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Impact of personal protective equipment on clinical output and perceived exertion
  1. Shelly Lyn Maynard1,
  2. R Kao2,3 and
  3. DG Craig4
  1. 1High Readiness Detachment Halifax, 1 Canadian Field Hospital, Halifax, Nova Scotia, Canada
  2. 2Royal Canadian Medical Services, 1 Canadian Field Hospital, London, Ontario, Canada
  3. 3Division of Critical Care, Department of Medicine, University of Western Ontario, London, Ontario, Canada
  4. 4Endoscopy Unit, James Cook University Hospital, Middlesbrough, UK
  1. Correspondence to Dr DG Craig, Endoscopy Unit, James Cook University Hospital, Marton Road, Middlesbrough, North Yorkshire TS4 3BW, UK; darrencraig{at}


Background and aim Safe clinical care within Ebola Virus Disease Treatment Units (EVDTUs) mandate the use of personal protective equipment (PPE), comprising a fluid impermeable hooded suit, visor, gloves and rubber boots. The aim of this study was to assess the impact of this PPE on clinical personnel's performance in the EVDTU, Kerry Town, Sierra Leone.

Methods An anonymous questionnaire was administered to healthcare professionals (HCPs) entering the EVDTU ward area (Red Zone (RZ)), during a 2-week period to assess perceived exertion using the Borg Rating of Perceived Exertion Scale.

Results A total of 62 clinical episodes undertaken by 20 HCPs were analysed. There were no episodes of heat illness during the study. HCPs spent a median of 74 (IQR 55–95) minutes within the RZ. Median durations of RZ activity were similar throughout the 24 h period (p=0.22), but Borg scores were significantly higher between 11:00 and 14:59 compared with RZ entry between 15:00 and 10:59, respectively (12 (6–15), n=13; 8 (6–9), n=48; p=0.022). Rates of weight loss per minute spent within the RZ were significantly greater between 11:00 and 14:59 compared with 15:00–10:59, respectively (0.014 (0.009–0.023) kg/min, n=6; 0.007 (0.004–0.013) kg/min, n=37; p=0.037).

Conclusions Despite acclimatisation and proactive clinical tasking, HCPs in the EVDTU experienced significantly greater rates of weight loss and perceived exertion scores during the hottest times of the day. These findings should be considered by those planning healthcare facilities for future humanitarian missions where HCPs will provide clinical care in full PPE.

  • Ebola Virus Disease
  • Personal Protective Equipment
  • Heat illness

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