PPE Levels A to D and Medical Monitoring of Entry Teams Practice Questions

25 multiple-choice questions on PPE levels A to D and medical monitoring of entry teams for paramedic and EMT students, from Chapter 50 (Hazardous Materials). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. Level A protection consists of:

   1. A. A vapor-tight encapsulating suit with SCBA
   2. B. A splash suit with an SCBA worn outside it
   3. C. A splash suit with an air-purifying respirator
   4. D. A work uniform with gloves and safety glasses
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   Answer: A. A vapor-tight encapsulating suit with SCBA

   Level A gives the highest protection for both skin and lungs, with SCBA worn inside a fully encapsulating, vapor-tight suit. A splash suit with SCBA is Level B, which protects the lungs fully but not the skin from vapor.

2. Level B protection is chosen when responders need:

   1. A. Full skin protection but no respiratory protection
   2. B. Full respiratory but lesser skin protection
   3. C. Splash protection with filtered room air
   4. D. Minimal protection for nuisance contamination
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   Answer: B. Full respiratory but lesser skin protection

   Level B pairs SCBA with a nonencapsulating, chemical-resistant splash suit, so it is used when the main danger is breathing the agent and skin-absorbing vapors are not expected. Filtered air with splash protection describes Level C.

3. An air-purifying respirator worn with Level C protection may be used only when:

   1. A. The agent is unknown and oxygen levels are unclear
   2. B. The air is above IDLH and the agent is skin-toxic
   3. C. The agent is identified and oxygen is adequate
   4. D. The decon team needs a longer work time than SCBA
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   Answer: C. The agent is identified and oxygen is adequate

   Level C uses canister or cartridge respirators that filter room air, so the contaminant must be identified and measured below IDLH, and oxygen must be at least 19.5%. With an unknown agent or low oxygen, supplied air (Level A or B) is needed.

4. Level D protection is appropriate for:

   1. A. Decon of contaminated patients in the warm zone
   2. B. Entry into an unknown atmosphere
   3. C. Work near a corrosive liquid spill
   4. D. Areas without respiratory or skin hazards
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   Answer: D. Areas without respiratory or skin hazards

   Level D is a standard work uniform with gloves and eye protection; it offers no respiratory protection and little chemical protection. It belongs in the cold zone, not in the warm or hot zone.

5. A hazmat team must enter a building where an unidentified vapor is leaking, and the agent may be absorbed through the skin. The entry team should wear:

   1. A. Level B
   2. B. Level C
   3. C. Level A
   4. D. Level D
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   Answer: C. Level A

   An unknown agent that may be toxic through the skin calls for the highest protection, the vapor-tight Level A ensemble. Level B is a common choice for unknown atmospheres, but its splash suit does not protect against skin-absorbed vapor.

6. A firefighter in full turnout gear and SCBA offers to walk into a chemical spill to rescue a worker. The main limit of this gear is that it:

   1. A. Gives little protection from chemical splash or vapor
   2. B. Gives no protection for the lungs in a toxic atmosphere
   3. C. Is too heavy to wear for the time a rescue will take
   4. D. Melts when it contacts chemical liquids
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   Answer: A. Gives little protection from chemical splash or vapor

   Structural firefighting gear with SCBA protects the lungs, but the coat and pants absorb and let through many liquids and vapors, so it is not chemical protective clothing. Some short rescues may be done in it per local protocol, but it is not equivalent to a chemical suit.

7. Permeation of a chemical protective suit refers to the chemical:

   1. A. Leaking through zippers, seams, and small tears
   2. B. Passing through intact material molecularly
   3. C. Breaking down the material so that it cracks
   4. D. Collecting on the outside of the suit's surface
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   Answer: B. Passing through intact material molecularly

   In permeation, the chemical moves through intact suit material molecule by molecule, often without visible damage. Leaks through seams and closures are penetration, and visible breakdown is degradation.

8. After a short entry, a technician notices her suit's sleeve has become stiff, swollen, and cracked where it touched the product. This is:

   1. A. Permeation
   2. B. Penetration
   3. C. Polymerization
   4. D. Degradation
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   Answer: D. Degradation

   Degradation is a physical change in the suit material, such as swelling, stiffening, or cracking, from contact with a chemical. Permeation passes through intact material without visible damage.

9. A chemical can get past a suit through an open zipper, a poorly sealed seam, or a pinhole. This form of failure is called:

   1. A. Permeation
   2. B. Degradation
   3. C. Penetration
   4. D. Sublimation
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   Answer: C. Penetration

   Penetration is the flow of a chemical through openings in the suit such as closures, seams, and tears. It differs from permeation, which goes through intact material.

10. The hazmat team chooses chemical protective clothing for a specific product mainly by:

    1. A. Picking the thickest suit that is available
    2. B. Using compatibility data for suit materials
    3. C. Choosing the suit color linked to the hazard
    4. D. Using the suit level listed on the placard
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    Answer: B. Using compatibility data for suit materials

    No single suit material resists every chemical, so teams check manufacturer permeation and degradation data for the product. Thickness alone does not predict resistance, and placards do not list PPE.

11. Workers in chemical suits develop heat stress quickly, even on cool days, mainly because the suits:

    1. A. Block the evaporation of sweat
    2. B. Trap carbon dioxide in the hood
    3. C. Press on major blood vessels
    4. D. Raise the wearer's metabolic rate
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    Answer: A. Block the evaporation of sweat

    Chemical suits are designed to be impermeable, so sweat cannot evaporate and the body loses its main way of shedding heat. The physical work adds heat, but the barrier to evaporation is the key problem.

12. A cooling vest worn under a chemical suit is used to:

    1. A. Protect the chest from splashes
    2. B. Absorb sweat to keep the skin dry
    3. C. Keep the wearer warm in the cold
    4. D. Reduce heat stress during entry
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    Answer: D. Reduce heat stress during entry

    Ice or phase-change cooling vests absorb body heat under the suit and lengthen safe work time. They are not chemical barriers, they do not wick away sweat, and they are worn to remove heat, not to keep the wearer warm in cold weather.

13. Before a hazmat entry, the pre-entry medical evaluation should include:

    1. A. Blood glucose, a chest x-ray, and a urine drug screen
    2. B. Vital signs, weight, and recent illness or drugs
    3. C. A 12-lead ECG and a cardiac stress test on scene
    4. D. An eye exam and a test of the suit's air supply
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    Answer: B. Vital signs, weight, and recent illness or drugs

    Pre-entry checks record baseline vital signs, temperature, and weight and screen for recent illness, alcohol, or medications that raise heat risk. The baseline lets the monitoring team compare findings after the entry.

14. A technician scheduled to enter the hot zone has a pulse of 128, a temperature of 38.6°C (101.5°F), and says he had diarrhea yesterday. You should:

    1. A. Let him enter if he drinks a liter of water first
    2. B. Let him enter but shorten his work time to 10 minutes
    3. C. Advise against entry and tell the entry leader
    4. D. Let him enter as backup team rather than entry team
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    Answer: C. Advise against entry and tell the entry leader

    Tachycardia, fever, and recent fluid loss put him at high risk of heat illness in a suit, so he should be excluded from entry. The backup team must be just as fit, because it may have to do a strenuous rescue.

15. To reduce heat stress, entry team members are usually advised before entry to:

    1. A. Drink a large caffeinated beverage
    2. B. Drink about 2 L (68 oz) of water
    3. C. Take a salt tablet with each glass
    4. D. Drink about 0.5 L (16 oz) of water
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    Answer: D. Drink about 0.5 L (16 oz) of water

    Prehydrating with water or a diluted electrolyte drink helps offset sweat losses in the suit, but 2 L at once fills the bladder, is absorbed too slowly to help, and can lower blood sodium. Caffeine is a mild diuretic and stimulant, and salt tablets are not recommended.

16. After a 25-minute entry in a Level A suit, a technician is confused, hot, and dry, with a temperature of 40.2°C (104.4°F) and a pulse of 150. After he is decontaminated and out of the suit, you should:

    1. A. Begin rapid cooling and transport him
    2. B. Have him rest in rehab and drink fluids
    3. C. Recheck his vital signs in 15 minutes
    4. D. Give him a cooling vest and observe him
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    Answer: A. Begin rapid cooling and transport him

    Altered mental status with a core temperature above 40°C (104°F) is heat stroke, which needs aggressive cooling and transport. Rest and oral fluids suit milder heat stress, not a confused patient.

17. After an entry, a technician is alert with a pulse of 118 and a temperature of 38.1°C (100.6°F). He feels tired but has no other complaints. The most appropriate care is to:

    1. A. Start two large-bore IVs and transport him at once
    2. B. Rest, cool off, drink fluids, and recheck
    3. C. Clear him for reentry once he has had a drink
    4. D. Cool him with ice-water immersion and transport
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    Answer: B. Rest, cool off, drink fluids, and recheck

    Mild heat stress with a normal mental status is managed with rest in a cool area, oral fluids, and repeat vital signs before any further assignment. IVs, cold-water immersion, and transport are for heat exhaustion that does not improve or for heat stroke with altered mental status. One drink does not correct his fast pulse and raised temperature, so he is not cleared for reentry until his vital signs recover.

18. A technician weighed 80 kg before entry and weighs 77.4 kg afterward. This weight loss suggests:

    1. A. Significant dehydration; rehydrate before reentry
    2. B. Normal sweat loss that needs no special attention
    3. C. Fluid loss that is replaced by drinking one cup
    4. D. A mild loss, under 2% of body weight, from sweating
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    Answer: A. Significant dehydration; rehydrate before reentry

    Body weight change after an entry is a simple measure of sweat loss. A loss of 3% or more (here 2.6 kg, about 3.3%) reflects significant dehydration, so the technician should rehydrate and be rechecked before any further entry. Calling it normal sweat loss misses a level that predicts heat illness on the next entry. One cup (about 240 mL) replaces a small fraction of the 2.6 L lost. That is well above the 2% level often used as the line for mild dehydration.

19. During post-entry monitoring after a pesticide warehouse entry, a technician has a runny nose, small pupils, and mild chest tightness. You should suspect:

    1. A. Heat exhaustion from the long entry
    2. B. Anxiety from wearing the closed suit
    3. C. A suit breach with chemical exposure
    4. D. A viral upper respiratory infection
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    Answer: C. A suit breach with chemical exposure

    Post-entry checks look for signs of exposure as well as heat stress, and cholinergic signs after work around a pesticide point to a breach in protection. The team must be told so the agent can be treated and other entrants checked.

20. Under OSHA rules, medical surveillance records for hazmat team members must be kept for:

    1. A. One calendar year
    2. B. Seven years after the date of the incident
    3. C. Until the employee retires from the agency
    4. D. The length of employment plus 30 years
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    Answer: D. The length of employment plus 30 years

    Because many chemical effects, such as cancer, appear years later, OSHA requires employee medical records to be kept for the duration of employment plus 30 years (29 CFR 1910.1020, applied to hazmat teams through 1910.120(f)(8)). One year, or 7 years after an incident, would discard the record before delayed effects appear. Keeping it until retirement fails for diseases that appear after retirement and for employees who leave early.

21. Compared with SCBA, a supplied-air (airline) respirator offers longer work time, but its main drawback is that:

    1. A. The hose limits mobility and distance
    2. B. It cannot be used above the IDLH level
    3. C. Its air pressure is lower
    4. D. It filters the room air instead of supplying it
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    Answer: A. The hose limits mobility and distance

    An airline respirator delivers air through a hose from an outside source, so work time is longer but movement is limited to the hose length and the hose can snag. With an escape cylinder, it may be used in IDLH atmospheres.

22. An entry team member's SCBA cylinder is rated for 30 minutes. During heavy work in a chemical suit, the team should plan on the air lasting:

    1. A. About 30 minutes, as rated
    2. B. Longer than 30 minutes, since the suit traps air
    3. C. 30 minutes plus a 5-minute reserve
    4. D. Often well under the rated time
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    Answer: D. Often well under the rated time

    Cylinder ratings assume a moderate breathing rate; heavy exertion, heat, and stress raise air use, so actual time is often far shorter. Entry time must also allow for the walk out and decon before the air runs low.

23. Members of the decon team generally wear PPE that is:

    1. A. Two levels higher than the entry team is wearing
    2. B. The same as or one level below the entry team's
    3. C. Level D, since the agent has been diluted
    4. D. The same as structural firefighting gear
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    Answer: B. The same as or one level below the entry team's

    The decon team handles contaminated people and runoff, so it needs protection close to that of the entry team, often the same level or one level lower. Level D gives no real chemical protection.

24. A technician leaving the hot zone feels hot and asks to remove his suit in the cold zone to cool off quickly. You should:

    1. A. Help him unzip it there to start cooling him
    2. B. Let him remove it if he keeps his gloves on
    3. C. Send him through decon before removing it
    4. D. Hose him down with the suit still on in rehab
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    Answer: C. Send him through decon before removing it

    Suits must be decontaminated and removed in the decon corridor so contamination on the outside does not reach the wearer or the cold zone. Heat stress is urgent, but the decon line is set up to remove suits quickly.

25. Besides heat stress, the encapsulated Level A suit most limits the wearer's:

    1. A. Blood pressure, from the pressure of the sealed suit
    2. B. Hearing of the SCBA low-air alarm
    3. C. Vision, dexterity, and communication
    4. D. Oxygen levels, since the hood traps exhaled CO2
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    Answer: C. Vision, dexterity, and communication

    Level A suits restrict visibility, hand dexterity, and voice communication, which slows tasks and increases fatigue and claustrophobia. The wearer breathes from the SCBA inside the suit, so exhaled carbon dioxide does not lower his oxygen supply, and the suit's slight positive pressure does not affect blood pressure. SCBA low-air alarms are designed to be heard or felt by the wearer inside the suit. These suits give the best vapor protection, which is why they are used despite these limits.