term comfort, work of breathing, and communication without the extra worry of batteries and moving parts.


 

Peak

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Communication in PAPRs is actually one of the challenges that limits its use without added noise of a fixed wing.

The only additional point I want to add from Akulahawk's comment, the risk of self contamination is generally higher with PAPR than N95 usage as doffing a PAPR correctly is much more difficult. Many places rely on utilizing an additional person to assist/coach in correct doffing.
With practice you can easily doff a PAPR by yourself. Since you don’t have to worry about the order of a bouffant, mask, and eye pro it is in my opinion quicker and easier. Plus I’d far rather have a cool breeze on my face than feel air hungry for hours.
 

Akulahawk

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With practice you can easily doff a PAPR by yourself. Since you don’t have to worry about the order of a bouffant, mask, and eye pro it is in my opinion quicker and easier. Plus I’d far rather have a cool breeze on my face than feel air hungry for hours.
On the "donning" side of things, since I "preflight check" the PAPRs I'm likely to use during my shift, I can go from no PPE to contact + aerosol (using PAPR) in about 1 minute or so. Doffing is a task that I go much more slowly with. It is, however, not all that difficult to do by yourself, once you know the steps. And as @Peak indicates, you don't have to worry about the order of bouffant/mask/eye pro because the PAPR hood/headpiece covers that all at once.

The silicon flexible/reusable respirators are a good option for longer-term wear than the usual N95 respirators. They should be able to fit under most headsets and helmets without difficulty and as shown above, some have been adapted to work with comm mics.
 
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Not to mention clearing your ears with an N95 or any PPE on descent isn't exactly easy. And then the sweat/snot factor of using an N95 on our 2-4 hour flight times (not fun).
 

Kevinf

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It's nuts that more services don't have half/full-face respirators with P100 filters. Work of breathing is super easy, the fit is far more secure, eye-wear does not fog due to exhalation, and they are far more crush and damage resistant than "dust mask" N95s. Most are very easy to clean and tolerate disinfectant solutions well... on top of being reasonably priced at $30-50 or so (at least before the mask price insanity hit).
 

DesertMedic66

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It's nuts that more services don't have half/full-face respirators with P100 filters. Work of breathing is super easy, the fit is far more secure, eye-wear does not fog due to exhalation, and they are far more crush and damage resistant than "dust mask" N95s. Most are very easy to clean and tolerate disinfectant solutions well... on top of being reasonably priced at $30-50 or so (at least before the mask price insanity hit).
I’m not surprised. Before COVID we were able to buy a box of N95s for $20. Masks were also a not widely used piece of equipment. In the 10 years I have been in the field I have only worn a N95 masks maybe a handful of times. Really the only time they would get utilized is during the annual fit testing.

Why spend $30 per mask for something that rarely ever got utilized when you could spend $20 per box of 10.
 

GMCmedic

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I’m not surprised. Before COVID we were able to buy a box of N95s for $20. Masks were also a not widely used piece of equipment. In the 10 years I have been in the field I have only worn a N95 masks maybe a handful of times. Really the only time they would get utilized is during the annual fit testing.

Why spend $30 per mask for something that rarely ever got utilized when you could spend $20 per box of 10.
Or why spend $350 for a mask with built in comms? I did try though, program shot it down quick.
 

VFlutter

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Rumor has it Air Methods may be negotiating a large purchase of respirators like mine but likely only for the pilots.

The cost sounds insane at first but I can't imagine how much companies are spending on surge priced sub-par PPE right now and the supply chain logistics involved with centralized stock piles. Likely makes more sense in the long run to find a reusable respirator to issue as part of standard equipment like helmets.

Or why spend $350 for a mask with built in comms? I did try though, program shot it down quick.
I bought my own. I'll gladly take the cost knowing I will always have an option when quality PPE inevitability becomes impossible to find. Plus I can rock it when I shoot suppressed to avoid that lead poisoning ha
 

CANMAN

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Rumor has it Air Methods may be negotiating a large purchase of respirators like mine but likely only for the pilots.

The cost sounds insane at first but I can't imagine how much companies are spending on surge priced sub-par PPE right now and the supply chain logistics involved with centralized stock piles. Likely makes more sense in the long run to find a reusable respirator to issue as part of standard equipment like helmets.



I bought my own. I'll gladly take the cost knowing I will always have an option when quality PPE inevitability becomes impossible to find. Plus I can rock it when I shoot suppressed to avoid that lead poisoning ha
Did have to change up the comm’s at all? Apparently we have had a few pilots get them and they were setup for military impedance comm’s instead which obviously isn’t compatible. We fly in the FRZ so comm’s at all times are an absolute, otherwise you will get a visit from Blackjack and the ready squadron.
 

DesertMedic66

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Rumor has it Air Methods may be negotiating a large purchase of respirators like mine but likely only for the pilots.
There has been no talks of this from the inventory or the field safety side of the house so I would be shocked if they actually do it. The company did secure a contract for 200k of actual N95s that are supposed to be delivered in June, provided the government doesn’t seize them.
 

VFlutter

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Did have to change up the comm’s at all? Apparently we have had a few pilots get them and they were setup for military impedance comm’s instead which obviously isn’t compatible. We fly in the FRZ so comm’s at all times are an absolute, otherwise you will get a visit from Blackjack and the ready squadron.
Yeah military impedance is 19ohm vs 300ohm for civilian comms. The LPPR Mic is listed as 150ohm so somewhere in the middle. I'm not an expert but usually using 19 ohm military stuff results in a very low volume with civilian comms. I have volume adjustment on my helmet as well as on our carter boxes so it hasn't been an issue and sounds equivalent to a boom mic. I also fly with CEPs. Some of our pilots use their military helmets and make it work.

I also hooked up to my Peltors and tested it over VHF with my handheld and it sounded just fine
 
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VFlutter

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There has been no talks of this from the inventory or the field safety side of the house so I would be shocked if they actually do it. The company did secure a contract for 200k of actual N95s that are supposed to be delivered in June, provided the government doesn’t seize them.
Confirmed on our CQI today, they are looking to purhcase either the Tiger or Gentex for all pilots and med crew
 

CANMAN

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Confirmed on our CQI today, they are looking to purhcase either the Tiger or Gentex for all pilots and med crew
Small program? That’s a huge cost. We are having to replace all our IV pumps ASAP (About 750k) as well so the 300 dollar half face piece respirator with comm’s is out, but we will have standard half face piece respirators. Our choice to wear that or an N95.
 

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