Background

Emergency physicians and other frontline clinicians are facing shortages of adequate PPE around the country amidst the COVID-19 pandemic.¹ In response, they are addressing this through non-traditional means by self-supplying industrial devices meeting NIOSH standards. Unfortunately, there are numerous reports of hospital systems and administrators forbidding, shaming, and threatening physicians who elect to use a higher level of PPE than is currently provided or required by their hospital system. This statement is being issued in response to those occurrences.

The WHO, CDC, and OSHA have issued rapidly changing PPE guidelines based on supply chain availability.¹ OSHA guidance on preparing workplaces for COVID-19 states: “Workers, including those who work within 6 feet of patients known to be, or suspected of being, infected with SARS-CoV-2 and those performing aerosol-generating procedures, need to use respirators.” Doctors are specifically categorized as high or very high exposure risk jobs.² OSHA guidelines authorize the use of other respirator devices that meet similar NIOSH standards (R/P95, N/R/P99, or N/R/P100 filtering face piece respirator; an air-purifying elastomeric (e.g., half-face or full-face) respirator with appropriate filters or cartridges; powered air purifying respirator (PAPR) with high-efficiency particulate arrestance (HEPA) filter).² The CDC recommends N95 (or better) respirators for aerosolizing procedures.³ AAEM recognizes that sneezing and coughing also do, in fact, produce aerosols.⁴ Finally, the CDC recommends that “when the supply chain is restored, facilities with a respiratory protection program should return to use of respirators for patients with known or suspected COVID-19.”³