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Objectives:The present opioid epidemic and abuse of fentanyl in the United States has led to an increased risk of exposure to first responders. Law enforcement, fire, and emergency medical services are receiving misinformation on fentanyl health and safety risks and this has led to miscommunication. Understanding the risk perceptions and knowledge of first responders regarding fentanyl can help identify training gaps.Methods:A 15-item 6-point Likert scale online questionnaire was developed and distributed to firefighters, police officers, and emergency medical technicians, regarding perceptions of fentanyl exposure, and additional questions concerning knowledge. The online questionnaire was sent to 15 associations of national and New York State first responders with 3 associations acknowledging and distributing the survey.Results:Of the 247 participants, 187 served New York State; 92 worked in law enforcement; and the other 95 worked in either fire, emergency medical service, or both. New York State first responders generally agreed with expert risk perceptions and knowledge of fentanyl exposure in the pilot study. Items pertaining to using hand sanitizer, selecting glove type, and dermal exposure to fentanyl had lower agreement with expert beliefs.Conclusions:Risk perceptions and knowledge could be used to evaluate fentanyl response training among first responders.