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Fentanyl: Preventing Occupational Exposure to Emergency Responders

Protecting Workers at Risk

Emergency Responders and Law Enforcement

Fentanyl and its analogs pose a potential hazard to law enforcement, public health workers, and first responders who could unknowingly come into contact with these drugs in their different forms. Police working dogs are also at risk of exposure. Possible exposure routes vary based on the source of the fentanyl. While dermal absorption of fentanyl commonly occurs through prescribed use of the drug, inhalation of powder is the most likely exposure route for illicitly-manufactured fentanyl. Inhalation exposure can quickly result in respiratory depression. Law enforcement personnel may come into contact with these drugs on the street during the course of law enforcement activities. The DEA recommends that officers do not field test drugs if fentanyl is suspected. The substance should be collected and sent to a laboratory for analysis.

First responders may also encounter violent behavior from the user when naloxone is used to reverse respiratory depression as it may put the user into withdrawal.

NIOSH has conducted Health Hazard Evaluations (HHEs) involving law enforcement and emergency responder exposure to hazardous substances at crime scenes.

Risk Assessment

The risks associated with fentanyl and its analogs highlight the need for first responders to perform a risk assessment on each crime scene and follow established work practices appropriate for the specific job tasking along with wearing personal protective equipment (PPE) to effectively manage risks that may cause an exposure. Established work practices are written policies and procedures, as well as tactics and techniques, used when fentanyl may be present to minimize the risk of exposure. This DEA website highlights the importance of adhering to established policies and procedures: https://www.dea.gov/divisions/hq/2016/hq092216.shtml.

Personal Protective Equipment

Fentanyl and its analogs such as carfentanil do not have established occupational exposure limits (OELs). Pharmaceutical manufacturers have developed internal OELs based on their own risk assessments. Time-weighted averages that have been used as OELs in the pharmaceutical industry are reported as 0.0001 mg/m3 for fentanyl, 0.000032 mg/m3 for sufentanil, and 0.001 mg/m3 for alfentanil (Van Nimmen et al.). NIOSH does not have any occupational exposure data on fentanyl among emergency responders. Therefore the NIOSH interim recommendations for PPE are based on the reported toxicity and chemical structure of fentanyl, NIOSH guidance for similar chemicals such as chemotherapy drugs, recommendations from previous NIOSH HHE Reports on a clandestine spice (synthetic cannabinoid) lab (HHE Report No. 2014-0039-3246) and on the preparation of pseudo drugs used at a Canine Enforcement Training Center (HHE Report No. 2004-0012-2948), and the basic principles of industrial hygiene. Standard safe work practices must to be applied to all operations where fentanyl or its analogs are known to be present, just as they are applied to any law enforcement operation where narcotics (i.e. a meth lab or heroin) may be present. Do not eat, drink, or smoke while performing operations involving any narcotics; and wash your hands after performing your duties.

NIOSH does not have enough empirical evidence to provide specific guidance for protection from exposure during every possible tactical law enforcement operation. Law enforcement personnel will need to assess the specific risks of each operation and determine the appropriate PPE to protect against respiratory and/or dermal hazards. Similarly, in the event of a large spill or release of fentanyl that could occur during the execution of a warrant or evidence collection operations, NIOSH recommends that law enforcement vacate the area of the release or spill and call a hazardous materials incident response team.

The following PPE recommendations are provided as interim guidance. These interim recommendations apply to routine activities after an arrest or search warrant execution such as evidence collection activities. This interim guidance applies to powder, pill, and liquid forms of fentanyl or its analogs that may be present during the evidence collection phase of the law enforcement operation. Following these recommendations can help to protect law enforcement and first responders while enabling them to carry out their important public safety functions.

Respiratory Protection

While handling and processing fentanyl and its analogs, first responders such as law enforcement personnel, emergency medical services (EMS), and fire fighters should wear either a NIOSH-approved: 1) half-mask filtering facepiece respirator rated P100; 2) elastomeric half-mask air-purifying respirator with multi-purpose P100 cartridges; 3) elastomeric full facepiece air-purifying respirator with multi-purpose P100 cartridges; or 4) a powered air-purifying respirator (PAPR) with high-efficiency particulate air (HEPA) filters. Both the filtering facepiece respirator and the half-mask elastomeric air-purifying respirator should be worn with appropriate eye and face protection. The multi-vapor P100 cartridges are designated by the olive and magenta colors on the cartridge. Additionally, chemical, biological, radiological, and nuclear (CBRN) canisters—designated by its olive green color—provide P100 protection.

Respiratory protection should be worn in accordance with the respirator selection, medical clearance, fit-testing, and other requirements of the OSHA Respiratory Protection standard. No facial hair is permitted when using any of these recommended respirators (except for the use of a loose-fitting hood with the PAPR) (Occupational Safety and Health Administration (OSHA), 2011).

Additional Respirator Resources
How to remove gloves infographic

Gloves

NIOSH recommends wearing nitrile gloves when handling fentanyl-related compounds. While the permeation rate of fentanyl through nitrile is unknown, nitrile generally shows low permeability to other hazardous drug compounds. While latex gloves may provide similar protection, NIOSH does not recommend the use of latex due to the potential for allergic reactions. Nitrile gloves should be purchased with a minimum thickness of 5 mil (0.127 mm). Although thicker gloves may offer better protection, thickness does not always indicate the level of protection and may interfere with dexterity. Powder-free nitrile gloves are recommended; powder particulates from the glove may absorb the narcotic compounds which may increase the potential for dermal contact/absorption during doffing and spread contaminants to unintended surfaces.

Gloves should be selected with the correct size and fitting—gloves that are too small may be uncomfortable to the user and may tear and overly large gloves may interfere with dexterity. If the gloves are torn or punctured, they should be changed immediately. Gloves should be replaced after 30-60 minutes of use. Gloves should be removed upon exiting the processing location and new gloves donned upon reentry of any location to reduce contamination. The practice of “double gloving” (wearing two sets of gloves) is suggested while handling fentanyl-related compounds. If sleeve cuffs are present, the inner gloves should be worn under the sleeves, while the outer gloves should be placed over the sleeve cuff. After handling the drugs, the outer gloves should be removed and properly disposed of while the inner gloves can be used to label evidence. The inner gloves should then be removed and hands washed immediately with soap and water. Gloves should be removed using the technique shown in the graphic on the right, “How to Remove Gloves”.

Glove color is simply a personal preference, however 1) the use of black gloves may allow the user to better visualize the amount of drug powder residue on the glove, and 2) the use of two colors while “double gloving” can help visualize outer glove holes and tears.

Eye Protection

If an elastomeric half mask respirator is used instead of a respirator with a full facepiece, safety goggles/glasses should also be worn for ocular protection.

Coveralls, Boot Covers, and Protective Sleeves

First responders who are performing any task that would potentially aerosolize fentanyl, such as sweeping or “burping” bags to remove air, should wear dermal protection that covers their arms and legs. Options include coveralls or chemical-resistant and disposable protective sleeves that are impermeable, coated, and film-based. Coveralls worn over work clothing should fit snugly at the wrists and ankles to decrease contamination at these interfaces; protective sleeves should fit snugly at the wrist and bicep. Chemical-resistant/disposable boot covers are also recommended to reduce spread of contamination. Gloves, coveralls, boot covers (which may be purchased as one piece), and protective sleeves should be appropriately disposed of immediately after use.

PPE tested and certified to the National Fire Protection Association (NFPA) standards are recommended. This will provide confidence that the different types of PPE components meet minimum acceptable levels of performance criteria such as permeation/penetration resistance and physical properties. This assures that the PPE products have passed independent third party certification and acceptable quality control requirements during manufacturing.

  • NFPA 1992 Standard on Liquid Splash-Protective Ensembles and Clothing for Hazardous Materials Emergencies
  • NFPA 1994 Standard on Protective Ensembles for First Responders to CBRN Terrorism Incidents
  • NFPA 1999 Standard on Protective Clothing and Ensembles for Emergency Medical Operations
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