The American College of Medical Toxicology (ACMT) Collaborates with Federal Agencies on ‘Fentanyl Safety Recommendations for First Responders’

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The American College of Medical Toxicology (ACMT) continues to clarify risk of fentanyl exposure for first responders

We want first responders to feel confident and to be safe when dealing with possible fentanyl calls; but we don’t want them to be paralyzed by fears that are unwarranted.

A position statement regarding fentanyl exposure in first responders, published by the American College of Medical Toxicology (ACMT) and American Academy of Clinical Toxicology (AACT) in July 2017, continues to pave the way in clarifying risks of dermal and inhalation fentanyl exposure.

ACMT is working with federal partners to achieve the goal of an informed and safe first responder workforce. ACMT’s medical toxicology experts collaborated with federal agencies on Fentanyl Safety Recommendations for First Responders recently published by The White House.

Emergency medical services (EMS) and law enforcement are concerned about the risk of inhalational or dermal absorption of fentanyl and its analogs following routine scene responses. Although there are media reports of illness, there are no credible reports in the medical literature, and it is highly improbable that such an adverse effect could occur, particularly with skin only or casual contact.

An intentional release of specially-prepared fentanyl analogs with long delays to identification and treatment is the only example documenting fatal adverse effects from airborne dispersion (Moscow in 2002). Drug dealers handle large quantities of these potent drugs – which are increasingly being found in the US heroin supply and counterfeit pharmaceuticals – without experiencing adverse effects. Absorption of fentanyl across the skin is very slow and requires special formulation (such as used in fentanyl patches). Drug users are not overcome by casual contact, but only through deliberate ingestion, injection, or insufflation.

Because fentanyl and its analogs are solids and are not volatile, there is no inhalational risk at a typical overdose or crime scene. Similarly, powdered drug on surfaces does not pose a risk if left undisturbed; gloves should be worn as a precaution in such situations. In the presence of airborne powdered drug, such as at a pill production facility, the risk of inhalation may be consequential; respiratory and ocular protection should be utilized in these uncommon encounters. Fully-enclosed biohazard suites complete with a self-contained breathing apparatus are not necessary if airborne exposure is unlikely (and may be hazardous to responders wearing them).

ACMT President Charles McKay, MD, adds, “We know that responders are concerned – we want them to feel confident and to be safe when dealing with possible fentanyl calls; but we don’t want them to be paralyzed by fears that are unwarranted in the vast majority of situations, nor burdened by time-consuming, costly, and cumbersome equipment that could put them and others in harm’s way.”

ACMT and AACT recognized the need to balance safety regarding fentanyl and its analogs in the workplace with the ability to function on the job. A team of physicians, pharmacists, and scientists – all of whom specialize in toxicology – combined their knowledge and expertise to create a fentanyl/analog guideline for EMS and law enforcement.

Recommendations include:

  • Using gloves and eye or respiratory protection based on a properly interpreted scene assessment
  • Recognizing the opioid toxidrome - the predictable slowing or “down” effects of opioids on breathing, alertness, and pupil size
  • Having naloxone available and training personnel for how and when to use this opioid reversal agent

Certain issues – such as benefits or risks to different cleaning practices, and actual measurement of possibly absorbed drug from workplace encounters – require more data.

Additional recommendations and guidelines can be found in the ACMT and AACT Position Statement: Preventing Occupational Fentanyl and Fentanyl Analog Exposure to Emergency Responders
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ACMT—Advancing the Toxicological Care of Poisoned Patients and Populations

The American College of Medical Toxicology (ACMT) is a professional, nonprofit association of more than 700 physicians with recognized expertise in medical toxicology. Medical toxicology focuses on the diagnosis, management, and prevention of poisoning/toxicity and other adverse health effects resulting from medications, chemicals, occupational and environmental substances and biological hazards.

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Kristen Malecki
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