. 2015 May 29;53(5):434–444. doi: 10.2486/indhealth.2015-0033

Table 3. Firefighters’ recommendations for general improvements to the entire personal protective system.

Category	Specific recommendations
Thermal characteristics	· Very hot as soon as I put it on, and before getting to the fire scene, due to the low breathability, accumulated sweat and heat, especially in summer. The turnout gear may withstand the heat, but the body will not endure the gear. Long duration work is impossible because of the heat, and mental performance is harmed as well. · Very hot due to the moisture barrier among three layers of the PPC. The liner should be removable in summer for easier rehabilitation. Further, the moisture barrier leads to increased heat injuries including skin burns due to steam, when we are wet (US). New PPC gives greater heat stress (KR, AU, US). · Officers have to wear an ID vest over the turnout gear, which makes the heat problem worse (AU). · It would be beneficial to develop undershirts with tubing running over the trunk that could have a quick connection to circulate cold water during rehabilitation (US). · PPC gets frozen in winter when wet by water or sweat.

Over-protection	· Because current PPC is so effective at reducing the sensation of heat, we are getting caught deep in fires that are extremely hot. We don’t know the temperatures we are getting into. Once the heat penetrates the gear it is almost too late to avoid flashover. Having gear that is too good gives a false sense of security. This causes more deaths and injuries to firefighters. A sensor could be incorporated into the PPC that warns us that we are in high temperature area (US).

Load and dimensions	· Equipment is very heavy and bulky when the gear is soaked by water (outer) and sweat (inner layer); when many tools/devices are added. Hard to move, hard to doff, and hard to raise the arms or feet when wet. · The waist area is especially bulky, often with layering of the coat over the pants, a belt for tools and the SCBA waist strap, making bending over at the waist almost impossible. Newer PPE is becoming bulkier, but any adjustments that add weight to the gear should be avoided. · Sizing of PPC does not take into account each individual’s unique body shape. A female size system is especially needed. SCBA harnesses are really not user friendly for females. Female shoulders are not as wide as males, and the chest strap is sometimes not placed in the best place. For gloves, females have smaller hands with a smaller palm.

Cleaning and management	· PPC develops nasty smells from sweat, blood or contaminants. More deodorisation is required. · Current PPC absorbs too much water which increases the total weight. · Anti-pathogen layer choices are needed. · Flame-resistance is reduced as cleaning is repeated. · Lint on the fabric surface and shrinkage increase after repeating cleaning. It is hard to clean soot from the PPC and takes many hours to clean up the gear. · Light colours are avoided in terms of the cleaning and management. · It takes a long time to dry the wet PPC. Extra liners are needed because firefighters often wear their gear half-dried.

Comments have been pooled within categories. Unless otherwise indicated using country identifiers (AU [Australia], JP [Japan], KR [Korea], US [United States]), these comments were common to all four countries. PPC: personal protective clothing (turn-out gear); PPE: personal protective equipment; SCBA: self-contained breathing apparatus