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By Sam Pearson
Nurses at an Ohio hospital were treating a patient suffering from an opioid overdose in August. Not long after, three of them felt sick, too.
The workers at Affinity Medical Center in Ohio’s Stark County, where 118 people died of opioid overdoses in 2016, didn’t know what drug they were exposed to, or what it could do to them.
“It’s a little scary,” Shaun Dadisman, a detective with the Massillon, Ohio, Police Department, who is investigating the incident, told Bloomberg Environment.
Luckily, they were “at the best place, because they’re going to receive immediate care,” Dadisman said, allowing them to be treated with naloxone, a medication used to block the effects of an opioid overdose.
Officers think the substance in question was fentanyl, a potent pain medication increasingly being used illicitly. While cleaning a hospital room multiple patients had used, the nurses must have touched or inhaled traces of a harmful drug someone left behind, police believe.
In Massillon, it was nurses that were exposed, but emergency responders have had to be treated for fentanyl exposures, too, in places like Hartford, Conn.; Chelsea, Mass.; East Liverpool, Ohio; Bucks County, Pa.; Abingdon, Md.; and Atlantic County, N.J.
The exposures highlight a growing problem for the nation’s estimated 1 million sworn police officers and support staff, 3 million nurses, and 250,000 paramedics and emergency response technicians that tend to the estimated 20,100 people who died in the U.S. in 2016 from fentanyl, the most powerful type of opioids.
Drug abusers who increasingly turn to concentrated opioids like fentanyl and an even more potent sister substance carfentanyl—strong enough that zoos use it to knock out adult African elephants—also create an escalating risks for workers who come in contact with them.
New Jersey Gov. Chris Christie (R), chair of the President’s Commission on Combating Drug Addiction and the Opioid Crisis, touched on the hazard at a field hearing in Baltimore Nov. 28. The chemicals are “so lethal that law enforcement officers who come to crime scenes where this is have to be careful in terms of the way they deal with the crime scene,” Christie said, “so they don’t contaminate themselves.”
Federal officials are slowly responding to the unfolding worker safety problems, aiming to coordinate outreach to first responders—and to a lesser extent, healthcare workers—who face exposure. However, the efforts don’t appear to include an emphasis on Occupational Safety and Health Administration regulations for public sector or hospital workers.
“If a nurse is at risk, the patient is at risk,” Bonnie Castillo, health and safety director at the National Nurses United union, told Bloomberg Environment. “This has a direct impact on our ability to give the care that our patients require.”
In healthcare settings, hospitals need to set procedures to protect workers and then practice them, Michelle Mahon, a nurse and organizer with National Nurses United in Ohio, told Bloomberg Environment. Training should include a process to screen patients for opioid symptoms so workers know to protect themselves and isolate the patient from others, Mahon said.
“It’s not just about the paper, but also about the performance,” she said.
Law enforcement workers are concerned, too. Officers don’t know when they may encounter drugs in the field, Dadisman said. It’s not just at scenes where drug use is obvious. Rather, it can happen suddenly, like when searching the pockets of a possible shoplifter who may also be carrying drug-tainted needles.
At a heroin overdose scene, Dadisman was once collecting needles as evidence. One of them was capped, he said, but it was bent from the side and stuck his hand. His gloves weren’t needle protective.
“It just went straight through,” Dadisman said.
Scientists in the federal government are learning more about how to protect healthcare workers and first responders from these hazards. As the science expands, the federal government is sharpening its outreach to state and local agencies.
The National Institute for Occupational Safety and Health was among 10 agencies in an interagency group that produced guidance for law enforcement agencies earlier this year.
The document reflected the limited knowledge available on law enforcement exposure pathways, Jennifer Hornsby-Myers, a senior industrial hygienist and regional operations director at NIOSH’s emergency preparedness and response office, told Bloomberg Environment. More research has occurred to date on preventing exposures in hospital settings, she said.
Workers can be exposed to fentanyl through inhalation or skin contact. Inhalation, a less common pathway, is more likely to cause harmful symptoms.
The document recommends that first responders wear gloves and avoid “actions that may cause powder to become airborne,” where they may inhale it. They also need to use NIOSH-approved respirators that fit properly, use eye protection and touch the substances as little as possible.
If exposure occurs, using hand santizers can actually make the problem worse. These products cause the skin to absorb more of the drugs, worsening their effects.
Employees that show slow or no breathing, drowsiness or unresponsiveness, or constricted or pinpoint pupils should move away from the exposure source and call for help. Exposed workers may need multiple doses of naloxone, rescue breathing or CPR until emergency medical responders can reach them, the document states.
In the White House’s report on opioids released in November, among dozens of recommendations was one to “develop a national outreach plan” for the fentanyl safety recommendations for first responders.
The federal government also needs to partner with state officials “to develop and standardize data collection, analytics and information-sharing related to first responder opioid-intoxication incidents,” the report said.
On Nov. 29, Attorney General Jeff Sessions said that White House Counselor Kellyanne Conway would be assigned to oversee White House initiatives on opioid abuse.
A White House official told Bloomberg Environment the goal of the interagency work, which began about two years ago, was to translate more technical information emerging from sources like NIOSH into something first responders could quickly understand.
Without the guidance, states and individual federal agencies might issue different versions of their own recommendations, and confusion could ensue if federal agencies responding to major incidents together all handled hazardous drugs different ways, the official said.
The White House aims to disseminate the information through its relationships with professional organizations like the American Industrial Hygiene Association, local agencies, and police unions, among others. They are also seeking to produce a smartphone application that first responders can download and a brief training video police supervisors can show officers before they leave to begin a patrol shift, the official said.
In theory, OSHA could also play a role in ensuring employers provide sufficient training and protective equipment for workers at risk from opioids.
No specific agency standard applies to how emergency responders handle fentanyl or carfentanyl, former OSHA director David Michaels said in an email to Bloomberg Environment. Employers could still be cited under the Occupational Safety and Health Act’s general duty clause if they fail to provide a work environment free of recognized serious hazards, Michaels said.
OSHA regional officials took no action after the Affinity Medical Center incident, Rhonda Burke, a spokeswoman for OSHA’s Region 5 office in Chicago, which also covers Ohio, told Bloomberg Environment.
Burke said the regional office didn’t inspect the hospital to determine what they were doing to prevent staff exposure to the drugs. Affinity wasn’t required to report the incident since “no one was hospitalized,” she said.
But, union officials said the nurses were treated on site—at the hospital where they worked.
Affinity has provided additional training to hospital staff and now requires “all clinical team members” to use protective gear if they are treating a patient suspected of overdosing on fentanyl, Susan Koosh, vice president for marketing and community relations at the hospital, said in a statement to Bloomberg Environment.
In addition, many of the workers likely to encounter high-risk opioids are not covered by worker protection laws.
Only in 26 states are public sector employees, such as police officers, protected by the law. Excluded are some of the states seeing the largest impacts from the opioids crisis, like Ohio, West Virginia, and New Hampshire.
The Department of Safety in New Hampshire recently implemented new guidance for police responding to synthetic opioids.
In major cities, police leaders are implementing more standardized procedures in larger departments, which must coordinate among thousands of officers.
Police have to balance between the need to analyze drugs quickly to allow investigations to go forward and the imperative to protect officers from harm.
As recently as two to five years ago, officers might field test drugs, sometimes without their hands covered, Lt. Andrew Struhar, who leads the narcotics and special operations division at the Washington Metropolitan Police Department, told Bloomberg Environment. An officer might leave drugs loose on his desk, test and package it, and then eat lunch without washing his hands.
These days, MPD officers use protective gear, such as nitrile gloves, while handling powdered substances, measures Struhar said have prevented the kind of accidental exposures seen elsewhere.
MPD has centralized drug testing activities to specialized officers for each of MPD’s police districts, who are certified in safe methods. When patrol officers find drugs that are risky to handle, they are trained to call others who will arrive and test the product, Struhar said. Some samples also go to the Drug Enforcement Administration’s Mid-Atlantic regional laboratory for evaluation.
“We have to be sensitive about it, so we can still do our jobs,” Struhar said, “but we have to be safe in doing it.”
Further out, the District of Columbia is evaluating, Struhar said, whether to purchase a handheld device called TruNarc, made by Thermo Fisher Scientific, which can identify more than 415 types of suspected illicit substances without officers needing to touch the material.
But the real risk may be at smaller police departments, Strahar said, which don’t always have the resources to invest in pricey technologies like TruNarc, which can cost as much as $20,000 per machine.
“By providing the protective gear, we’re doing a service for the officers,” Struhar said.
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