UTSW/BioTel EMS System

November 2014

EMS TB 14-007: Use of Medical Personal Protective Equipment (PPE)   (PDF Here)     (PPE Video)



To provide UTSW/BioTel EMS agency EMS Providers with guidelines for the proper use and removal/disposal of Personal Protective Equipment (PPE).


Recent events surrounding the confirmed cases of Ebola Virus Disease (EVD) in Dallas have prompted the need for refresher training and review of Department and EMS System Policies in the
proper use of PPE for all EMS Providers. The situation and official recommendations remain fluid. Moreover, there are many possible types of PPE equipment. The recommendations set forth in
this Training Bulletin are intended to be both safe and operationally feasible for EMS. The type of PPE components varies according to the mode of disease transmission. These PPE components
are deployed as part of four different, partially overlapping levels of “Isolation Precautions” for treating the patient and for interacting with the patient’s environment of care. These four categories
are: Standard, Contact, Droplet and Airborne Precautions. PPE is “what” is worn, while Isolation Precautions describe “how” the wearer uses this PPE when providing medical care. The procedure
for putting on (donning) and removing (doffing) PPE is also tailored to the specific type of PPE needed for each level of Isolation Precautions. A Buddy System with a second EMS Provider
observing the first EMS Provider during donning and doffing can help to ensure proper PPE use. The Buddy System shall be used whenever removing (doffing) PPE, if staffing allows.

Infection Control & Prevention Items Needed Prior to Patient Contact:

PPE Selection Recommendations:

NOTE: EMS Providers may always exercise clinical judgment to don a HIGHER level of PPE, especially RESPIRATORY Protection, if the clinical scenario warrants.

NOTE: This table does NOT include specific guidelines for disinfection of the environment of care (e.g. medical equipment, environmental surfaces, and ambulance surfaces, etc.)
Refer to UTSW/BioTel EMS TB 14-008, and to other BioTel and agency educational materials.

NOTE: Except for Air-Purifying Respirators (APRs), all equipment shall be disposed of after single use. APRs may be disinfected, as appropriate, per UTSW/BioTel EMS TB 14-008 and manufacturer recommendations.


PPE Component

PPE Selection According to Clinical Scenario


ALL Patient Encounters

Patients with fever and/or other signs/symptoms, with any known or suspected infection, such as Ebola, Influenza & other viruses, Plague, Hepatitis B/C

Patients with fever and/or other signs/symptoms & known or suspected infection with airborne-spread organism, such as TB, measles, or chickenpox; or unknown history


“Standard Precautions”

“Contact and Droplet Precautions”






(Impermeable or Fluid Resistant)

As needed




  1. One-Piece Surgical Mask with Splash Shield (may be worn with 3M Safety Goggles), OR
  2. Full-Face Splash Shield and Surgical Mask or N95 (can be worn with 3M Safety Glasses), OR
  3. Green Safety Goggles and Surgical Mask or N95, as indicated (minimal exposed skin)


Option 1,
As needed

Option 2 (preferred), 
or Option 3







  • Standard Surgical Face Mask*


As needed

YES, or higher



  • N95 or N100 Respirator*                      (Must be worn with Eye Protection)



YES, especially if“High-Risk” or “Aerosol-Generating” Procedures (AGP†), e.g. CPR, Airway interventions



(If available)

  • Air-Purifying Respirator*                      (Must be worn with Eye Protection, unless full face) OR SCBA




YES, especially if“High-Risk” or “Aerosol-Generating” Procedures (AGP†), e.g. CPR, Airway interventions





Special Circumstances:

Procedures – Putting On (Donning) PPE:

NOTE: A Buddy System with a second EMS Provider or other trained observer monitoring the first EMS Provider during both donning and (especially) doffing shall be used whenever possible.
Such a system can help to ensure proper PPE use and removal, and it has been shown to minimize the chance of a procedural breach and accidental exposure.

NOTE: Double Gloves should be worn if gross contamination is likely (e.g. due to a large volume of body fluids) or for other high-risk patient contacts. Wearing more than double gloves does NOT
provide more protection and may increase EMS Provider risk, because doing so complicates the doffing procedure.

  1. Remove personal items and perform Hand Hygiene
    1. Use ample alcohol-based hand gel and allow time for gel to be fully absorbed
  2. Tuck pants legs into socks or boots to facilitate donning and doffing with less risk of contamination
  3. Don Boot Covers
  4. Don waterproof or fluid impermeable Gown, tying at the waist and neck:
    1. Do not tie a tight knot that will make it hard to unfasten during doffing
  5. Don DOUBLE Gloves:
    1. Select outer glove size one size larger than inner gloves, if needed
    2. Gown cuff must be inside (under) the inner gloves, with no exposed skin
  6. Don Respiratory Protection (disposable mask or respirator):
    1. Standard surgical mask: routine, low-risk patients (“Standard Precautions”)
    2. N95: Patient with fever or other symptoms (“Contact and Droplet Precautions”)
    3. Air-Purifying Respirator: Patient with known or suspected high-risk infection with TB or similar airborne agent, or Unknown History (“Airborne Precautions”)
  7. Don Eye and Face Protection – based on PPE readily available as of October 2014:
    1. Green Wraparound Protective Goggles, OR
    2. Disposable Full-Face Splash Shield
      1. Can be worn with 3M Safety Glasses
      2. Cannot be worn with Green Protective Goggles
  8. Don Bonnet
  9. Buddy inspects PPE, front and back, for breaches or other defects

Procedures – Removing (Doffing) PPE:

➢ Start with both Medics in full PPE (including double gloves), after transfer of patient care.

 ➢ Refer to the November 2014 DFR PPE Video on the BioTel website


Steps To Take In the Event of Possible EMS Provider Contamination (Refer to the UTSW/BioTel TB 14-008 Decon):

SUMMARY of Recommendations:


For ANY questions or concerns, contact your EMS Supervisor or BioTel immediately.

CDC Resources*:
















*Accessed 6 November 2014

AGP: Aerosol-Generating Procedure
“Although there are limited data available to definitively define a list of AGPs, procedures that are usually included are Bilevel Positive Airway Pressure (BiPAP), bronchoscopy, sputum induction, intubation and
extubation, and open suctioning of airways.”  CPR is not specifically included on the list as an AGP; however, endotracheal intubation may be performed during CPR.

(Representative Examples, as of October 2014)