In this episode, we broadcast live from the 2018 IAFC Baltimore Hazmat Conference. You’ll hear from Dr. Christina Baxter, Dr. Mork Norman, Dave DeGregorio, and Toby Frost on all things fentanyl. This episode is brought to you by 908 Devices.
Thank to our sponsor, CBRNE Convergence World 2018. This show will be held in Orlando, Florida, USA. Click here for registration information and other fantastic information.
Complete Show Notes
2:35 Background on Panelists
- Dr. Christina Baxter
- Program Manager for the Chemical, Biological, Radiological, Nuclear and Explosives (CBRNE) subgroup at the Technical Support Working Group (TSWG)
- Currently the chairperson of the NFPA Hazardous Materials Protective Clothing and Equipment Technical Committee and a member of the NFPA Technical Correlating Committee on Fire and Emergency Services Protective Clothing and Equipment, the NFPA Technical Committee on Hazardous Materials Response Personnel and the ASTM International Technical Committee on Protective Clothing
- Also a member of the InterAgency Board for Equipment Standardization and Interoperability
- Brings 20 years of fire and hazmat experience to the table
- Listen to THMG086 – Fentanyl, Part III: Interview with Dr. Christina Baxter
- Dave DeGregorio
- Previously the Deputy Director for the Massachusetts Department of Fire Services in hazmat for 2 years
- Spent 32 years in the military working with the civil support team – CST off and on for 10-plus years
- Held 3 different positions as a medic before becoming deputy director
- Worked with hazmat teams throughout his time on the CST, so he knows the hazmat world well
- Listen to THMG047 – Interview with Dave DeGregorio, Director of Massachusetts Hazmat
- Dr. Mark Norman
- Started back in 2001 with a company out of Danbury, CT called SensIR Technologies – known for the TravelIR, which was the first portable infrared identifier
- TravelIR played a huge role in identifying white powders and was particularly helpful during a time of white powder scares (i.e. anthrax)
- He’s been working with a lot of different emerging technologies over the past 16 years as they enter the field
- Currently Director of Technical Services at 908 Devices – runs the training and customer service group
- Also responsible for a lot of field activities with M908 and MX908 identifiers
- Listen to THMG128a – Advanced Fentanyl Detection Techniques with Dr. Mark Norman of 908 Devices
- Toby Frost
- Captain at Lafayette FD in Indiana and team leader on the hazmat team
- Does technical rescue, underwater rescue, and much more
- Teaching several classes – includes topics like meth labs, synthetic drug labs, and training ideas
- Listen to THMG083 – Fentanyl, Part I: Interview with Toby Frost
6:00 Which fentanyls are we seeing on the streets today? Where do you see the problem going in the future?
- We’re only seeing a few analogues on the street at the moment, but the variations are only going to keep increasing because the ingredients are so cheap and the profit margin is so large
- Much easier to create at home with ingredients from the dark web than to have it shipped into the country prefabricated
- Most deaths from drug overdoses involve fentanyl – very few are from straight up heroin, cocaine, etc.
- There are 1,400 possible fentanyl derivatives out there (500 of which are more toxic than morphine), and there are analogues around the world that we haven’t seen in the U.S. yet
10:30 How should responders protect themselves when responding to fentanyl incidents?
- Start by doing an on-site risk assessment – i.e. someone with a needle in their arm vs. someone who’s overdosed via powdered fentanyl in their car
- Fentanyl has electrostatic properties that make it want to stay airborne, and the particles are so small that they’re barely visible to the naked eye
- You need your M95/P100 SCBA, venting goggles, and gloves AT ALL TIMES when handling fentanyl
- Determine whether you’re dealing with a user or a dealer based on the number of baggies they have – this affects your level of protection
- Minimize exposure by covering your skin – fentanyl absorbs very slowly transdermally, but we don’t want to take any chances
- Fentanyl production labs are like meth labs – essential to wear the highest level of protection and be extremely thorough with your decontamination (no dry decon)
16:55 What kind of energy is required to get fentanyl up and suspended in the air?
- Similar to baby powder – likes to stay airborne, takes a while to come down, and can be hard to clean up because it gets everywhere
- Remove fentanyl from the air by increasing humidity – increases the product’s weight and causes it to drop
- Approach your patient from the head down – most material originates at the mouth and moves downwards
- Do whatever it takes to get the patient away from the fentanyl – wash them off with water, cut away contaminated clothes, etc.
20:45 How do detection device manufacturers keep up with all of the changing analogues? How will the situation change once we move from imported to manufactured fentanyl?
- Rather than developing libraries and algorithms based on a specific type of fentanyl, we need to be more predictive
- Fentanyls have a common backbone – the different forms are just how we arrange them (i.e. methyl group placement)
- Fentanyls tend to fragment in characteristic ways – this discovery led 908 Devices to come up with more predictive algorithms for their substance libraries
- Another goal of detection device manufacturers is to help you determine whether you’re dealing with pure fentanyl or not – measure at trace and Raman levels
27:10 Are there statewide SOGs in Massachusetts for dealing with fentanyl?
- Dave says Massachusetts responders use a tiered response – any information is good information, even if it’s not conclusive
- Initially skeptical of using strips to detect fentanyl, but they’ve proven very helpful when measuring fentanyl
- Situational awareness is key – there’s no predetermined way to handle fentanyl responses
32:20 What are the differences between masks used on fentanyl scenes?
- Only difference between M95 and M100 masks is filtration efficiency – 95% particle removal vs. 99.99% particle removal
- Keep in mind that there’s a huge cost difference between different masks – this is important because many of them are single use
- In most cases, M95 mask provides you with the protection you need – may not be enough if you’re on a pure material call, though
- Carfentanyl is 100-200 times more potent than regular fentanyl, so we have to be even more careful when dealing with this substance
- Go to the NIOSH website to double-check that your mask is certified against legal standards
38:35 What is the surface-enhanced Raman spectroscopy (SERS) technique?
- Enhances Raman by scattering molecules adsorbed on rough metal surfaces
- Takes Raman spectroscopy techniques down from from bulk methods to trace methods
- Allows you to measure down in the nanogram range (even single molecules)
45:10 What are immunoassay test strips?
- There are probably 6 different immunoassay test strips out there – think of pregnancy test kits
- If you have a high purity sample, you may go off the test strip’s reading scale before you even get a chance to read it
- Keep in mind that some of these strips are also specific to 1 or 2 fentanyl analogues
- One of the best immunoassay test strips brands is BTNX (from Canada)
- Keep in mind that these strips require liquid to function – some departments use their own buffer solutions
- Immunoassay test strips can run between $1-5 per strip depending on the brand
- It’s important to remember than some non-fentanyl opioids can also show up as positive on these strips
49:35 How would you select equipment for dealing with fentanyl if you were building a team from the ground up?
- Start by making sure you have the appropriate PPE to do your job in the first place – be very careful and deliberate as you do this
- Have a Raman or MX908 meter in hand – ideal for detecting fentanyl and provides you with a host of useful capabilities
- Look at the totality of the situation – you can never be too careful when it comes to fentanyl and its analogues
- Always think about bulk and trace detection and choose your meters and detection devices accordingly
Have a question? Send an email to firstname.lastname@example.org or leave a message on our Haz Mat Guys comment hotline: 843-628-1484
- THMG085 – Fentanyl, Part II: Interview with Brian Escamilla
- THMG088 – Fentanyl, Part IV: Analysis from The Haz Mat Guys
- THMG125 – Fentanyl Detection Devices