title: Does wearing CBRN-PPE adversely affect the ability for clinicians to accurately, safely, and speedily draw up drugs?
abstract: OBJECTIVE
  Following a Chemical, Biological, Radiation, or Nuclear (CBRN) incident, the attending rescuers will be required to administer drugs while wearing the CBRN Personal Protective Equipment (CBRN-PPE). Little is known regarding the impact of the CBRN-PPE on the ability to speedily, safely, and accurately draw up drugs for subsequent administration.
  
  
  METHODS
  A randomized control trial examining the ability of rescuers to draw up drugs from four different drug presentations (a Minijet prefilled syringe, an Aurum prefilled syringe, and glass and plastic ampoules with needle and syringe) was undertaken with participants wearing and not wearing the National Health Service (NHS) CBRN-PPE. Each participant underwent the procedure once in "normal clothes" and twice while wearing the CBRN-PPE. The speed and accuracy of each participant were measured as well as the participant's perceived risk of suit damage associated with the four different drug presentations.
  
  
  METHODS
  The participants constituted a non-homogenous group of emergency nurses, nurse lecturers, paramedic lecturers, and student paramedics. A total of 81 participants were recruited; one participant withdrew due to claustrophobia. All participants had used all four drug preparations prior to being enrolled into the study.
  
  
  RESULTS
  Wearing the CBRN-PPE had a negative effect on drawing up drugs in the first attempt while wearing the CBRN-PPE, typically taking 63.8% longer time than without (95% confidence interval: 55.3-72.9%). Improvements were noted on second attempts. The choice of drug presentation had an effect on the time taken to draw up the drugs, with Aurum being overall the fastest and glass ampoules the slowest (p-values < 0.001). All participants rated the prefilled syringes as the easiest and the safest to use, and the glass ampoules with needles and syringes as the most difficult to use and the ones most likely to puncture the CBRN-PPE. During the drawing-up process, varying amounts of "drug" were lost, although in two-thirds of the attempts all 10 mL was drawn up. The lowest volume was lost from the prefilled syringes and the maximum volume of fluid was lost from the glass ampoules.
  
  
  CONCLUSIONS
  The NHS CBRN-PPE has a negative effect on the drawing up of drugs especially from glass ampoules. Glass ampoules represent a poor choice of drug preparation when considering speed, safety, and accuracy of drawing up of drugs while wearing protective clothing.
authors.affiliation: Emergency Department, Frimley Park Hospital, Camberley, UK. castle.nicholas@googlemail.com
authors.forename: Nick
authors.initials: N
authors.lastname: Castle
authors.forename: James
authors.initials: J
authors.lastname: Bowen
authors.forename: Neil
authors.initials: N
authors.lastname: Spencer
mesh_terms: D000931:Antidotes / Q000008:administration & dosage*; D004349:Drug Packaging; D006801:Humans; D004364:Pharmaceutical Preparations / Q000008:administration & dosage*; D010820:Physicians; D011481:Protective Clothing / Q000009:adverse effects*; D013997:Time Factors
chemical_list: D000931:Antidotes; D004364:Pharmaceutical Preparations