Overdoses from fentanyl and other highly potent opioids are becoming common in American society. More often than not, it is police who are confronted with identifying and tending to these overdose victims; at potential risk to themselves and their own health.
At the same time, there is a lot of misinformation associated with opioids says Dr. Michael Dailey, professor of EMS and emergency medicine at Albany Medical College, and Medical Director for REMO (the Regional Emergency Medical Organization – Albany NY). He has also helped prepare an opioid first aid program for use by New York law enforcement officers.
“If you believe what you read in the media, a police officer can accidentally overdose on fentanyl by touching an overdose victim or some powder,” said Dailey. “That’s just not true. The only time you might be at risk is if you do a dynamic entry into a fentanyl lab or packaging operation, and fentanyl powder somehow gets blown into the air and is inhaled. Unless there is visible powder in the air, there is limited risk to responding officers. It is actually very difficult to absorb fentanyl through the skin.”
Still the realities of the opioid crisis mean that police should keep an opioid response kit at hand at all times. Here’s what needs to be in it.
Naloxone is a must
Also known as narcan, naloxone can temporally reverse the effects of opiate overdoses caused by fentanyl, heroin, methadone, morphine and oxycodone.
When administered to an opioid overdose patient, a patient who is unconscious and breathing slowly or not breathing at all, naloxone will disrupt the opioid’s attachment to receptors in the body allowing normal breathing and consciousness to resume.
“We use the single step intra-nasal naloxone at this point, which is 4 milligrams of naloxone and 0.1 milliliters of liquid per dose,” said Dailey. “We teach officers how to squirt this into people’s noses, and then roll them onto their sides.”
The decision whether to administer naloxone to an unconscious patient is based on their breathing rate. “If they’re breathing slowly, you give them naloxone,” said Dailey. “If they’re not breathing at all, you give them naloxone and CPR. If they’re breathing faster than you are, you roll them on their side and you watch them while you wait for EMS to arrive.”
The right equipment
A police opiate response kit should be developed based on the training the department employs. It should be equipped with naloxone, as well as a rescue breathing pocket mask or bag valve mask, either of which can be used to provide artificial respiration to the patient while avoiding the need for officers to do mouth-to-mouth.
“If nothing is available, the officer should at least administer hands-on CPR as required,” said Dailey. “We teach all of these approaches in our program.”
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Some departments include nitrile gloves in their kits as well, but many officers already carry these for assisting medical patients. If not available, an officer may also use their patrol gloves.
If there was a situation where there was concern about airborne opioid powder, in a drug lab for example, hazmat or contaminated crime scene experts should be deployed rather than patrol officers.
For officers who find themselves in a dusty environment, masks are a good idea – not just because of opioid risk. Some departments may choose to carry disposable hazmat suits for officers to wear.
The most important part of preventing skin exposure from contaminating an officer’s skin is to use soap and water. Alcohol-based hand cleaners may make any drug more likely to be absorbed through the skin. Use lots of soap and water as frequently as possible throughout the day while at work, between each victim encounter and every time your hands appear dirty.
Train, train, train
The real key to treating and managing suspected opioid overdose patients before anything happens is extensive and ongoing police training.
“Basic initial first aid by officers is lifesaving. To ensure they are ready to both treat the public, or even treat other officers, everyone should be trained in CPR and basic techniques for first aid including Stop the Bleed. Opioid overdose care is a brief and simple addition to this,” said Dailey. “You need to train police to respond to opioid overdoses, so they know what to do without effort when one occurs, as well as knowing how to keep themselves safe. Keep the training simple and direct, because police officers don’t want to be doctors – they want to be cops.”
