Table 2. Survey of Manuscript Outcomes by Domain of First Aid Education (n=59).

Opioid Education & Naloxone Distribution (OEND)

People Who Inject Opioids (PWIO)

Survival Behavior Domain	Frequency of citations	Key Concepts
Prevent & Prepare	45 (76%)	Address impact on behaviors for carrying naloxone, storing, and any stigma. Several studies applied modified attitude assessment tools, which are not necessarily validated in the population of learners [25].
Early Recognition	52 (88%)	Some programs tailored these lessons to learners’ experience with overdoses and used different media or common language to improve knowledge and context for the need to act to save a life.
First aid / Access Help	First Aid 59 (100%) Accessing Help 42 (71%)	First aid education varied from passive, to demonstrated, to practiced skills. Contextual issues of safety from a variety of risks were often included and went beyond simple naloxone knowledge and skills in most instances. Although early activation of emergency services can improve clinical outcomes in opioid-related emergencies, past fears and adverse experiences with law enforcement personnel, and the variable protection of Good Samaritan legislation, seems to present a barrier to activation.  This problem was directly addressed in multiple studies and represents a unique challenge for first aid education in this domain.
Advanced Care	8 (14%)	Opioid Education & Naloxone Distribution (OEND) programs do not necessarily address Advanced Care domain practice, but the awareness of health professionals to help those who have overdosed obtain training and naloxone, as well as recovery help, was addressed in studies, mainly within academic pharmacy and medical education programs.
Self-recovery	10 (17%)	Generally, this manifested in trying to build relationships between tertiary prevention programs and people who came to refill naloxone prescriptions. Some programs dealt with mental trauma for lay responders in light of social push back from the people who inject opioids (PWIO) or peers, who may perceive an injustice in taking away a “high.”