Report Reversal

OpiRescue does not support reversal reports in your state. Please use the OpiRescue app to record reversals.

Q1: On what dates did the overdose happen?

Q2: At about what time?

Select A Different Time Below

Q3: Street where it occurred?

Q4: Nearest cross street?

Q5: Was the person male, female, or other

Select from Options

Q6: What made you think this was an overdose?

Select from Options

Q7: What drugs had they taken? (only check the ones you are sure of)

Select from Options

Q8: Did you or anyone call 911?

Select from Options

Q9: Did you or anyone administer Naloxone?

Select from Options

Q10: Where did you get your kit?

Select from Options

Q11a: What type of naloxone?

Select from Options

Q11b: Which brand of nasal spray?

Select from Options

Q12: How many complete doses did you deliver?

Select from Options

Q13: What else did you do? (select all that apply)

Select from Options

Q14a: Did you use Fentanyl testing strips?

Select from Options

Q14b: What was the result of the Fentanyl test?

Select from Options

Q15: Did the person regain consciousness?

Select from Options

Q16: How long did it take?

Select from Options

Q17: Did the person survive?

Select from Options

Q18: Were there any side effects? (select all that apply)

Select up to 3 from options (IF None +1 pick, ignore None):

Q19: Did the person go to the hospital?

Select from options:

Q20: Are you a certified first responder (EMT, police, firefighter)?

Select from options:

Q21: Your name?

Q22: Your state?

Select state from drop-down menu

Q23: Your organization?

Q24: What is your department number or identifier?