Fentanyl, a synthetic opioid, has long been used in the management of pain from chronic disorders, cancer, and severe discomfort. ^{Reference Stanley1} The opioid epidemic, fueled by abuse of prescription opioids, has created demand for illegally manufactured opioids, including fentanyl. The introduction of fentanyl into the illicit drug supply has exacerbated the mortality associated with the opioid epidemic. ^{Reference Jannetto, Helander and Garg2} From 2016 to 2017, synthetic opioid-involved overdose death rates increased 45.2%.” ^{Reference Scholl, Seth and Kariisa3}

New York State’s experience is similar to the nation’s condition. New York State in 2016 would register 8.3 deaths per 100,000 people once adjusted for age, compared with 1.4 deaths per 100,000 in 2014 due to synthetics opioids other than methadone. ⁴ The epidemic in New York State would not be limited to rural or suburban areas as New York City would also face increased rates of fentanyl-involved overdose deaths of almost 3,000% from 2014 to 2017. ^{Reference Colon-Berezin, Nolan and Blachman-Forshay5}

As overdoses have surged, first responders (police, emergency medical services [EMS}, and fire) have been thrust into emergency scenes in which contact with extremely potent drugs is a possibility. These scenes include traffic stops, laboratory seizures, and overdose scenes with unknown drugs in proximity. There are widely varying perceptions of hazard associated with exposure, complicated by the numerous forms in which fentanyl can appear. ^{Reference Howard and Hornsby-Myers6}

Initial concerns over hazards to responders may have been heightened by early warnings from law enforcement sources. ⁷ Since these early concerns, guidance from authoritative sources places the risk of an overdose exposure to fentanyl by means of skin contact as very low in likelihood. ^{Reference Hornsby-Myers, Headley and Dowell8,Reference Moss, Warrick and Nelson9} Nonetheless, uncertainty over protection from fentanyl-containing drugs has contributed to anxiety and misinformation among first responders. As exposures have grown, sensational media reports reporting often nonspecific symptoms following casual exposure to suspect materials have become commonplace. ¹⁰

To understand first responder risk perceptions and knowledge regarding fentanyl exposure and identify potential gaps in their training, a pilot survey of first responders was developed and launched in early 2019. The goal was to gather basic information that can be used to develop evidence-based interventions, including training programs, and to fill gaps in information for first responder perspectives on occupational exposure.

RESULTS

A total of 247 responses were received. Of these, 187 responses were from first responders serving New York State, while no other state registered more than 9 responses. Based on the small relative number of responses from outside New York State, it was decided to limit the analysis to New York first responders. As a diverse state with regard to community and agency size, the results offer some generalizability.

Of the 15 associations contacted for distribution, 3 acknowledged and responded that they would distribute the survey among first responders in their associations. The average time to complete the survey was approximately 5 min per respondent.

The 187 responses were mostly from law enforcement and EMS, with a smaller number of fire service respondents. In terms of agency service area and size of municipalities within the State, the law enforcement sample was fairly evenly distributed, while EMS was skewed toward large agencies of those serving population greater than 250,000 people. Agency affiliations and populations served are summarized in Table 1.

TABLE 1 Agency Affiliation and Population Served

The sample was generally of personnel with significant experience, with a majority of all disciplines having more than 15 years of experience. Notably, 53.5% of EMS, law enforcement, and fire/EMS personnel had encountered fentanyl or suspected fentanyl in the course of their work.

A series of questions on general knowledge of fentanyl self-protection and symptoms of exposure were asked using a Likert scale. The results are summarized in Table 2.

TABLE 2 Risk Perception Responses by Occupation

Protective Measures

Ninety-two percent of personnel were aware that naloxone could be used to treat exposure to fentanyl. With regard to proper gloves for handling suspected fentanyl-containing substances, 61.5% of respondents selected “nitrile” gloves. Notably, 29.4% of respondents were “unsure” and another 9.1% selected “latex,” both of which indicate a need for additional knowledge.

Regarding having adequate personal protective equipment (PPE) to protect them from fentanyl exposure, 76.1% of law enforcement personnel believed that they did not have access to proper PPE, while 55.8% of fire, EMS, or dual roles believed they did have access to the proper PPE.

Fire and EMS workers were nearly split in their responses to fentanyl in pill form being safe to handle, with 42.1% agreeing and 57.9% disagreeing. However, 85.9% of law enforcement disagreed that is was safe to handle fentanyl in pill form.

Information Sources

A series of questions were asked about what information sources were used by respondents to gather information on fentanyl exposure and safety measures. Respondents were allowed to select “all that apply.” Specifically, 78.1% selected seminars or courses, 76.5% department training, 67.4% federal agencies, 46.0% professional or labor organizations, 23.0% social media or Internet pages, and 13.9% news media. It appears that a sizable majority relies on official sources for information, with specialized courses and departmental training being the most common.