You receive the call at 10:45 p.m.: "Man down in alley between 12th and Grunell." That's only a few blocks from your location, and you arrive before police. The victim, lying on his back in the middle of the alley, has extensive burns on his right arm, chest and the right side of his face. His clothes smell foul, like dirty gym socks. Just down the alley a door stands ajar; looking in, you observe another person facedown just inside the doorway and a third further inside. The foul chemical odor coming from inside is considerably stronger than from the man's clothes. A quick look around the room, and it is apparent this is some type of laboratory--probably an illegal methamphetamine (meth) production lab.
So here you are, with three victims with undetermined injuries and a situation that is one of the most hazardous EMS personnel will ever face. What do you do? Slow down, fully assess the situation, and then back off. This is not a normal scene. You are not equipped to enter this scene.1 Wait till police and firefighters arrive and apprise them of the situation. If fire and hazmat have not been notified, contact them. Your charge is to save lives, and in this case that means your own. The meth lab is more dangerous than any legal laboratory or chemical manufacturing plant. A legitimate production operation will have safety equipment and procedures, fire-suppression measures, appropriate ventilation and chemical-handling equipment in place. In contrast, an illegal lab will have no safety procedures or equipment, nor likely much concern for safety. Ventilation will be minimal, and chemical handling will be haphazard. Open fires, exposed electrical wires, broken glass and other hazards may be present.
AN EXPLOSION WAITING TO HAPPEN
Meth labs have been characterized as an "explosion waiting to happen."2 In fact, 25%-30% of all labs discovered in the U.S. are found as a result of fire or explosion.3 These pose a threat to all emergency personnel. The CDC published a report in 2000 on the number of first responders injured in meth-related lab accidents in states that report such incidents. In 112 reported events from 1996-99, 79 emergency providers were injured: 55 police officers, 9 EMS personnel, 8 firefighters and 7 hospital workers.4 The police and EMS numbers reflect that these groups do not typically wear appropriate PPE for this type of situation, whereas firefighters approach most situations with splash suits and respiratory equipment in place.
One of the most telling characteristics of a meth lab is the foul smell produced during cooking. It is typically what gives away meth houses in populated areas. But labs may not be restricted to urban areas;3 rurally there are old barns and houses that sit far from the road with few neighbors, and a lot of fresh air to dilute the smell. This means EMS providers, even in small towns and rural locations, need to be aware of the characteristics of meth labs and how to deal with them safely.
THE RISK BEFORE YOU OPEN THE DOOR
Depending on which of several methods a lab uses to produce meth, there can be different activities going on. The most dangerous is the final heating or chemical-reaction step, called the "cook," which may take up to 48 hours.5 It is not unusual for lab operators to set up a cook and then leave the lab until it's done. The reason is important: It's the time when a lab is most likely to blow up.
Labs may also have defense measures such as guard dogs. In 2005, Massachusetts police reported finding alligators inside labs raided in that state.6 Operators may employ booby-traps or anti-personnel devices (APDs) to keep people out and help them escape in case of a raid, potentially killing or incapacitating responders.3,7 APDs can include mines, grenades, improvised explosive devices (IEDs) or even automatic weapons. They are often triggered by monofilament fishing line that is difficult to see until it is too late. The line may be connected to a door or something further inside a room. In some lab raids, trip wires have set off pots of black powder filled with razor blades, nails, acids or lye.7 One innovative lab had a trip wire that dumped a jar of acid into potassium cyanide crystals, releasing hydrogen cyanide gas on unsuspecting responders.5