By Shawne Maile and Jerry Knapp
A county hazmat team responded to a police station for a white powder call and was asked to identify the unknown powder. On arrival, the team was surprised to see the station surrounded by yellow barrier tape. Team members were directed to enter through a back door, where they received a situation report from the desk sergeant.
A mother and her nine-year-old son were in the lobby. A small lunch bag containing the white powder was on the shelf in front of the police desk window. Although fear permeated the air as the woman described this mysterious powder her son brought home, team leaders entered the lobby to interview her. They did not wear any personal protective equipment (PPE). Team leaders first asked if any of the police officers, the mother, or her son had any ill effects. They did not. She did not know where her son had gotten the powder. The young boy was wide-eyed and silent at his mother’s side. The desk sergeant asked if he needed to move his public safety answering point and dispatcher to an alternate site. All Mom knew was white powder came out of a small toy, and she was very afraid.
Team leaders sat down in the lobby chairs to be closer to the boy’s level and asked a few questions. In summary, he explained that he had gotten a small stuffed animal from a vending machine at the exit of the local grocery store. When he brought it home, he cut it open to see what was inside, and the white powder came out. Additional discussion of the events revealed no skin rashes, sickness, or ill effects whatsoever.
“Have you ever done this before?” the team leader asked. “Oh sure, about a month ago,” the boy replied. Mom’s anxiety increased as that of the hazmat team and the police sergeant decreased. The team’s technicians donned latex gloves and sampled the material. Testing revealed the powder to be flour.
We have all been to numerous “mysterious white powder” calls. Like natural gas odor calls, the majority of them turn out to be nonhazardous, so we naturally get complacent over time. Complacency is dangerous. Hazmat teams and police across the country routinely find the mysterious white powder to be flour, sugar, or talcum powder. It is no wonder we get complacent.
Fentanyl, New Threat to Responders
This article is to familiarize you with fentanyl, another common but much more dangerous white powder. Following are suggestions for response procedures, PPE, and lines of questioning that will help protect you and your members.
Members of a police department’s Special and Weapons and Tactics (SWAT) team fell ill during the execution of a narcotics search warrant. The narcotics unit had requested the police department’s SWAT team to assist in executing a search warrant at a known drug trafficker’s residence. Over the course of the past month, the narcotics unit had been using an undercover officer to purchase heroin from this trafficker, building probable cause to execute a search warrant. According to a confidential informant, the trafficker stated that he was mixing (homogenizing) his heroin with fentanyl.
On the day of the operation, the local SWAT team executed the search warrant. In the process of arresting the trafficker, suspected heroin and another powdery substance were aerosolized. A small table was kicked over during the raid and scuffle with the suspects. White powder on this work table spilled onto the floor. Just after the suspect was handcuffed and the situation seemed to stabilize, things went bad. Members of the SWAT team started to feel drowsy, and some operators vomited and developed respiratory distress.
Narcotic unit detectives followed the SWAT team into the apartment after the “All Clear” was given over the radio. The detectives, aware of the new and deadly hazards of fentanyl, looked for and found some of the warning signs suggesting this dangerous chemical/synthetic drug was present. In the area of the spilled white powder, they observed that the trafficker had been mixing a kilogram of heroin with fentanyl and then packaging the heroin for street sale. A used Tyvek® suit and an air-purifying respirator (APR) were observed nearby. Unsure of what was sickening the SWAT team members, the police department requested that the fire department and hazmat unit respond.
Fentanyl in its powdered form represents a new and dangerous threat to all emergency responders. We need to be aware of and apply new and seemingly complex response protocols as well as don additional PPE. Fentanyl is classified as a narcotic analgesic. Analgesics are drugs that dull or reduce pain. It is legitimately and legally distributed medically as patches or lozenges. In these forms, it serves legally and admirably in the medical community. (See sidebar “Fentanyl Facts.”) Fentanyl is a synthetic or manmade narcotic analgesic that has effects similar to, but more potent than, heroin. Fentanyl is often referred to as “heroin on steroids.” It is 30 to 50 times more potent than heroin.
A chemical variant (analog) of fentanyl is carfentanyl (or carfentanil) and can be 10,000 times more potent than heroin. Both fentanyl and carfentanyl look like harmless white powders. According to Ohio officials, 174 individuals overdosed in the Cincinnati area over the summer of 2016. Officials believe that some of the heroin was cut with carfentanyl.
Historically, fentanyl is nothing new; it has always played a small part in the illicit opioid narcotic trade. The northeastern portion of the United States has seen the worst of the explosive heroin epidemic. Drug users are always looking for the next newer or stronger high, and fentanyl is filling that void. Law enforcement personnel are encountering fentanyl, whether while executing search warrants at heroin mills, making undercover purchases of what was believed to be heroin, or responding to overdoses.
Because of the heroin epidemic, other first responders in joint operations with law enforcement are also coming in contact with fentanyl on a daily and dangerous uncontrolled basis. Numerous case histories like those described earlier are not uncommon. Illicit fentanyl is often manufactured in China and smuggled illegally through western Canada, where it is trafficked across the northern United States border for distribution in kilogram-size lots.
The lethal dose of fentanyl is as small as two milligrams, which is equal to three granules of salt or sand. Mixing very small quantities of fentanyl with heroin can result in lethal overdoses for drug users. This is also a concern for first responders that necessitates wearing specialized PPE. Because of the microgram size of the powder, fentanyl can penetrate the filters of commonly used APRs. First responders should consider using self-contained breathing apparatus and Level A PPE when encountering fentanyl operations.
Teamwork is the formula for success at incidents involving fentanyl. Specialized law enforcement units are trained to wear the necessary PPE and are familiar with the hazards. Fire/hazmat units are experts in this level of PPE but may lack familiarity with the hazards of fentanyl. Don’t hesitate to call specialized law enforcement teams to help mitigate these dangerous drug situations.
New Response Considerations
Fentanyl enters the human body through inhalation and is also absorbed through the skin or mucous membranes (transdermal absorption). Operationally, many specialized law enforcement drug units are using Level A hazmat PPE as the standard for protection for their members. Although this sounds like an excessive level of PPE, fentanyl ranks right up there with PCP and LSD laboratories in terms of their numerous deadly hazards. Consider flash protection of the totally encapsulated suit since many drug-processing procedures use flammable liquids as solvents.
One currently employed method of producing fentanyl in the United States is the Siegried Synthesis Lab. It is not difficult to recognize an illegal drug lab. Apparatus and tools common to this method include laboratory glassware such as round bottom flasks and petri dishes, heating platforms, condensers, containers of solvents, PPE, and possibly pressurized tanks. In addition to toxicity concerns, consider air monitoring for the flammable vapors arising from the solvents used in the synthesis process, especially if containers are open or spilled during a raid. Since flammable vapors may be present, limit ignition sources (pilot lights, electric sparks) as a component of your response or entry plan. Exothermic reactions involving other components may provide an ignition source for flammable solvent gases.
Strategic Response Considerations
The following approaches can help to reduce the hazard to your team members when responding to a call that may involve fentanyl:
- Be aware of the potency and exposure routes. Ask questions to determine if there is any chance that the powder you are dealing with may be fentanyl. The goal is to prevent exposures by proper planning before the operation begins. Appropriate on-scene questions include the following: Is anyone injured or showing any symptoms? Has anyone been transported to the hospital? Is this an overdose call? Are there any persons with altered mental status or dead-on-arrivals (DOAs) on scene? Is there any chance this is a drug lab or a drug-associated call? Did law enforcement do any field tests on the powder in question? If so, what were the results? Why did you call the hazmat team or the fire department? Are there any unusual odors? Are the occupants exhibiting suspicious behavior?
- Tactical and immediate withdrawal may be your best option if you are actually or potentially exposed to fentanyl. This could occur during a law enforcement operation, an emergency medical services (EMS) call (possible overdose, DOA, for example), or on a fire response because of the lab catching fire. Tactical withdrawal may be especially important if on-scene members present with symptoms of overdose such as vomiting, dizziness, headaches, breathing distress, or respiratory/cardiac arrest. Get appropriate amounts of naloxone on scene quickly, or transport to the nearest hospital immediately. Because of the potency of fentanyl, inhalation or transdermal overdoses are possible.
- When planning operations of any kind that may involve fentanyl, be prepared to treat members that may be exposed. Plan for adequate amounts of naloxone to be immediately available and a wet decon line and hazmat or HazTac paramedics to be on standby at the scene.
- Consider NOT collecting and field testing samples to avoid contaminating the crime scene and becoming a fentanyl victim. Only a specialized law enforcement clandestine lab team should handle powders and unknown liquids.
- Maintain physical security. Be sure that the suspects are under arrest and the scene is safe from firearms and other weapons.
- Although responders may be experts in their discipline, they may not be familiar with the numerous hazards of drug labs and powerful narcotics. Responders should consider NOT entering the area if they do not have a specific mission. In short, if lives are not involved, waiting for the local or state police or Drug Enforcement Administration (DEA) Clandestine Drug Lab Team may be the most prudent option.
- If fentanyl is involved, it is likely a crime scene. Preserving evidence by not moving deceased victims, drug-processing apparatus, and other objects is a must. If the incident was a fire scene, delay overhaul until investigators can process the scene and identify any hazardous chemicals involved in the drug-making process. If this is not possible, photograph or videotape the scene. With the help of local law enforcement, maintain custody and the chain of evidence these photos captured.
- Calls that start out as relatively common narcotics investigations, EMS, or fire calls will become immediately more complex and dangerous if drugs like fentanyl or carfentanyl or drug labs are discovered. State police or DEA Clandestine Drug Lab Teams have the combination of specialized training and PPE to safely mitigate these types of calls.
- Raman spectroscopy-based field instruments can determine if controlled substances, precursors, and other cutting agents are present. Although these instruments are often part of the hazmat team instrument capability, consider close cooperation with law enforcement specialized drug teams to ensure evidence protection and other legal and safety issues.
The scenarios at the beginning of this article come from real-life cases. They provide three very valuable lessons. First, law enforcement, EMS, and fire and hazmat must never become complacent. We all work in uncontrolled environments. Second, we must consider hazards not usually associated with our primary mission when planning a response operation. Third, fentanyl is one of the latest evolving extreme hazards every public safety discipline faces. With a proper understanding of the hazards and how to mitigate them, we can respond and safely resolve this new and different type of call.
Authors’ Note: The opinions and statements contained in this article are those of the authors only and do not represent the opinions or interests of the New York State Police. The authors thank Racheal Stubbs, forensic scientist, New York State Police, Mid-Hudson Crime Laboratory, for her help with this article.
SHAWNE MAILE is an investigator with the New York State Police Contaminated Crime Scene Emergency Response Team and has been involved in narcotic investigations for 14 years, with a specialty in investigating and processing clandestine drug laboratories and indoor marijuana grow operations. He is a State Police instructor for clandestine drug labs and marijuana grows and has lectured on these topics to more than 80 federal, state, and local law enforcement and first responder agencies. He has been featured in training articles and lectures for the U.S. Drug Enforcement Administration, U.S. Customs and Border Protection, and the Fire Department of New York. He is a certified New York State hazardous materials technician.
JERRY KNAPP is a 40-year veteran firefighter/EMT with the West Haverstraw (NY) Fire Department and a training officer at the Rockland County Fire Training Center in Pomona, New York. He has a degree in fire protection, is the chief of the Rockland County Hazmat Team, and is a battalion chief and a member of the Rockland County Hazmat Task Force. He is the author of the Fire Attack chapter in Fire Engineering’s Handbook for Firefighter I and II and of numerous articles for Fire Engineering. He is on the technical panel for the latest Underwriters Laboratories study on fire attack at house fires and recently retired from the U.S. Military Academy, West Point, as the plans officer, Directorate of Emergency Services.
By Mike McEvoy
Fentanyl is an extremely potent synthetic (manufactured) opioid medication that acts quickly and has a short duration of action. It is used for treatment of severe pain. Fentanyl comes in several forms including intravenous, transdermal patches, and oral or nasal spray. It acts on the opioid receptors in the brain, spinal cord, and other tissues and results in analgesia (pain relief), euphoria, and drowsiness. Fentanyl is also a respiratory depressant and a cough reflex suppressant; it causes constriction of the pupils. It directly stimulates the chemoreceptor trigger zone and slows peristalsis in the gut, both of which can result in nausea or vomiting.
Dose-wise, 100 micrograms of fentanyl is roughly equivalent to 10 milligrams of morphine. A dose of morphine given intravenously would be expected to last for three to four hours, whereas fentanyl can be expected to last less than two hours. This makes morphine a safer drug for patients with severe pain, as the longer duration of action requires less total narcotic each 24-hour period. In addition, compared to equivalent doses of morphine, patients with severe pain often need more fentanyl for effective pain control. The advantage of fentanyl for patients with acute pain is the much shorter duration of action. Fentanyl may also be less likely to lower blood pressure and produce other side effects believed to be associated with histamine release (such as itching) compared to morphine.
The strength of fentanyl and its availability in various forms has led to numerous deaths from accidental overdoses. The victims include children chewing on fentanyl patches disposed of in household waste containers and friends or family members given fentanyl liquid, sprays, or patches by patients with prescribed fentanyl. Patients themselves are at risk of overdose when adjusting fentanyl doses. To reduce accidental deaths, the Centers for Disease Control and Prevention is encouraging better prescribing practices; education of patients and family members on the proper use, storage, and disposal of fentanyl; and increasing the availability of naloxone when fentanyl is prescribed.
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