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
BACK OFF, GET OFF
Once you realize you're in a drug lab, get out as quickly as possible. Watch for trip wires or other hazards as you exit. Try to get a quick mental picture of the area so you can relay as much information as possible to other responders. Move your vehicles, equipment and yourself to a secure area. With victims down, as in the opening scenario, some accident has already occurred, and if the lab hasn't exploded yet, it could be just a matter of time before it does.7
EMS's main role in this situation will be to provide monitoring and medical assistance to law enforcement, firefighters, hazmat and other responders. Because of the wide array of toxic chemicals potentially present (see Table 1), a variety of health problems can arise. These include respiratory problems, skin and eye irritation, headaches, nausea and dizziness. In the early stages of an incident, police and firefighters may be exposed to concentrations sufficient to cause severe health problems, including lung damage and severe burns to exposed parts of the body.8
A TOXIC WASTELAND
A clandestine meth lab will likely have hazardous, flammable chemicals stored in every type of container imaginable--in closets, under stairs, under tables or even out in the open. Little of the glassware and equipment will be standard laboratory materials. Most will be improvised using casserole dishes, CorningWare, crock pots, etc.; pieces may be broken and have jagged edges, sometimes covered with duct tape. Heaters, ovens or power strips may have frayed or exposed wires. Trash, including empty solvent bottles and boxes of cold medicine tablets (containing pseudoephedrine, a component of meth) will be piled about. In addition to the smell, the second-most notable characteristic of meth labs is trash. This is one of the reasons they go up so quickly in fires.2
Depending on the form of the drug you want to produce (rock, crystal or powder), there are several methods for synthesizing meth.9 However, the chemicals used are more or less the same. These include common solvents such as acetone, methanol, isopropanol, benzene, toluene, Freon and ether. These can come from common sources like nail polish remover (acetone), fuel additives like HEET (methanol), rubbing alcohol (isopropanol), scientific supply houses (benzene, toluene, diethyl ether) and old air conditioners (Freon). Other solvents that might be present include kerosene, petroleum ether and chloroform.2 These can be exposure hazards through the skin, eye and inhalation routes.
A variety of gases are used in meth production; these include phosphine, anhydrous ammonia and methylamine, as well as propane for the cookers. These gases can be compressed in small cylinders or in tanks like those used for gas grills or campers.2 The greatest danger from these gases is their explosive potential. Many recent meth lab explosions have been the result of anhydrous ammonia or phosphine gas tank explosions;10 in recent years there has been an increase in thefts of liquid ammonia from agricultural supply houses, where it is loaded into small propane tanks by lab operators. Exposure to anhydrous ammonia can cause dehydration, caustic burning and freezing. Liquid or vapor contact with the eyes causes severe injury and blindness. Liquid contact with skin causes chemical burns.
Meth labs also have a wide assortment of metal salts and other inorganic compounds present, such as lead metal, lead acetate, magnesium chloride, palladium, lithium, sodium and potassium metals, iodine crystals, red phosphorous and mercuric chloride. These may be labeled or unlabeled. Bottles containing kerosene with strips or chunks of silver or grayish metal present a high level of danger: The metal inside is either metallic sodium or potassium. These metals are kept under kerosene to prevent their contact with air or water. Once they are exposed to either, they react rapidly and violently, leading to a large explosion. The sodium or potassium metal reacts with water to form sodium or potassium hydroxide, hydrogen gas and a great amount of heat.5 The heat ignites residual kerosene on the material, and this causes the hydrogen gas to explode. The resulting explosion can set off other solvents nearby.2
Meth labs contain all sorts of hidden hazards. Red phosphorous has been banned from commercial sale for years, but lab operators have discovered that it can be extracted from wooden match heads. Containers of these are usually found in labs. A coffee can or jar full of match heads has the same explosive potential as a small improvised explosive device.5,11 Iodine crystals (purple/reddish in color) will be present and are used to form hydriodic acid, a key component, along with red phosphorus, in the conversion of pseudoephedrine to methamphetamine. When heated even moderately, iodine crystals undergo sublimation, a process where the solid material is converted to gas without going through a liquid state. This purplish iodine-containing gas is highly toxic and an intense eye and mucous membrane irritant. Another source of iodine is disinfectants like Betadine.5,11 Lithium batteries of all sizes may be present, stripped apart to extract the lithium metal, which is used in one of the chemical reactions.5
A final class of chemicals in the meth lab will be acids like hydrochloric acid, sulfuric acid (muriatic acid or battery acid) and hydriodic acid and bases like sodium hydroxide (drain cleaner), potassium hydroxide and ammonium hydroxide. A variety of salts, like mercuric chloride, lead acetate and magnesium sulfate, will also be present.5
The risk of explosion here is great. Do not turn off any hot plates, ovens or other heating devices; too-rapid cooling could lead to an adverse chemical reaction. Don't even turn off lights--they could be booby-trapped. Leave the site for hazmat teams to handle.12
And don't forget that the meth lab is a crime scene. It is a responsibility of EMS to preserve evidence. Don't move things unnecessarily, enter areas you don't need to enter or remove anything from the site.3
THE PEOPLE HAZARD
In addition to the chemical and explosive hazards, the people in meth labs can also be a serious threat to EMS responders. These individuals may be severe addicts and highly paranoid, possibly having gone days or weeks with little or no sleep. They may be irrational, unpredictable and capable of violence.13
There may also be children present. It is estimated that there are 1,800 children growing up in active meth labs in this country.13 These children are exposed to the immediate dangers of fire and explosion and, in addition, may have been exposed for long periods of time to toxic chemicals and the drugs being produced in the lab. They may suffer from neglect/abuse and the trauma of living in the chaotic lifestyle of the drug lab. The child exposed to low levels of amphetamine and/or toxic chemicals may exhibit headaches, nausea, fatigue and paranoia. Exposure to higher levels can produce coughing, shortness of breath, chest pain, dizziness, lack of motor coordination and even death. In addition, the children may show signs of skin or eye irritation and chemical burns from playing in areas contaminated with toxic waste products.13
- Vanek M. 10 Steps for EMS Survival at Clandestine Methamphetamine Lab Scenes. www.merginet.com/index.cfm?searched=/operations/field/MethLabs.cfm.
- Hanson D. The illegal drug lab: An accident waiting to happen. Frontline First Responder3(3): 47-50, July 2005.
- Peterson DF. Hazardous Materials--Clandestine Drug Labs. http://server.firehouse.com/training/hazmat/training/2001/08_drug.html.
- Public health consequences among first responders in emergency events associated with illicit methamphetamine laboratories: Selected states, 1996-1999. MMWR49(45): 1,021-24, 2000.
- Hanson D. Right in your backyard: Identifying illegal drug labs lurking in the shadows. Law Enforcement Technology 32(5): 8-16, May 2005.
- NBC Nightly News, Sept. 19, 2005.
- California Attorney General's Office, Crime and Violence Prevention Center. Clandestine Drug Labs. www.stopdrugs.org.
- Meth lab chemicals ignite, present danger to EMS responders. EMS Update23(3): 2-3, Fall 2002.
- Moose Jaw Police Service. What Is Methamphetamine? www.mjpolice.ca/meth.htm.
- Minnesota Department of Public Safety. Anhydrous Ammonia in Propane Cylinders: Safety Considerations for Mitigation. www.dps.state.mn.us/fmarshal/HazMat/AmmoniaCylinderMitigation.htm.
- Personal communication with former meth addict/lab operator, September 2005.
- Florida Department of Financial Services. Background: Meth Labs. www.fldfs.com/fightmeth/meth_background.htm.
- Office of National Drug Control Policy. Drug Endangered Children (DEC). www.whitehousedrugpolicy.gov/enforce/dr_endangered_child.html.
Douglas M. Hanson writes extensively for EMS, law enforcement and first responder publications. He has also written hundreds of technical papers and presented testimony before Congress. He writes a monthly column for the website Officer.com. Reach him at firstname.lastname@example.org.