During my career, reviving unconscious drug users has unfortunately become as routine as treating hypoglycemic diabetics.
But with the recent spike in overdoses related to fentanyl, a new fear is on the rise; one fueled by news stories like the police officer who instantly fell unconscious after brushing a small amount of powdered fentanyl from his uniform.
Many physicians have come out against the heightened sense of danger created by this story, believing that the threat of accidental overdose for first responders during routine operations is minimal.
Whatever level the threat may be, fire departments and EMS agencies have a responsibility to train their employees in how to safely decontaminate their gear if they come into contact with fentanyl or other opiates.
The facts are out there, but it is up to the agencies and responders to convert them into practice. So I did some research. Then I reached out to a few of my friends to discuss and demonstrate how we would handle the situation if it were to happen today (special thanks to: Lieutenant Brad Dean, Firefighter Blake Moore and Firefighter Wesley Langston for their assistance).
The following steps are what we came up with if our firefighter gear was to be contaminated with a small amount of powdered fentanyl.
1. Don’t panic
If you’re not sure what that white powdery substance stuck to your turnout gear is, you probably want to go ahead and call out your haz-mat team.
But if you know for a fact that it is fentanyl, don’t panic.
According to NIOSH, “Skin contact is 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.”
Fentanyl is water soluble. If it were to get on your skin, washing it away with soap and water should be sufficient protection from the effects of the drug.
Inhalation, ingestion and contact with mucus membranes pose higher potential risk for exposure than contact with skin.
Keep your hands away from your eyes, nose and mouth until decon is complete.
2. Get a partner and don recommended PPE
Whenever a small amount of fentanyl is visible or if the drug is suspected to be present, NIOSH recommends that responders don the following PPE:
- Safety goggles/glasses
- N100 mask for respiratory protection
- Nitrile gloves
- Wrist/arm protection
Though most of the PPE is readily available to us, N100 masks are not a typical piece of equipment we carry on our front-line fire engines.
In our exercise, agreeing that some respiratory protection is better than none, our guys donned the readily available N95 masks.
Noe: PPE should be worn by the assistant as well as the contaminated person during the doffing sequence.
3. Remove gear on-scene
To avoid contaminating the cab of the apparatus, any potentially contaminated gear should be removed on scene.
While removing the gear, keeping the powder from becoming aerosolized is optimal. Movements should be slow and clearly communicated between partners.
If the wind is a factor and there is no reasonable shelter, the partner assisting with clothing removal should stand upwind.
Lightly wetting the contaminated area is also an option. This will dampen the dry powder, which will reduce the chance of it aerosolizing.
After removal, the gear should be placed in a sealed plastic bag. The gear should be transported in one of the compartments outside of the cab.
All contaminated PPE worn during the doffing process should also be stored or disposed of appropriately.
4. Gross decon
Upon returning to the station, the person who was contaminated should hit the showers.
The assistant should once again don the appropriate PPE to conduct a gross decon of the contaminated gear in a safe area.
Gross decon should include the use of copious amounts of water, a soft bristle brush and soap.
Scrub the soles of the boots as an extra precaution.
If during this process, it is suspected that the contaminate may have soaked through the moisture barrier of the turnout gear, the gear should be disassembled and washed in a turnout extractor.
5. No gear in the station … ever
Even when not contaminated with powdered fentanyl, turnout gear is gross. Keep the gear where it belongs, outside of the station’s living quarters.
Buy a comfy pair of station shoes and wash your hands after every call.
Today we are dealing with fentanyl. Who knows what they will come out with next?