This article appeared in the November 2017 issue of the Georgia's Cities newspaper.
According to the Georgia Bureau of Investigation, it only takes 2-3 milligrams of fentanyl to induce respiratory depression, arrest and possibly death. Pictured here, 2-3 milligrams of fentanyl is abo
Fentanyl and its analogues pose a potential hazard to a variety of responders who could come into contact with these drugs in the course of their work. Possible exposure routes to fentanyl and its analogues can vary based on the source and form of the drug. Responders are most likely to encounter illicitly manufactured fentanyl and its analogues in powder, tablet and liquid form. Potential exposure routes of greatest concern include inhalation, mucous membrane contact, ingestion and percutaneous exposure (e.g., needlestick). Any of these exposure routes can potentially result in a variety of symptoms that can include the rapid onset of life-threatening respiratory depression. Skin contact is also a potential exposure route, but is not likely to lead to overdose unless large volumes of highly concentrated powder are encountered over an extended period of time. Brief skin contact with fentanyl or its analogues is not expected to lead to toxic effects if any visible contamination is promptly removed.
CDC’s National Institute for Occupational Safety and Health (NIOSH) identified law enforcement officers and those responsible for investigation and evidence handling as positions that might come into contact with fentanyl or its analogues.
The NIOSH provided the below health hazard recommendations:
- Do not eat, drink, smoke or use the bathroom while working in an area with known or suspected fentanyl.
- Do not touch the eyes, mouth and nose after touching any surface potentially contaminated with fentanyl.
- Field testing of fentanyl or its analogues is not recommended due to an increased risk of exposure to responders performing field testing. However, if detection and identification of fentanyl is critical to the incident response, develop an incident specific plan to perform the field testing in accordance with agency policies and procedures. Personnel specifically trained to perform the field testing should perform the field testing in the appropriate personal protective equipment (PPE). Never handle fentanyl or its analogues without the appropriate PPE. The Georgia Bureau of Investigation (GBI) suggests that a personal PPE kit includes Nitrile gloves, an NT95 dust masks, sturdy eye protection, paper coveralls, shoe covers and Naloxone Injector(s).
- Avoid performing tasks or operations that may aerosolize fentanyl due to increased exposure risks. Activities that aerosolize fentanyl require higher levels of PPE and should be conducted by appropriately trained personnel and in accordance with agency policies and procedures.
- Wash hands with soap and water immediately after a potential exposure and after leaving a scene where fentanyl is known or suspected to be present to avoid potential exposure and cross contamination. Do not use hand sanitizers or bleach solutions to clean contaminated skin.
Responders who perform jobs where fentanyl or its analogues are reasonably anticipated to be present should receive special training in conducting an on-scene risk assessment related to fentanyl and its analogues and demonstrate an understanding of the following:
- How to recognize the form and determine the quantity of the suspected fentanyl and other drugs.
- When to use PPE; what PPE is necessary; how to properly put on, use, take off, properly dispose of, and maintain PPE; and the limitations of PPE.
- What the potential exposure routes are for fentanyl and its analogues.
- How to recognize the signs and symptoms of opioid exposure.
- When and how to seek medical help.
Employers must comply with OSHA’s hazardous materials standard (29 CFR 1910.120) when conducting clean-up operations involving hazardous substances. When required, responders should be trained on the potential hazards they might encounter and the necessary knowledge and skills to perform their work with minimal risk to their own safety and health and that of other responders.
When identifying fentanyl, the GBI instructs personnel to look for any cyanosis (turning blue or bluish color) of victims, including the skin or lips, as this could be a sign of fentanyl overdose caused by respiratory arrest. Further, before proceeding, personnel should examine the scene for any loose powders (no matter how small), as well as nasal spray bottles, as these could be signs of fentanyl use. Opened mail and shipping materials located at the scene of an overdose with a return address from China could also indicate the presence of fentanyl, as China-based organizations may utilize conventional and/or commercial means to ship fentanyl and fentanyl-related substances to the United States.
The bureau also reminds first responders to be mindful of the potential “Fentanyl Footprint” in their respective jurisdictions, which are clusters of overdoses and overdose deaths occurring within a small geographic area, within 48-72 hours. Based on incident reporting and analysis, this could possibly indicate fentanyl or fentanyl-related substances being present.
Responders who come into contact with fentanyl should immediately use soap and water to thoroughly wash and rinse contaminated skin. They should take care not to break the skin during the decontamination process and to cover all open wounds. Do not use hand sanitizers or bleach solutions to clean contaminated skin. All contaminated clothing should be removed and laundered, being careful not to disturb any areas of contamination. Shower immediately after a potential exposure.
Decontamination of reusable PPE and equipment should be done according to the manufacturer’s recommendations. Contaminated single use PPE should be placed in labeled durable 6 mil polyethylene bags and disposed of appropriately.
Working dogs, especially police K-9s performing detection activities, are also at risk of exposure to fentanyl and its analogues. As is recommended by the Interagency Board’s August 2017 document regarding opioids, working dogs should be removed from an area where suspect synthetic opioids are encountered. If exposed, residual drug powder might remain on the dog’s body; therefore, the proper precautions and procedures mentioned above should be employed by those handling the dog.
For more information on prevention occupational exposure to fentanyl or to learn how to best determine the types of PPE based on exposure levels (minimal, moderate and high) visit the CDC website
for a detailed chart.