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Evaluation of potential occupational exposures to opioid drugs during an emergency medical services response (interim report)
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    "Introduction: The Health Hazard Evaluation program received a request for an evaluation regarding concerns about possible exposure to opioids (including fentanyl or its analogues) after a fire fighter-EMS responder developed symptoms during an EMS response to a drug overdose in January 2018. We visited the fire department on January 31 - February 1, 2018. After the visit, in February 2018, we sent interim letters to the fire department and employee representatives summarizing our activities and preliminary findings. At the time of the evaluation, the fire department had approximately 65 full-time career fire fighters, who were cross-trained to provide EMS at the emergency medical technician level or above, and 6-7 office-based employees. The fire department had two fire stations. In addition to three engine and ladder/tower companies, the fire department staffed two ambulances. One ambulance was continuously staffed by fire fighter-EMS responders. The second ambulance was staffed by fire fighter-EMS responders during daytime hours and a volunteer rescue squad at night. Fire fighters also provided EMS from fire apparatus as needed, for example, when ambulances were responding to other calls. Fire fighters worked in 24-hour shifts on days 1, 3, and 5 of a 9-day cycle and were off on days 2, 4, and 6-9 of the cycle. The fire department responds to approximately 6,500 fire and EMS calls each year. Recently, the fire department has received an increased volume of calls related to drug overdoses or in which suspected opioid drugs were visible on-scene. This trend is consistent with the increased number of drug overdose fatalities related to fentanyl, fentanyl analogues, and heroin in the Commonwealth of Virginia. No incidents of fire fighter-EMS responders developing symptoms after exposure to opioids had been reported prior to the January 2018 incident. However, a first responder in a neighboring jurisdiction reportedly developed symptoms after potential exposure to an opioid in the past year. Conclusions: During an EMS response incident in January 2018, Responder A developed health effects after treating a victim with suspected opioid overdose. The etiology of symptoms and potential source of exposure for Responder A could not be definitively identified. First responders wore PPE that followed current NIOSH interim guidance [NIOSH 2017] in situations where opioids are suspected to be present, but not visible. Further evaluations and research are needed to improve understanding of the routes of exposure and potential health effects among first responders potentially exposed to opioid drugs (including opioids such as fentanyl and fentanyl analogues) in the course of their work. Training to improve understanding of (a) the routes of exposure to opioids likely to cause symptoms; and (b) measures to protect against exposure to opioids can likely help prevent exposures and prevent health effects among fire department employees and other first responders." - NIOSHTIC-2

    NIOSHTIC no. 20051369

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