Volume 2 - Issue 5 (2025-08-20)

Personal Protective Equipment (PPE) Utilization among Emergency Responders during Disasters: A Systematic Review of Compliance and Barriers

Eshaq Essa A AlBasha

Mohammad Abdulaziz F Alhowidi

Saif Abdullah D Aldawsari

Sultan Sukhayf T Alanazi

Abdulelah Hussain Y Hussain

Ayidh Salem B Alyami

Aseel Mohammed S Alghofaili

Ahmad Hammad M Almutairi

Background: Personal Protective Equipment (PPE) is essential for safeguarding emergency responders during disasters, yet compliance remains inconsistent due to logistical, ergonomic, and organizational challenges. Understanding these barriers and identifying effective strategies is critical to improving responder safety and operational performance.

Objectives: This systematic review aimed to (1) assess compliance levels with PPE protocols among emergency responders during disasters, (2) identify barriers that hinder consistent use, and (3) synthesize evidence-informed strategies to enhance adherence.

Methods: A systematic search was conducted following PRISMA guidelines, covering studies from diverse disaster contexts—including infectious disease outbreaks, chemical/biological/radiological incidents, and fire/hazardous material emergencies. Eligible studies were evaluated for evidence on PPE adherence, barriers, and interventions. Data were synthesized thematically across individual, organizational, and system-level determinants.

Results: PPE adherence was highly variable across settings. While some contexts reported strong knowledge and positive attitudes toward PPE use, observational data frequently revealed significant gaps in practice. Barriers included equipment-related burden (heat strain, impaired communication, reduced mobility), procedural complexity (errors in donning/doffing), time pressure in acute scenarios, and inadequate or poorly trusted supplies. Interventions that improved compliance included simplification of ensembles, high-fidelity training with coaching and debriefing, communication supports, and system-level policies such as updated OSHA and NFPA standards. Evidence gaps persist regarding natural disasters, gender-specific fit/comfort, and long-term evaluation of new regulatory frameworks.

Conclusions: PPE remains both a critical safeguard and a persistent operational challenge for emergency responders. Strengthening supply chain resilience, enhancing ergonomic design, and integrating structured training and monitoring systems are essential to improve compliance. These findings have particular relevance for disaster-prone regions and for countries such as Saudi Arabia, where ongoing healthcare transformation provides an opportunity to embed global best practices into emergency preparedness frameworks.