It seems simple enough right? We operate in temperature extremes, harsh environments, performing physically and mentally demanding tasks; all in the blink of an eye. Sometimes, they must be carried out by waking from a deep sleep or even mid bite from our long awaited holiday dinner. All of this must be accomplished without forsaking comfort; after all, we must be ready in a moment’s notice, during all hours of our shift yet have functional clothing that will weather the extremes that we will be subject to when the time to work comes calling. We need clothing and equipment that will be thin enough to keep us cool, soft enough to not chafe or cause irritation, be constructed of material that will wick away any perspiration to keep us dry during our daunting tasks, and let’s not kid ourselves, comfortable enough to lounge around in between flights,. When we look for clothing that will meet these categories, unless we do our research, we will fall into the traps of marketers all throughout the media. We want clothing that will allow us to move freely, keep us cool, and offer durability. So we seek what the professionals wear; professional athletes of course!
When we look at athletic wear, it seems to be a perfect fit for what we think we need. Athletic wear is typically made from 100% polyester or a polyester blend. This makes the clothing extremely soft and comfortable for the wearer. There is a plethora of choices on the market, making them easy to come by and affordable. They are usually sold in a compression fit which provides muscle activation during movement. We also look at footwear that we can stand to wear, potentially, all day long. The need for a pair of boots in the helicopter EMS (HEMS) industry is pretty well known, but what type of boots? It seems that when a pair of boots is needed to be worn for hours on end, a pair similar to an athletic shoe would be a good choice. These are typically made from lightweight, breathable, synthetic material allowing the wearer hours of comfort for those long shifts.
Getting dressed for our shift, we throw on a pair of athletic shorts, a short sleeve athletic compression top, and throw on a pair of athletic socks, for extra moisture wicking ability. So, we have it figured out right? On top of all of our comfort gear we step into our Nomex © flight suit and zip it up to our chest, lacing up our athletic wear boots. As we stand up from tying our shoes, we feel as if we can take on the world with all of our dexterity and comfort. After all, we are wearing a “fire proof” flight suit. What else do we need to protect us?
Little do we know, as we walk towards the helicopter for a patient flight we have completely stacked the deck against ourselves. In the event of a fire within the aircraft the only layer of protection we have between us and the flames from the burning jet fuel is the tiny layer of fire resistant material in our flight suit. If subjected to the heat for any amount of time the temperatures under our flight suit will far exceed the approximately 350 degrees Fahrenheit that it will take for our athletic wear to melt and drip directly onto our skin. (3) This will exacerbate and prolong any burning process that takes place.
As much as I hate to admit it, this is how I dressed for my very first flight shift as a paramedic and continued to do so for quite a while into my first year of flying. All because it was comfortable and I was too stubborn to heed the warnings offered by numerous individuals within the industry. It wasn’t until one day I was responding to a fire, as a volunteer firefighter, that I realized I had not been taking my safety seriously enough. Before I enter a house fire I don turnout gear made of fire resistant material. This includes pants, coat, a hood, gloves, leather boots, and a helmet secured with a chin strap and visor. Why now did I take the time to do this? Well it seemed obvious, I was about to readily expose myself to a dangerous environment including the possibility of direct flame. These pieces of clothing were meant to protect my body from the harshest of environments, so that in the event of an incident my body would be as protected as it could be. These pieces of clothing were meant to ensure that I go home at the end of my shift alive, maybe beaten and bruised, but still alive. Why didn’t I take these measures at work? I may fight one fire a year …but I step into the helicopter every shift and risk the possibility of exposure to flames every day that I am at work. Why had I become so complacent in my own safety in my full time job? I knew that I had to make a change, but wearing full turnout gear within the aircraft wasn’t feasible. I started my research into fire resistant garments and was quickly overwhelmed by the options that were available.
After extensive research and trials of different garments and fabrics I have come up with a few suggestions as well as information from others within the industry about their recommendations for proper personal protective equipment (PPE) for those involved in air medical transport. Let’s first look at why we need to be concerned with wearing the proper PPE.
We work in an inherently dangerous environment. We ask pilots to fly an aircraft as close to maximum gross weight as possible, into unimproved landing areas, all hours of the day and in all temperature extremes. We max out our aircrafts and crews in order to offer life-saving access to a complete stranger. In 2013 the accident rate of civilian helicopters topped out at 4.0/100,000 flight hours. Also, the 2013 information shows a fatal injury rate of 1.44/100,000 flight hours. (2) This statistic is neither a new number nor an unknown within the industry. That being said, that doesn’t mean we can’t strive for a 0 accident level. As we work towards that number we also have to make sure that we are properly protecting ourselves in the meantime. One of the biggest threats that face occupants within the aircraft is not the crash impact itself but the fire that erupts upon impact. A USA Today study in 2014 reports that 79 people had been fatally wounded and 28 others injured by fires that followed a low-impact collision. (4)
Fires are one of the biggest threats to life and safety within our line of work. One manufacturer of fire resistant clothing carried out a burn test on different clothing in order to test for body surface area (BSA) burnt while wearing different layers of clothing. The results shows that when a Nomex © 27/P flight suit was worn directly against the body, burns totaling nearly 52% BSA covered the body, the flight suit coupled with short cotton underwear reduced that number to around 34% BSA, and finally, including Nomex © long underwear beneath the 27/P flight suit drastically reduced BSA affected by the burn to 9%. (3) A 9% total BSA burn is very survivable and preferable in comparison. These numbers include the unprotected head, hands, and feet. This number would be almost nonexistent had the test included a pair of sturdy leather boots, fire resistant gloves, and a flight helmet with the visor down.
This burn test can tell us a lot about what is needed to properly protect ourselves from flash fires. First and foremost, layering of clothing is the key to greatly diminishing the exposure and burns. Specifically, it shows that the layering of fire resistant garments on top of each other is the best practice. Next, it shows that protection of the head, hands, and feet, is also very important. According to the American Burn association, a burn of any level to these areas constitutes admission to a certified burn center. (1) These are areas of the body that are easily protected. Strong leather boots will offer protection from impact during day to day operations and the leather will offer burn protection in the event of a flash fire. A pair of fire resistant glove will offer a layer of thermal protection from flame exposure and a well fitted helmet with the visor in the down position will also offer protection to the head. The Commission on Accreditation of Medical Transport Systems (CAMTS) recently updated their standards to their 10th Edition. Within this edition, CAMTS offers several recommendations for protective clothing. Specifically, boots or sturdy footwear, flame retardant clothing, approved outerwear for survival in the environment, and finally an appropriately fitted and maintained helmet must be worn at all times. (5)
To date, there are no mandates within the HEMS industry for the layering of fire resistant clothing. Only recommendations to avoid those garments made of fabrics with low melting and ignition points such as polyester. Currently, measures such as those listed above fall on the individual to carry out. Protective clothing is not a cheap investment. That is why you need to make sure that the clothing you purchase is exactly what you need, fits properly, and will stand up to the rigors of the job. Though these garments come with a hefty price tag, if the correct pieces are acquired, they will stand the test of time and protect you above and beyond that of what your flight suit will do by itself. So I challenge you; continue researching what the professionals wear; just make sure it is the HEMS professionals.
In my next article, we will examine what to look for in a piece of clothing, different types of fire resistant materials and treatments, and how to properly wear the clothing for the most protection.
1. “Burn Center Referral Criteria.” American Burn Association. American Burn Association, 2006. Web. 8 Dec. 2015. PDF
2. “Comparative U.S. Civil Helicopter Safety Trends.” Www.rotor.org. Helicopter Association International, 2014. Web. 8 Dec. 2015.
3. “Flight Suits-Functional Protection.” Transportation Canada. Government of Canada, 20 May 2010. Web. 7 Dec. 2015.
4. Frank, Thomas. “NTSB Urges Fire-resistant Tanks for Helicopters.” USA Today. Gannett, 28 Aug. 2015. Web. 7 Dec. 2015.
5. “Tenth Edition Accreditation Standards.” Commission on Accreditation of Medical Transport Systems, 1 Oct. 2015. Web. 7 Dec. 2015. PDF
Darrin is a certified flight paramedic who is currently working within the critical care transport environment for a national air medical provider. Along with serving as a clinical provider he also has the opportunity to serve as an educator for both his peers as well as the public. Darrin has had the privilege of serving for several emergency response organizations including those providing firefighting, dive rescue/recovery, hazardous materials response, district level disaster response, hospital based EMS, municipal based Fire/EMS, tactical medicine, and private for-profit critical care transport. He has not only served as an operational member of these teams, but has also had the opportunity to of instruct on topics specific to each discipline. Darrin holds a Bachelor’s of Science degree focused on Homeland Security and Public Safety.