Fentanyl Exposure: What’s The Risk for Emergency Responders?

HYANNIS – A fentanyl overdose case in Wareham in which a local police officer was hospitalized after reportedly coming in contact with the drug while reviving the victim is raising questions about the safety of first responders.

Public safety officials have said there is a real and immediate risk to those who arrive at a drug overdose scene where drugs like fentanyl or even worse, carfentanil, may be in an area in which a police officer or EMT could be exposed.

The story, which gained attention across the country, has raised issues with some in the medical industry who say it’s highly unlikely for a first responder to be exposed to fentanyl, through skin contact or particles in the air, and be at risk of bodily harm.

On the night of Saturday, February 23, Wareham Police reported that a Wareham Police Officer was transported to Tobey Hospital “due to likely fentanyl exposure,” after performing life-saving measures on a man suffering from an overdose.

Police, in a statement, went on to say that while the officer was injecting the victim with Narcan he began to feel “dizzy and disoriented,” resulting in his transport to the hospital. Wareham Police said the officer was “most likely exposed to fentanyl particles in the air.” After treatment by emergency room staff, the officer was released.

Events similar to this have been reported by law enforcement agencies across Massachusetts and the rest of the country.

Yarmouth Police Chief Frank Frederickson said officers he oversees have dealt with similar situations while responding to overdose calls.

“We’ve had exposures of our own officers and it’s very real. We need to take all the precautions we can, but in emergency situations we may not have exactly the right amount of time or equipment to do the right thing save someone’s life, and have all those precautions ahead of time,” said Chief Frederickson.

“Since fentanyl has been introduced and growing in popularity over the past few years, the risk of getting exposed to fentanyl has increased, obviously.”

Both Chief Frederickson and Wareham Police Chief John Walcek said they had never heard of people in the medical community saying that fentanyl exposure for first responders was “highly unlikely.”

“I have not heard any of that and all I know is that Saturday night I was in the hospital with an officer that said that he felt like that was an exposure and the hospital staff felt like it was an exposure, and I’ll go with that,” said Chief Walcek.

“We consider it one of the hazards of the job. We do our best to minimize any exposure to the fentanyl, but we do the best we can. This is the first time that there appears to be an issue with it.”

Dr. Ryan Marino, an emergency medicine physician and medical toxicologist at the University of Pittsburgh School of Medicine, said that passive exposure – such as being in close proximity, breathing, or touching a drug is “dramatically different than intentional exposure,” – identified as injecting, snorting, smoking or vaporizing a drug.

“Fentanyl in street drugs comes as a dry powder. The fentanyl does not aerosolize. Additionally, it has to hit mucous membranes (like being snorted up the nose) to even be absorbed because it is not absorbed through skin,” said Marino. 

“In order to achieve airborne quantities sufficient to cause toxicity we would have to be talking about quantities in a massive fentanyl lab, assume that piles of the powder are just sitting out in the open, and then add in an element like a wind tunnel to get them inside the nose. Besides being extremely unlikely to ever happen, this isn’t a cause for concern when responding to overdose scenes.”

Marino said what he believes is a misconception presents a danger to overdose victims because it causes first responders to take up critical time meant for saving the victim with prepping for a harmful exposure to the drug.

“Just as with a heart attack or a stroke, in an overdose time is of the essence. When the public and first responders fear that just being at an overdose scene could make them sick then the overdose victims suffer, because they are in need of immediate active resuscitation, and do not receive that as instead time can be delayed for unhelpful and unnecessary measures like preparing a HazMat response,” Marino explained. 

Dr. Matthew Bivens, the EMS Medical Director for St. Luke’s Hospital in New Bedford, also said that fentanyl exposure at the scene of a single patient’s overdose is unlikely. 

He said fentanyl and similar synthetic opioids in powder form can be absorbed through moist mucous membranes including the eyes and nose, so if a first responder had a significant amount of fentanyl powder on their hand and then rubbed their eyes, for example, they could theoretically get a small opioid exposure. But he said the dose involved would be ‘trivial.’ There would be no local eye or nose damage, only systemic exposure, and the expected symptoms “would be totally trivial. At most you may feel vaguely unwell.”

But Dr. Bivens and Dr. Marino noted they had not been involved in the medical care of the specific case and so don’t really know exactly what happened.

“First responders see tens of thousands of overdoses every year, so with that kind of volume, even extremely rare hypothetical events are important to try to prevent. That’s why we encourage police and fire and paramedics to wear mask, gloves and eye protection on these calls, and to wash hands with soap and water afterwards,” Bivens said.

“At the same time, it is such a low-likelihood that anyone can be exposed to an opioid by caring for an opioid overdose, that the medical and first responder profession wants the public to feel safe to care for an overdose, and to provide Naloxone intranasal if indicated.”

But the potential for harm has prompted the Commonwealth of Massachusetts to implement strict rules regarding the presence of the drug inside courtrooms.

In Bay State courthouses, fentanyl and carfentanil has been banned from being brought into the building.

The State Executive Office of the Trial Court lists its official policy regarding drugs deemed to be too much of a “danger” to allow in courthouses as evidence. Only in specific scenarios, such as valid prescription medications containing the drug, can it be present.

The policy was last updated in January of 2018 on the official website of the Commonwealth of Massachusetts, mass.gov.

The State Executive Office of the Trial Court policy reads:

“Given the danger that even a small amount of these substances poses, the following policy measures are effective immediately:

1. Substances containing any amount of fentanyl or carfentanil are banned from entry into the courthouse, except as provided in paragraphs 2 and 3 hereof. This includes substances that have been collected as evidence and which would otherwise be entered in evidence at a hearing or trial. Parties who seek to present the appearance of a substance containing fentanyl or carfentanil to a fact finder must do so through means other than introduction of the actual substance, such as a stipulation, photographs, video, or witness testimony.
2. Persons who have a valid prescription for a medication containing fentanyl and who have a medical need to use such medication during the court day, will be permitted to bring their medication into the courthouse. Court staff taking notice of a prescription medication containing fentanyl will take precautions to avoid contact and exposure.
3. Deviation from the general ban on fentanyl or carfentanil from being entered as evidence may occur when a judge determines that admission of the substance as evidence is necessary for the Commonwealth to prove its case or to protect a defendant’s constitutional right to a fair trial. If a judge determines it necessary that a party be permitted to bring such substances into a courtroom, the substances shall be packaged and handled in the manner approved by the Drug Enforcement Administration (DEA);shall be handled while in the courthouse – including presentation of the substances in a courtroom – only by individuals who have been trained to handle fentanyl and carfentanil; shall not be permitted to be handled by jurors, but, even during jury deliberations, shall be presented to deliberating jurors for observation by an individual trained to handle fentanyl and carfentanil; and shall not under any circumstances be accepted for safekeeping by a clerk of the court, but shall immediately be returned after presentation in the courtroom to the officer or agent of the law enforcement agency that has custody of the substances. Determination that fentanyl, carfentanil, or its derivatives will be permitted to enter a courthouse shall be made in advance of the hearing or trial at which the substance will be presented. Court security shall be notified in advance of the date on which the substance will be entering the courthouse, the name of the case for which it is being brought into the courthouse, how the substance will be transported and who will be transporting it the courtroom in which the substance will be presented, and when the substances has been taken out of the building.
4. Because fentanyl and carfentanil take many different forms and appear as common street level controlled substances, any controlled substance that a party intends to introduce in evidence at a hearing or trial will not be permitted into a courthouse unless the substance has been chemically analyzed and determined not to contain fentanyl or carfentanil. A judge shall not permit a controlled substance to enter a courthouse until he or she has reviewed the certificate of analysis and is satisfied that the substance does not contain fentanyl or carfentanil.
5. Given the potency and potential lethality of fentanyl and carfentanil, any contact with these substances must be treated as a hazardous material (HAZMAT) situation and should be assessed only by individuals who have been trained to handle hazardous materials.
6. Because the potential exists that in-custody defendants or members of the public entering a court house could introduce fentanyl and carfentanil into the courthouse environment, and because fentanyl and carfentanil can appear as white or brown powder, all Trial Court personnel must be extremely cautious of any white powder and consider it a hazardous material. Any Trial Court staff member observing unidentified white powder should take immediate action to avoid personal exposure, limit public exposure, and isolate the substance from other court personnel or members of the public. Court security personnel should then be notified immediately. Court officers shall immediately notify the appropriate local first responder agency by calling 911. Court officers will also isolate the substance and avoid personal exposure. Only persons with appropriate personal protective equipment (PPE) shall be allowed in proximity to the suspect material. Court Officers will be prepared to administer first aid to those suspected of exposure to fentanyl or carfentanil.”

While Dr. Marino and Dr. Bivens both believe in the unlikelihood of harmful fentanyl exposure, they also expressed belief in the symptoms police officers and other first responders claim to experience.

“I understand this concern and I believe the symptoms they experience. It’s crazy what is happening out there and, frankly, it’s scary. If I was told that something was killing people and touching it could poison me, then I would react the same way,” said Marino, who went on to say that first responders should be reassured of their safety.

“As long as they follow standard precautions, though, they are safe from fentanyl and other opioids. This is one thing they don’t need to worry about. There are plenty of other hazards they encounter all the time, and I want them to be able to perform their job safely because they are truly the front line of this crisis and we all depend on them to resuscitate our loved ones. I can’t express how grateful I am for the work that first responders do day in and day out.”

On Friday, Attorney General Maura Healey announced a major fentanyl trafficking bust.

Months after her office won a new $3 million federal grant to support its Fentanyl Strike Force, two Lawrence men were arrested and arraigned this week after a joint federal, state and local investigation revealed their involvement in an alleged cross-state fentanyl trafficking operation in Massachusetts and New Hampshire.

The AG’s Office has been working closely with its federal, state and local partners to combat illegal drug trafficking.

Healey formed a Fentanyl Strike Force to more aggressively combat the heroin and prescription drug abuse crisis in New England.

By TIM DUNN, CapeCod.com NewsCenter