AIHce EXP Panel Addresses Dangers of Opioid Crisis for First Responders

By Kay Bechtold

Pennsylvania Convention Center, Philadelphia, Pa. (May 22, 2018)—AIHA Past President Steven E. Lacey, PhD, CIH, CSP, set the tone for Tuesday morning’s general session on mitigating opioid exposure risks to first responders with some sobering statistics: in 2016, more than 65,000 Americans died of drug overdose, which means that overdoses killed more people in one year than the number of Americans killed in the entirety of the Vietnam War. Two-thirds of those deaths were attributed to opioids. The opioid crisis carries an economic burden as well: Lacey noted that in 2015, the U.S. spent 2.8 percent of its GDP to fight the opioid crisis.

“We’re talking about a public health crisis, not a moral crisis,” Lacey said before introducing a panel of experts to discuss the precautions first responders must take when responding to medical emergencies and investigating illicit drug activity. “It’s our job as hygienists to think as far upstream as possible about prevention. Everyone in this room is involved in the opioid crisis whether they know it or not.”

The panel comprised Philadelphia Fire Commissioner Adam K. Thiel; Kemp Chester, associate director of the White House Office of National Drug Control Policy; NIOSH Director John Howard, MD, MPH, JD, LLM, MBA; and AIHA Board member Donna S. Heidel, CIH, FAIHA. While the speakers focused on first responders, including law enforcement, emergency medical technicians, and crime lab analysts, they acknowledged that many other workers are potentially affected by the opioid crisis. Other professionals at high risk of exposure include healthcare workers, funeral directors, customs and border control agents, and workers in the pharmaceutical manufacturing industry.

In Philadelphia, AIHce EXP 2018’s host city, the fire commissioner expects that his department will likely have to administer naloxone, a drug that reverses opioid overdoses, 5,000 or more times this year. Thiel said that his department treats fentanyl “like a hazmat incident,” sometimes going so far as to decontaminate ambulances that carried victims of fentanyl overdose.

“It is absolutely a tragedy,” he said of the opioid crisis. “And it’s absolutely preventable.”

Thiel said that medics and EMTs generally approach most incidents by first listening to the information from dispatchers. First responders know where they’re going, sometimes they know the address, and sometimes they even know the patients, he noted. Medics and EMTs now wear gloves on every incident, and Thiel stressed that glove selection makes a difference.

“These are nonroutine operations for firefighters, EMTs, and law enforcement, and they’re very unpredictable in nature,” Heidel said. “The industrial hygienist needs to really have a detailed understanding of the work tasks that are performed by each responder group [in order to apply exposure assessment principles].”

When responding to a person who may have been overdosed with fentanyl or its analogues, responders must realize that activities such as disturbing clothing that may be contaminated or gathering up bedding has the potential to cause airborne concentrations that could result in health consequences, she explained. Cleaning and standard vacuuming could also cause adverse effects to workers in that environment.

Thiel said that the fire department will soon be hiring an industrial hygienist to help address opioids and other exposures.

“Our work environment is not a controlled situation,” he said. “We never have home field advantage, and we never know where we’re going. Sometimes we’re in a bathroom, a car, or a gas station parking lot, so whatever the ideas are for protection have to be calculated to the actual operating environment and all those variables.”

NIOSH’s Health Hazard Evaluation Program allows the agency, upon request, to investigate occupational exposures. NIOSH personnel have never seen any of the typical opioid overdose symptoms in any first responder, Howard said.

“They’re just not feeling right, and they notice when they’re not at 200 percent,” Howard said, likening first responders to athletes. “Nobody has had any respiratory depression that you would associate with a classic toxic response.”

One big lesson NIOSH has learned from these health hazard evaluations is that mucus membrane contact is the number-one cause of opioids exposures to first responders. Howard described a video he had seen of a police officer responding to a situation in which powder was visible in a car. The officer put on gloves before handling anything in the vehicle, but then went back to his squad car and began typing on his computer before removing the gloves. The incident demonstrates the importance of situational awareness, Howard said.

Together with many other agencies of a federal interagency working group, NIOSH helped develop new fentanyl safety recommendations for first responders, which were published in November 2017 in conjunction with the fifth meeting of President Trump’s broader Commission on Combating Drug Addiction and the Opioid Crisis. Leading up to the meeting, AIHA provided several recommendations to the commission on protecting first responders from exposure to opioids and their synthetic analogues. The recommendations answer several key questions and lay the groundwork for future actions.

Chester, of the White House’s Office of National Drug Control Policy, outlined some of the recent achievements in the fight against the opioid crisis. The commission’s recommendations meet the need for consistent, science-based guidance across the federal government, he said. Chester mentioned that AIHA was instrumental in that process.

“We were thinking about EMS, but not thinking about other worker populations, so when we came up with guidelines, we included those other workers,” he said. “There was this entire universe of folks who could come into contact with these drugs that we weren’t even considering.”

Chester’s office is in the final stages of completing a four-minute video that depicts the scene of an overdose that will be released across the country to help raise awareness about this issue. The administration is focused on reducing the availability of opioids, doing a better job of bringing in the postal inspection service to address drugs being shipped by mail, and increasing the availability of naloxone across the country. Chester said his office is also working hard to prevent initiates to drug use and provide treatment to affected individuals.

“We cannot be in a situation where in a community it’s easier to get heroin or fentanyl than it is to get treatment,” he said.

Chester urged AIHce EXP attendees to keep discussing the issue and sharing information and best practices.

“This opioid crisis is affecting all of our workplaces,” Heidel said. “We have to make sure that our people in our workplaces who deliver first aid understand the signs and symptoms of overdose, how to render aid to those people, and how to protect themselves.”

She also urged attendees to join AIHA’s Opioids Work Group, which is developing specific practical guidance in this area. One possible upcoming project is to produce a video that shows proper PPE donning and doffing techniques. Wallet-sized reference cards are another product the group intends to develop for first responders to tuck into their uniforms while they’re on the job.

“Keep doing what you’re doing,” Lacey urged the industrial hygienists and occupational health and safety professionals in the audience. “If no one gets injured in the workplace, those opioids won’t be prescribed in the first place.”

“We did not get here overnight, and it would be irresponsible to think we could solve this in 90 days or so,” Chester warned. “We ought to be realistic about how long it’s going to take us to emerge from this.”

Kay Bechtold is senior editor of The Synergist.

View more Synergist coverage of the conference on the AIHce Daily page.

Related: The Synergist has published several recent articles on fentanyl and opioids exposure, including “The Opioid Abuse Epidemic: How Can Our Profession Help?,” “Occupational Exposures to Fentanyl,” and “Protection in an Uncontrolled Environment: Emergency Responders and Opioids Exposures.” Additional perspectives from Synergist readers can be found in the letters to the editor published in the March 2018 issue.