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Narcan Use Report (Saratoga County, NY)

Use this form to report citizen or off-duty first responder use of Narcan

DO NOT USE this form if:

A Patient Care Report (PCR) was completed by fire or EMS
Fire or Law Enforcement gave the Narcan and a PCR was not completed (instead, click here for the public safety reporting form)

1.What date was Narcan used?

Date

SuSunday

MoMonday

TuTuesday

WeWednesday

ThThursday

FrFriday

SaSaturday

2.If you know the zip code where the overdose happened, please enter it here:

3.How many doses were administered?

3 or more

Unknown

4.Did the person who overdosed survive?

Yes

Unknown

5.Was 911 called?

Yes

Unknown

6.Was rescue breathing performed before EMS, fire, or police arrived?

Yes

Unknown

7.Were chest compressions (CPR) performed before EMS, fire, or police arrived?

Yes

Unknown

8.What kind of place did the overdose happen?

Someone's home or apartment

Public place outside (like a park, sidewalk, yard)

Public place inside (like a car, restroom, bus, school, business)

Other (please specify)

9.How old were they? (Use best guess)

10.All information is anonymous and confidential. Please add any additional comments about this Narcan administration.

Current Progress,

0 of 10 answered

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