Deadly carfentanil changes how Basalt first responders handle drug overdoses
June 19, 2017
Basalt police and medical responders have altered their policies on how to handle drug overdoses after the deadly substance carfentanil played a role in the fatalities of two men in El Jebel earlier this year.
Basalt Fire Chief Scott Thompson said emergency medical technicians and ambulance crews will suit up in protective gear when responding to an obvious drug overdose. In cases where the cause of medical distress isn't obvious, they may take more time to assess the scene before acting.
"If it's obvious it's a drug overdose, we may not respond until we're prepared to respond safely," Thompson said. "I'm back to the adage, 'We're not going to give up a life to save a life.'"
Carfentanil, a tranquilizer used on elephants, was found in the systems of both men who died in Blue Lake, along with cocaine, benzodiazepine and a small amount of alcohol, the Eagle County coroner said.
“We’re very fortunate our responders weren’t affected on that call.”
— Basalt Fire Chief Scott Thompson
The Blue Lake overdose was the first time carfentanil was known to be present in the middle Roaring Fork Valley, according to Thompson. It also has been detected in Glenwood Springs, he said.
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A third man was found unconscious in the Blue Lake home. Thompson said at least seven medical personnel responded to the house and immediately started trying to revive the men. He said there was nothing to indicate a drug overdose. No needles or white powdery substances were found near the bodies, for example.
"We're very fortunate our responders weren't affected on that call," he said.
They were able to revive the unconscious man via techniques that included use of a substance that temporarily reverses the effects of opiates and helps restore breathing. He was rushed to a hospital and survived.
There has been a national epidemic on deaths from fentanyl and carfentanil. They are often mixed with heroin.
It poses such a threat to police and medical personnel that the U.S. Drug Enforcement Agency released a briefing guide for first responders this spring.
The bulletin said fentanyl is a synthetic opioid that mimics the effects of morphine in the human body but has a potency level 50 to 100 times that of morphine. Carfentanil is 10,000 times more deadly than fentanyl, according to the DEA. The agency said it's been identified in powder, pill, capsule and liquid form and on blotter paper.
Two to three milligrams of fentanyl — about the same as five to seven grains of table salt — could lead to respiratory depression, arrest and possibly death, according to the DEA.
"There is a significant threat to law enforcement personnel, and other first responders, who may come in contact with fentanyl and other fentanyl-related substances through routine law enforcement, emergency or life-saving activities," the DEA bulletin said. "Since fentanyl can be ingested orally, inhaled through the nose or mouth, or absorbed through the skin or eyes, any substance suspected to contain fentanyl should be treated with extreme caution as exposure to a small amount can lead to significant health-related complications, respiratory depression or death."
The DEA said cops are at risk from the drug from executing search warrants, processing evidence or field-testing substances. When fentanyl is detected at a site, first responders should don nitrile gloves, dust masks, sturdy eye protection and paper coveralls and shoe covers, the agency said.
Thompson said his department has the equipment necessary to safely respond to a situation where fentanyl or carfentanil is present. Blue Lake was a wake-up call to consider "gowning up," he said.
"We didn't have a clue (the substance was in the valley) until it happened to us," he said. "We have to do a better job of assessing the threat."
While Blue Lake is in the Eagle County Sheriff's Office's jurisdiction, the incident helped steer the policy of Basalt Police Department. Chief Greg Knott said the department's officers typically started providing CPR when they arrived first on a scene where there was a medical issue. Now, the department policy is to slow down and make an assessment, he said.
Knott also reached a decision after consulting with Thompson not to supply Narcan or other opiate arrestors in patrol cars. Many agencies are carrying cans of the drug because of the increasing frequency of encountering overdose victims.
Knott said the Basalt Fire Department is "so quick" to get to scenes that there is little advantage to his officers carrying Narcan. There's also a potential risk to officers using it.
Thompson noted that Narcan typically won't revive a victim of fentanyl and related drugs because they are so potent.
When asked if a more cautious policy could adversely affect a person in need of medical care who doesn't pose a risk of fentanyl exposure, Knott said there could be times when it is a tough call. Thompson said there will be cases when drug use is evident, so the responders will take an extra couple of minutes to put on protective gear. In cases where it isn't clear, they will err on the side of caution.
"We can articulate why we can't work a patient until a scene is safe," Thompson said.
Knott said his officers will no longer field test suspected drugs. If fentanyl is detected, officers will call the DEA or Colorado Bureau of Investigation and ask, "What do you have that will help us collect this?" he said.
Aspen Assistant Police Chief Bill Linn said the department has thankfully not encountered fentanyl or related substances firsthand but is aware they are in the valley. An opiate antagonist is carried in every patrol car and is present at the evidence room. The drug was issued this spring, he said.
"We have [also] changed our handling policies of suspected narcotics," Linn said.
That change was spelled out in an affidavit filed by an Aspen police officer Monday in the warrantless arrest of Jose Douglas Canton Lopez on Saturday.
Officer Daniel Davis wrote in the affidavit that he was notified at 1:38 a.m. Saturday that a man identified as Lopez allegedly stole money from a tip jar at Bootsy Bellows nightclub. Davis encountered Lopez on East Hyman Avenue and asked him how much money he took. Lopez took out his wallet and a clear plastic baggy allegedly fell to the ground, the affidavit said. Lopez said it wasn't his but Davis said he saw it fall from Lopez's wallet. The officer arrested Lopez for suspicion of possession of cocaine.
"Due to the uptick in dangerous drugs that can cause death by being absorbed into the body through the skin, I did not test the white powder," Davis wrote. "It will be sent to the Colorado Bureau of Investigation for testing."
Linn said the policy changes were made for the safety of officers.