Use the preloaded 4 mg NARCAN device for suspected opioid overdose under SO-B-002.
OCEMS source summary · Updated 2026-09-16
Product-specific pathway
This guide covers the preloaded 4 mg nasal product on equipped BLS units. The 2 mg atomizer method has different instructions in SO-B-002.
Anticipate agitation, withdrawal, or vomiting. If CPR is unnecessary and positioning permits, use the left lateral position to reduce aspiration risk.
Check & support breathing
Confirm ALS is responding. Use PPE and attempt stimulation.
Suspect opioid exposure from history or the scene, with poor responsiveness and slow/shallow breathing, or unresponsiveness without breathing.
Provide BVM ventilation or CPR as appropriate. For the medication pathway below, a pulse is present but response to stimulation and breathing are inadequate.
Use the 4 mg device
Administer the full preloaded 4 mg dose into one nostril.
If breathing or consciousness improves only partially, the source permits another 4 mg dose into the opposite nostril.
Continue checking breathing and consciousness. Maintain airway support, prepare transport, and await ALS.
Reassessment & positioning
Observe breathing and consciousness after treatment. If improvement is inadequate, continue BVM ventilation or CPR as indicated by the assessment rather than waiting for naloxone to work.
When CPR is unnecessary and positioning allows, the source recommends the left lateral position to reduce aspiration risk. Watch for agitation, abdominal cramping, sweating, or vomiting.
Keep the product and scope clear
SO-B-002 also describes a 2 mg syringe-and-atomizer option, split between nostrils, with a separate repeat instruction. That is not the same device as the 4 mg preloaded spray.
The ALS medication guide uses separate doses and repeat intervals. Record the device strength, doses already given, response, and the continuing need for ALS care.