How to prepare for and react after contact with emerging opioids

Manufactured, concocted and blended opioids require EMS training, PPE and decontamination strategies


There’s been a lot of recent discussion over whether or not the mere sight, smell or contact with certain opioids can lead to unintended exposure or overdose risks. Two primary points of focus have come about because of this attention: emerging opioids and field decontamination.

Let’s face it, there are times where we may unintentionally walk into a hazardous environment and we need to know how to react if this happens; what we’re dealing with or treating our patient for and how we can clean ourselves to rid any exposure.

More potent, addictive opioids present new risks

There are times when EMS providers may unintentionally walk into a hazardous environment and will need to know how to react if this happens; what they’re dealing with or treating their patient for and how to rid themselves of any exposure. (Photo/Wikimedia Commons)
There are times when EMS providers may unintentionally walk into a hazardous environment and will need to know how to react if this happens; what they’re dealing with or treating their patient for and how to rid themselves of any exposure. (Photo/Wikimedia Commons)

Opioids extend further than the traditional morphine, fentanyl and heroin that we’re used to discussing and treating overdoses from. Naloxone, of course, is the antidote indicated in these situations – typically 0.4-0.5 mg, titrated to 2 mg for adult patients.

The emergence of various manufactured, concocted and blended opioids, moreover, is of concern. They’re more potent and more addictive than what we’ve seen, and they’re requiring us to think about how to treat “non-traditional” overdoses as a result.

States like West Virginia, New Hampshire and Ohio are at the top of the list when it comes to recent opioid-related overdose deaths, while Montana and Nebraska are toward the bottom.

Mixtures of fentanyl and heroin commonly hit the headlines as new warnings to the public, along with synthetic cannabinoids like K2 or Spice, which also prompts alerts from state and federal governments. Extending into the toxicity and extreme risk of some of these synthetic blends, we’ve even seen headlines warning about anticoagulants being mixed with some of these drugs in order to increase the effect of the high.

Counterfeit oxycodone, laced e-cigarettes, combination opioid-benzodiazepines and the illustrious carfentanil have emerged into the drug trafficking world, and crossed our path in EMS as a result.

Unfortunately, this isn’t an all-inclusive list. We haven’t even touched upon the remaining emergence of other drugs like methamphetamine, synthetic cathinones (bath salts), MDMAs (ecstasy) and other hallucinogens.

Overdoses and direct exposure to any of these types of drugs can present with different signs and symptoms, hazardous material risks and needs for provider (and patient) decontamination.

Protection through PPE and decontamination

To start, wearing appropriate PPE (or taking appropriate BSI precautions) can go a long way. Wearing gloves is a given, but double-gloving allows you to change out pairs easily without having to fight to squeeze a new pair on over your sweaty hands. Safety glasses should also be a given in our industry, but unfortunately, they’re often overlooked.

Tyvek suits, protective aprons, boot/shoe covers, goggles, N95 face masks and other forms of disposable scrubs should also be available in your cache of PPE in your ambulance (yes – all of these items).

Not every decon operation requires a full assembly line involving a tool drop location, dry decon, wet/gross decon, scrub-down and then a wash-off (which reminds me of going through a car wash). In fact, there are a number of simple options that we can take to effectively decontaminate ourselves on scene.

When it comes to cleaning and physical decontamination, all of your providers should be properly trained in basic decon principles. Attending a HAZWOPER or hospital first receiver course may be a great way to accomplish this training.

Cleaning wipes, access to water for flushing, as well as various cleaning solutions should be available on-scene for any situation where a hazardous material may be encountered. Agencies should also have a plan in place regarding how providers can obtain on-scene full decontamination via portable shower (washing off with soap and hot water for at least 5 minutes). Relying solely on getting sprayed-off by a fire hose line should not be our only alternative (and besides – that water is going to be cold no matter where you are!).

Times have certainly changed. The hazards of the past are still out there, but now they’re combined with many new and emerging hazards. Being aware of them and knowing how to properly decontaminate ourselves brings us right back to the first lines of every EMS skills station; “BSI, scene safety.”

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