fireEMS ❘ By JOHN BURKE
Our nation is battling an intensifying opioid epidemic, seen consistently in our newspapers and on TV. However, it’s not until it affects our daily lives that we truly see the ramifications and magnitude of the problem. As firefighters, we have more exposure to this epidemic than most, since many of us have been trained on naloxone use and have responded to a drug-related call or know someone who has.
However, this escalating public safety problem only truly began to hit home for me when residents in my community started finding needles on our streets, beaches, and playgrounds. At the same time, the Sandwich (MA) Fire Department (SFD) Community Wellness program was identifying a growing epidemic of storage of used medical needles in homes. Like other communities across the country, we were worried for the safety of our residents and struggled to find a long-term and affordable solution.
One of the first steps we took was to get a handle on the scope of the problem by partnering with community groups on opioid addiction and with our Visiting Nursing Association (VNA), who deal in the home health care of our most vulnerable populations. Unfortunately, Sandwich’s story is not an uncommon one; this is a real and growing problem in all of our backyards.
To tackle this problem, the SFD became a needle drop center two years ago through the Barnstable County Health Department, a facility where all town residents could bring used needles for free and with no questions asked. Every firefighter was trained on how to safely handle the hazardous waste both in the station and on a scene as well as how to interact with residents who used the drop center. The first challenge we faced was to get the word out about the new drop center. We solved this by partnering with local community organizations and found that the number of needles collected grew as knowledge of the drop center grew. Since its inception, the program has been highly successful, but we’ve learned a few unexpected lessons as well.
Spreading the Word
Needles from drug users are only one component of this problem. Our nation is also facing a major public health problem with diabetes, and we see strong evidence of this in Sandwich. Countless local people with diabetes and drug users are storing used needles with no safe, easy, and cheap way for disposal. Most commonly, we see needles from people with diabetes, heroin users, Vitamin B-12 injectors, and pet medications. There were a staggering number of needles in homes that many residents were hoarding in tin cans and drink bottles. Specifically, so-called “snow birds” who spend the winters in Florida would return to the drop center in spring looking to dispose of months’ worth of needles.
(1) Photo by author.
Spreading the word about the needle drop center took a few months, but now that residents know it exists, we’ve seen steady traffic there, and we accept drop-offs nearly every day. Initially, we received around 100 needles a week, but we now estimate that we are accepting 500 to 700 needles a week, with the numbers still growing.
Needles that still contained medication were brought instead to the local veterinarian, who collected and “paid it forward” for animal care in Haiti and other Caribbean areas (which is, at times, the “ground zero” for animal-based disease). This allowed those with unused medications to feel their contribution was worthwhile and was not being wasted.
Needle Disposal
One additional valuable lesson we learned about needle storage was that instead of storing needles in a back room or closet, where they pose a risk of a puncture injury (and become susceptible to flooding given our coastal location), we use an onsite and on-demand needle sterilization and disposal device from Sterilis© (photo 1) that allows us to quickly and easily sterilize and grind both needles and containers for disposing them on site in the regular trash. So far, we’ve remediated thousands of needles, a process that is safer and much less expensive than hiring a regulated medical waste disposal company to truck away the waste for incineration. Every firefighter in our station is trained on this device, and we run five to six waste cycles through it per day. The device transforms the needles and medical waste into confetti-like material, which can be tossed safely in regular trash. Therefore, as soon as needles are brought in, we can safely treat and dispose of them.
In addition to the station’s use as a needle drop center, the SFD will sometimes treat trauma victims because we are about 65 miles from a level 1 trauma center. We treat and then transport them to a medevac location. Often, we come back to the station with blood-soaked bandages and equipment. The members can then place the medical waste red bag into the disposal machine immediately to remedy the waste and remove the potential for cross contamination of our first responders. By treating the material immediately instead of storing it for pickup by a medical waste disposal company, the device also helps us have a safer station and a cleaner environment for our firefighters.
The SFD was one of the earliest pilot programs for the device. Since then, we’ve heard of other communities that have begun using the device to implement needle drop centers in their towns. These communities have financed their device purchase by securing funding from outside vendors, grants, community organizations, and their waste disposal budget (the device can be purchased for $50,000 or leased for $1,000 a month).
By providing the community with a means of safe, free needle disposal as well as issuing compliant sharps containers as part of the exchange, we are preventing untreated and potentially hazardous waste from ending up in our landfills, washing up on our beaches, and remaining in our homes and garages unattended.
This waste problem will continue to grow as more patients receive medical treatment at home. Combined with projections surrounding escalating opioid use,1 the need for safe needle disposal will only increase.
The SFD’s needle drop center is a small but important step that can easily be replicated in many other communities. It is our hope that this program can and will serve as a model for cities, towns, and regions—across the state and across the nation—to motivate new, proactive behaviors to make our communities a less dangerous place and keep our frontline public safety and sanitation workers safe.
Reference
1. www.statnews.com/2017/06/27/opioid-epidemic-game-changers.
JOHN BURKE is the deputy chief for the Sandwich (MA) Fire Department and a faculty member at Boston University’s Healthcare Emergency Management Graduate Program.
