NORTH ADAMS — Call 911, clear the scene of any needles or hazards, then check for a pulse.
If there is a heartbeat but breathing has slowed to less than one breath every five seconds, supply two quick breaths, mouth to mouth, every five to 10 seconds.
Meanwhile, assemble the naloxone. Once the three pieces are together, spray half of the dose in one nostril and half in the other.
Continue supplying oxygen and wait three minutes. If he doesn't wake up, it's time for another dose, but by then hopefully emergency responders have arrived.
The steps necessary to save the life of a person overdosing were provided — in much more clinical detail — during a free training session Tuesday at North Adams Ambulance Service headquarters by Amalio Jusino, assistant chief of service. The training thoroughly explained to a small but rapt audience how to recognize an overdose, administer a potentially life-saving dose of naloxone and provide CPR if necessary.
"What's the problem with the whole thing? You're going to be nervous," Jusino said.
In an interview with The Eagle, one Northern Berkshire resident said she was using drugs with a group of friends when one slumped over and turned blue. The woman spoke on the condition of anonymity because she is an addict in recovery and fears the stigma surrounding addiction could result in negative consequences professionally and otherwise if her name is shared.
"There's three pieces to it, and you'd think it wouldn't be hard to do. I practiced it many times, but it's difficult to get together in the situation," she said.
They had called an ambulance first, but still felt the pressure to quickly administer a dose, because it's never clear how long of a window the overdose patient may have before he or she falls into cardiac arrest.
"You just get butterfingers and you're like 'how is this put together,'" the woman said. "If you don't get it together in the right way, then you get flustered."
Of course, naloxone has its limits. It will not reverse cardiac arrest.
Jaycee Bressette has received multiple doses of naloxone on two occasions, and once had to be revived with an automated external defibrillator because her heart stopped.
"One minute you're doing whatever and the next you're waking up on a stretcher not knowing what happened or where you are," Bressette said. "The last time it happened to me I woke up in the back of the ambulance with an EMT saying 'please breathe, please breathe.'"
Bressette, now in school and on a methadone treatment program, said it's easy to overdose "if it's heroin you have never tried, you never know what is in it or its potency."
The public training, whose participants ranged from interested community members to Massachusetts College of Liberal Arts police officers, is just one piece of a concerted effort in the Berkshires to arm anyone and everyone who might encounter an overdose with the knowledge and materials to save a life.
The public has more access to naloxone now, with standing orders of the drug at CVS and Rite Aid, according to Wendy Penner, the Northern Berkshire Community Coalition's director of Prevention and Wellness.
The drug is also available through Tapestry Health, which has limited hours in North Adams but also has a location in Pittsfield. Weekly Learn to Cope meetings in Pittsfield, a group session held for family members of those with substance abuse disorder, also provide access and training for naloxone.
The Community Coalition, which sponsored the public training, is working this week to make available a pamphlet that lists relevant information for those seeking naloxone, including how to use it and where to find it in the Northern Berkshires.
Earlier this year, the city utilized a bulk purchasing program implemented by the state to purchase naloxone for its police and fire departments. Though the North Adams Ambulance Service has long been equipped with the overdose treatment, which is required by the state, the belief was that training officers and firefighters could only increase the odds an overdose victim receives treatment as quickly as possible.
On Monday, Berkshire District Attorney David Capeless announced a $17,000 grant to stock the emergency departments of Berkshire Medical Center with naloxone for victims of an overdose and their families.
Despite the efforts to combat addiction by a number of community leaders coupled with increased access to Narcan, the number of overdose deaths in North County remains alarming.
According to state Department of Public Health data, there were a combined 11 overdose deaths across the 10 towns in Northern Berkshire in 2014 and 2015. And according to a different DPH study, more people in North Adams sought treatment for substance issues in fiscal years 2013 and 2014 than in any of the eight years prior.
But Jusino's experience in the field, some of which he shared with the class on Tuesday, provides perspective on an epidemic that has spread throughout the community. At one point, the ambulance responded to an overdose every day for 14 days straight, and once responded to nine overdoses in one night,
Officials have also worked to educate residents on the state's Good Samaritan law, which provides those who call 911 in the event of an overdose with legal protection. Under the law, passed by the Legislature in 2012, a person cannot be charged with drug possession as a result of calling for or receiving emergency assistance in the event of a drug overdose.
The law does not apply to other, more significant charges, such as drug trafficking or distribution.
The Department of Public Health has a "Make the Right Call" public information initiative, imploring people to utilize emergency medical services in the event of an overdose, saying "the lives of those who overdose on opioids relies on the help of bystanders, the law has significant potential to help reduce the impact of the opioid epidemic."
"Do not delay calling 911," Jusino said.
As the training wound down, one thing was a certainty among its participants: More people should have been there.
Contact Adam Shanks at 413-496-6376