Hardly a day goes by without news related to the opioid epidemic, whether on a national scale or in your local community. If you work or are planning to work in the field of emergency medical services, you face the results of opioid addiction closer than many people. Heroin, fentanyl, and other opiates probably play a role in your daily work. Opiate addiction strongly affects your chosen profession. What should you know about the opioid epidemic before choosing an EMS career?

Assessing an Overdose Scene

As a first responder, you will be trained in what information to collect when you arrive on the scene of an apparent overdose. You will attempt to find out what drug the person took, how much, how long ago, and through what method. However, it is understandably difficult to elicit true information from the victim or others on the scene. Often, someone will dispose of any physical evidence before you arrive.
Overdose patients may go into respiratory arrest, and first responders can administer naloxone to save them.
First responders are receiving special training for how to handle a scene where fentanyl may be present. Fentanyl, a powerful synthetic opioid analgesic and a schedule II prescription drug, packs 50 to 100 times the potency of morphine. It is known by the brand names Actiq®, Duragesic®, and Sublimaze® and street names that include Apache, China Girl, China White, Dance Fever, Friend, Goodfella, Jackpot, Murder 8, TNT, and Tango and Cash.
In today’s epidemic, remember there is no typical opioid addict anymore. Forget the stereotype of the heroin addict. Some users become addicted from taking prescriptions. Cocaine users might cut synthetic opioids into their drug of choice. You can not assume that an addict lives on the street or comes from a “broken home.” Addiction is not restricted to a certain age, social group, or type of person.

Risk of Exposure

Protective equipment is important at any emergency scene, but take extra precautions against accidental overdose on a scene where opioids are present. In particular, fentanyl and carfentanil are highly potent and can be ingested from the air.
The CDC warns that not only EMS workers but also law enforcement and those handling evidence risk contact with fentanyl. They explain that “responders are most likely to encounter illicitly manufactured fentanyl and its analogs in powder, tablet, and liquid form. Potential exposure routes of greatest concern include inhalation, mucous membrane contact, ingestion, and percutaneous exposure (e.g., needlestick). Skin contact is also a potential exposure route, but is not likely to lead to overdose.”
The CDC makes a number of recommendations for avoiding contamination. For example, they advise against eating, drinking or using the bathroom at the scene or conducting field testing for fentanyl.
More recently, you may have heard of carfentanil. It’s even riskier, with a potency 10,000 times that of morphine. EMS World reports, “Public health teams across North America are distributing naloxone kits to anyone who might come into contact with a person overdosed on narcotics.” They add, however, that naloxone cannot always stand up to carfentanil.

Opioid and Addiction Training

Municipalities around the country are wrestling with how to address the opioid epidemic. Many have deemed it a public health crisis. They seek to contain the epidemic through both treatment and prevention. Some have formed task forces, comprising law enforcement, local government, social workers, medical professionals and EMS workers. Each area of expertise provides its own perspective for how everyone, working together, can best address the situation. The National League of Cities offers information on addressing the problem as a community.
Each profession continues to address training, too. A program of Johns Hopkins Medical Center trains paramedics in the Baltimore area. Says the Johns Hopkins Gazette, “Paramedic participants will learn about recovery success stories, evidence to counter the negative perception of substance abuse, principles of addiction science, and how to better communicate .” They will learn a screening and referral protocol, and gain a stronger understanding of how addiction works.

Compassion Fatigue

Some EMS workers report “compassion fatigue” after seeing so many overdose cases. They often visit the same addicts over and over again. They also witness the effects on the addict’s loved ones, including children. The Cincinnati Enquirer interviewed several EMS workers and reported that they “have become more like counselors or pastors or caregivers interceding for children.” The article when on to describe compassion fatigue as “when typically caring people find themselves unable to empathize anymore because the frequency of the appeals for their help is so overwhelming.” An EMS worker may seek out emotional support to handle the toll.

The opioid epidemic is an inescapable part of an EMS career these days, regardless of where you live and work. Educate yourself about the drugs, the addiction, and precautions you can take. Protect your physical and mental health so you can give your best to your patients.

PHOTO: Premier of Alberta / CC BY-ND 2.0