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Reader Feedback: January

Concerns Over Webinar

We are writing to express concerns regarding your November 7 webinar, “Opioids and Fentanyl: Preventing Exposure to This Growing Threat.” The webinar was presented by Ansell’s vice president of research and development, Derek Warneke.

As repeat authors and presenters in your publication and at your conference, we are staunch supporters of your mission to educate providers in the prehospital arena and encourage science-based best practices. This is what is so concerning about your decision to support this webinar.

Recently we have seen an epidemiological explosion of cases of law enforcement officers—and, to a smaller extent, healthcare providers—who have “overdosed” following incidental exposure to what they believed to be fentanyl. A recent example in Lincoln, Neb., occurred in October; in this case the victim did not suffer an “overdose” until a field test found the substance in question contained a heroin base. Strangely, the victim then experienced a rapid heart rate, high respiratory rate, and tingling in his arms. These symptoms were alleviated with the administration of naloxone.

What is interesting about this case and so many others is that the symptoms experienced are not indicative of those seen in the opioid toxidrome. However, they do correlate with those of a panic attack. Stranger yet, this appears to only affect first responders, not the suspects who possessed the substance or the bystanders on scene. 

The fear generated by bad science has created what may be considered one of the largest cases of mass hysteria in history. The first responder community as a whole faces enough real threats on a daily basis. Creating a new threat out of bad science, media hype, and corporate support is unnecessary, inappropriate, and dangerous.

There have been multiple statements by medical toxicologists, including a joint statement from the American College of Medical Toxicologists, emphasizing there is no danger to first responders from incidental exposure to fentanyl. Furthermore, it is a fact that fentanyl absorbs extremely poorly through the dermal route; in fact, it took several years to develop a carrier agent that made the transdermal fentanyl patch a reality.

Yet the webinar speaker made several tenuous statements, including asserting that dermal exposure is possible. To be fair, that is correct if you go by the dictionary definition of exposure, which means simply coming into contact with something. But this is not what first responders groomed by fentanyl hysteria are hearing. To them, exposure and overdose are synonymous.

Another question referenced an incident in which multiple law enforcement officers were supposedly exposed to fentanyl—the questioner asked if there was any evidence of fentanyl being the culprit. A quick search on the Internet yielded a story that seems to reference the event in question. The speaker acknowledged there was no evidence but claimed symptoms of “fentanyl exposure” were present. These are just a few of our concerns with the presentation.

In his closing remarks Warneke said, “Our goal, along with EMS World, is to provide good information, not to try to tell people what to do.”

In your mind, is that what this webinar achieved?

—Branden L. Miesemer, NRP, FP-C, and Andrew D. Fisher, MPAS, PA-C

Move EMS to Public Health

John Todaro’s guest editorial, “If I Were the Zeus of Prehospital Care,” was amazing. He was right on every point. His article struck down many of the points posited in a recent Firehouse column regarding EMS’s place in the fire system. I enjoyed John’s take because his article felt like it equated medics to the next role up from “new guy on the truck/hose dragger” role.

I present a lecture called “A Futurist Look at EMS,” and the majority of it is about us being more professional in various ways and not just seeking more technology to play with on the trucks. We all have our opinions, but I firmly believe EMS will have to someday move into the public health side of medicine to finally realize our full potential as providers. Even though we will always work alongside public-safety folks, we have to become more than that.

We have to take steps to become valid, valued, professional members of the team, rather than just the redheaded stepkids of several teams. Great job!

—David W. Powers

A Hard Look at ACLS

I just finished reading Mike Rubin’s column [“ACLS 2018: Did You Hear the One About the Medic and the ABG?”] and couldn’t agree more! After I dried my eyes from laughing so hard, I quickly forwarded it to other folks I know who feel exactly the same way. Thanks for verbalizing the worst and best the AHA can offer!

—To Henery, NREMT-P

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