S: Stimulate

Check if the person is responsive and try to wake them up.

a) Can they hear you?

• Speak loudly or make noise.

• Call their name.

• Say phrases like "Wake up!" or "Are you okay?"

b) Can they feel you?

• Announce who you are and what you’re doing, even if they appear drowsy or difficult to wake.

Signs of Responsiveness:

• Awake and alert.

• Answers questions.

• Easily roused.

• Minimal or no sedation.

c) Put on gloves (if available)

d) Try to wake them up physically:

• Tap or squeeze the muscles between their neck and shoulders.

• Squeeze their fingertip firmly.

If they do not respond, this is a medical emergency—CALL 911 immediately. Tell the operator that the person is unresponsive and may be experiencing an opioid overdose.

A: Airway

Check breathing and make sure their airway is clear.

a.) Are they breathing notmally?

• Look to see if the chest is rising and falling.

• Listen for any unusual choking, gurgling or snoring sounds. 

• Put your hand near their mouth or nose to feel for their breath.

Breathing Normally:

• Taking 12 or more breaths per minute.

• Breathing on their own.

• No abnormal or unusual breath sounds.

b.) Check in the person's mouth to see if there is anything blocking the airway.

• Example: needle caps, gum, or chewing tobacco.

c.) If the person does have something in their mouth:

• Do not do a blind sweep.

• Remove any solid material obstructing the person's airway.

d.) If not, check pulse (heartbeat) for less than 10 seconds if you are trained and comfortable to assess.

If there is no pulse detected, give chest compressions and rescue breaths.

V: Ventilate

Give rescue breaths.

a.) Give rescue breaths with the face shield provided in the Take Home Naloxone (THN) kit.

b.) Start rescue breathing: give 1 breath every 5 seconds for 3 minutes (35-40 breaths).

• Make sure their chest rises and falls

• If you do not see their chest rise and fall, re-position their airway (i.e., head tilt-chin lift) or check the seal of the face shield around their mouth.

E: Evaluate

Check if the person is breathing, responsive, and has a pulse.

a.) Check again if they have started breathing.

b.) Check if they are responsive or waking up. 

c.) Check pulse (heartbeat) for less than 10 seconds if trained and comfortable to assess. 

Evaluate and Support 

Breathing still not returned to normal? 

Continue giving rescue breaths 1 every 5 seconds, and give naloxone.

M: Medication

Give naloxone if the person is not breathing normally

a.) How will you give naloxone?

• Injection: 

  • Inject naloxone into a large muscle.

  • It will start to work within 2-5 minutes.

  • Continue giving rescue breaths. 

• Nasal Spray:

  • Spray into the nostil.

  • It will start to work within 3-4 minutes.

  • Continue giving rescue breaths. 

b.) Where you will give injectable naloxone?

• Outer Thigh: Outer middle area of the thigh muscle 

• Upper Arm: Upper arm muscle below shoulder

b.) Will you give intranasal naloxone?

• Ensure individual is laying on their back and administer medication through one nostril 

c.) Draw up one dose of naloxone into the syringe.

d.) Inject the needle at a 90 degree angle with a steady and smooth dart-like motion. 

In an emergency, naloxone can be injected through thin layers of clothing. 

e.) Push the plunger of the syringe until you hear or feel a click. 

f.) Safely dispose of the syringe and ampoule(s) into a sharps container (or other container if sharps not available). 

E: Evaluate and Support

Evaluate breathing and responsiveness. Provide support. 

a.) Keep giving 1 breath every 5 seconds until the person is breathing normally.

b.) STOP giving naloxone when breathing returns to normal. 

c.) Re-assess:

• If they are breathing normally

• If they are waking up

• If they have a pulse (heartbeat) if trained and comfortable to assess.

d.) If breathing has not returned to normal: 

• Repeat Medication (give another dose every 3 minutes) and Evaluate and Support steps until breathing is returned to normal.

• After giving two doses of nasal spray, if breathing has not returned to normal switch to injectable naloxone.