Overdose Response Survey

1.Have you responded to an overdose in 2024?

Yes- If yes, when?

No- If you witnessed or heard of an overdose, please continue with that information.

Date Overdose Occurred

2.Specify where overdose took place. (Apartment complex name, street name, camp name, etc.)

3.Was Naloxone/Narcan administered?

Yes- If yes, how many?

No

Number of doses administered.

4.Was 911 Called?

Yes- Person was transported to the Emergency Department

Yes- Person refused transport

No- Person was taken to the Emergency Department

No- No other medical intervention

5.Did the person think fentanyl was in the drug?

Yes

No

What substance did the person think they were using?