case histories like those described earlier
are not uncommon. Illicit fentanyl is
often manufactured in China and smug-
gled 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 micro-
gram size of the powder, fentanyl can
penetrate the filters of commonly used
APRs. First responders should consider
using self-contained breathing appara-
tus 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 oth-
er 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 mem-
bers 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
fireEMS
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