Overdose Response Worksheet

Name:

Date:

🚨 Part 1: Scene Assessment & Response

Scenario: You arrive at a scene where a person has been down for several minutes. Limited witness information is available.

1. What is your FIRST priority when arriving at the scene?

Check the person's pulse immediately

Assess scene safety

Call for backup

Interview witnesses

2. List THREE things you should check for scene safety:

3. What are the signs that suggest possible opioid overdose? (Check all that apply)

Blue lips or fingernails

Slow or absent breathing

Unresponsive to verbal commands

Loud snoring sounds

Small pupils

4. You suspect an opioid overdose. What should you do BEFORE giving naloxone?

💊 Part 2: Naloxone Administration & Follow-up

5. Put these naloxone steps in the correct order (1-4):

_____ Wait 2-3 minutes and give second dose if no response

_____ Insert device in nostril and press firmly

_____ Remove naloxone from package

_____ Tilt person's head back slightly

6. After giving naloxone, the person wakes up and becomes angry. What should you do?

Explain what happened and stay calm

Leave immediately

Restrain the person

Give more naloxone

7. Why is it important to wait for EMS even if the person recovers?

8. What information should you gather from witnesses? List FOUR key questions:

📝 Part 3: Report Writing

9. Write a brief incident report for this scenario. Include: time, location, condition found, actions taken, and outcome.

✅ Success Criteria - I Can:

I can assess scene safety before approaching

I can recognize signs of opioid overdose

I can properly administer naloxone

I can manage post-naloxone situations safely

I can write a clear incident report

Extension Activity: Research your local Good Samaritan laws. How do they protect people who help during overdoses?

Person Down Response Worksheet

Overdose Response Worksheet

🚨 Part 1: Scene Assessment & Response

💊 Part 2: Naloxone Administration & Follow-up

📝 Part 3: Report Writing

✅ Success Criteria - I Can:

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