NIOSH’s Virtual Toolkit for First Responders Addresses Illicit Drugs

The National Institute for Occupational Safety and Health (NIOSH) has released a new virtual toolkit to help first responders reduce their exposure to fentanyl and other illicit drugs. The toolkit provides resources to help keep first responders safe when arriving on a scene where illicit drugs, including fentanyl, are present or suspected to be present.

First responders are at risk of inhalation; mucous membrane contact through nose, eye, and mouth; ingestion; dermal and needlestick exposure to illicit drugs.

The toolkit includes two training videos that can be used during for roll call along with infographics and postcards based on NIOSH recommendations. The institute developed the training videos in collaboration with the Fredericksburg, VA Police and Fire Departments, and the FBI Laboratory.

The resources are intended to accomplish three goals:

• Highlighting how to assess a response scene for hazards that may indicate the presence of illicit drugs.
• Illustrating what personal protective equipment (PPE) to wear and how first responders should decontaminate themselves and their equipment, and
• Providing guidance on how to prevent take-home exposure to protect the families of first responders who may have been exposed.

The videos, infographics, and postcards can be shared with first responders and others via social media and text. Infographics and postcards can be printed.

Exposure Levels, PPE Recommendations

NIOSH has developed PPE recommendations for first responders—emergency medical services (EMS) personnel and law enforcement officers—based on observable exposure conditions.

The institute’s definitions of exposure levels and corresponding PPE recommendations are:

• Minimal exposure—Response to a situation where it is suspected that fentanyl may be present but no fentanyl products are visible, such as an EMS response to a suspected fentanyl overdose or law enforcement operation where intelligence indicates fentanyl products are suspected but are not visible on scene. NIOSH recommends wearing nitrile gloves only.
• Moderate exposure—Response to a situation where small amounts of fentanyl products are visible, such as, an EMS response to a suspected fentanyl overdose or law enforcement operation where fentanyl products are suspected and small amounts are visible on scene. NIOSH recommends wearing nitrile gloves, arm coverings, eye protection, and either an N, P, or R-100 disposable filtering facepiece respirator; or N, P, or R-100 reusable half-facepiece elastomeric respirator.
• High exposure—Response to a situation where liquid fentanyl or large amounts of fentanyl products are visible, such as, a fentanyl storage or distribution facility, fentanyl milling operation, or fentanyl production laboratory. NIOSH recommends first responders not enter spaces where high exposure is likely.

Special operations or decontamination personnel who must enter areas with high levels of exposure must use specialized PPE, including a powered air-purifying respirator (PAPR) with high efficiency particulate air (HEPA) filter or self-contained breathing apparatus (SCBA) and chemical hazards protective ensemble or particulate hazards protective ensemble.

First responders must undergo medical screening, fit testing, and training before using respiratory protection. Most respirators require wearers to be clean-shaven to ensure a proper respirator seal. Nothing should come between the respirator and wearer, including radio earpieces, hats or helmets, glasses or goggles, or ear-mounted cameras.

Users must first don a respirator before putting on other headgear. PPE wearers also must perform user seal checks of respirators before entering a hazardous environment.

After leaving the scene, PPE must be removed and either cleaned or disposed of.