The opioid epidemic and the EMS provider
Several agencies have published recommendations to protect frontline public safety providers from accidental occupational opioid exposures
Earlier this month, the Trump administration announced that it would declare the opioid epidemic a national emergency. The announcement came after a federal commission reported that the annual death rate from opioid overdoses has exceeded those from motor vehicle crashes; over 50,000 Americans died from opioid overdose in 2015.
As EMS providers, we are on the front lines of managing opioid overdose patients. As the epidemic has worsened, the types of opioids being abused have increased. Far more potent fentanyl is being used, both in its pure form and mixed into heroin. Carfentanil, the so-called "elephant tranquilizer" has also been reported.
These changes have not only exposed users to an unpredictable and potentially deadly interaction, but have also created potentially hazardous conditions for first responders such as EMS, law enforcement and fire departments. There have been widely reported cases of public safety providers becoming seriously ill after exposure to opioids.
Perhaps not surprisingly, there is little research regarding the significance of such exposures. Controlled lab experiments can provide some empirical information, but it's not clear how transferable the information is to real-world situations.
Nevertheless, several agencies have published a series of recommendations to better protect the frontline public safety provider against such occupational exposures.
Transdermal versus respiratory opioid exposure
In a typical overdose cases, the National Institute of Occupational Safety and Health and the InterAgency Board for Equipment Standardization and Interoperability recommend that the use of standard grade nitrile gloves while engaged in patient care provides sufficient protection against accidental skin exposure. Opioids are absorbed through the skin very slowly. According to a joint position statement released by the American College of Medical Toxicology and the American Academy of Clinical Toxicology, covering both palms with transdermal fentanyl patches for 14 minutes would result in only 100 mcg of fentanyl being absorbed.
A larger concern is with aerosolized opioids. In locations where the drugs are being manufactured, processed and/or sold, there are larger quantities of the substances. The chances of some of the drug getting released into the atmosphere are higher in these situations. NIOSH recommends that a P100 HEPA mask is sufficient to block inhalation of aerosolized opioids. Realistically, it is very difficult for such drugs to become aerosolized, and the chance of evaporative vapors in the atmosphere is not a practical concern.
Even in prolonged engagement in an incident where a large quantity of opioids is present, the chances of experiencing the effects of an accidental exposure is low. NIOSH recommends that in-field testing of drugs by law enforcement be minimized if opioids are suspected. If a spill is detected, the prudent procedure would be to withdraw and contact a hazardous materials team to assess and mitigate the situation.
Given the concerns expressed by public safety providers, these guidelines will help to establish safe operating procedures for first responders. EMS providers can help to educate members of their local public safety family about the concerns they may have in managing opioid incidents.