🚨 Emergency Protocols by Location

Common Home Emergency Scenarios & Responses

Scenario 1: Severe Anxiety/Panic Attack

1. Immediate Reassurance: Calmly remind person they are safe, the effects are temporary, and they will return to normal. Use phrase: "You took a substance, you're safe, this will pass."
2. Environmental Adjustment: Dim lights, reduce noise, play gentle music. Move to quieter room if current space feels overwhelming.
3. Grounding Techniques: Guide through deep breathing (4-7-8 technique: inhale 4 seconds, hold 7, exhale 8). Provide soft tactile objects (blanket, stuffed animal). Encourage focus on physical sensations.
4. Position Change: Help person sit or lie down in comfortable position. Elevate legs if feeling faint. Provide cool cloth for forehead.
5. Continuous Monitoring: Stay physically close (within arm's reach). Maintain calm, reassuring voice. Avoid touching without consent, but offer hand-holding if welcomed.
6. Duration Tracking: If panic persists beyond 30 minutes without improvement, contact Fireside Project for guided support.
7. Escalation Protocol: If person becomes unresponsive, shows signs of physical distress (chest pain, severe difficulty breathing), or panic intensifies to dangerous behavior, call emergency services.

Scenario 2: Nausea/Vomiting Episode

1. Immediate Preparation: Guide person to bathroom or provide basin. Support head if vomiting. Have towels and water readily available.
2. Position Safety: Ensure person is seated or on side (recovery position) if lying down. Never leave alone if severely nauseous or actively vomiting.
3. Hydration Management: After vomiting subsides, offer small sips of water (1-2 oz every 10 minutes). Avoid forcing fluids if person is still actively nauseous.
4. Comfort Measures: Cool cloth on forehead and back of neck. Fresh air if possible (open window or use fan). Ginger tea or crackers if person can tolerate.
5. Observation Period: Monitor for signs of dehydration (dry mouth, dizziness, decreased urination). Check for blood in vomit (requires immediate medical attention).
6. Duration Assessment: Nausea typically subsides within 30-60 minutes. Persistent vomiting (more than 2 hours) or inability to keep down fluids requires medical evaluation.

Scenario 3: Physical Injury (Falls, Cuts, Bruises)

1. Immediate Assessment: Safely approach injured person. Assess level of consciousness and severity of injury. Ask person to remain still while evaluating.
2. First Aid Application: Apply pressure to bleeding wounds with clean cloth. Clean minor cuts with antiseptic. Apply ice to bruises/swelling (wrapped in cloth, never direct contact).
3. Head Injury Protocol: If person hit head, check for confusion, vision changes, persistent headache, or vomiting. Any concerning signs require immediate emergency services call.
4. Pain Management: Assess pain level (1-10 scale). For minor injuries, offer over-the-counter pain relief (acetaminophen preferred over NSAIDs). Do not offer medication if person is disoriented.
5. Documentation: Take photos of injuries for medical reference. Note time of injury and circumstances.
6. Medical Decision: Seek emergency care for: deep cuts requiring stitches, suspected fractures, severe head trauma, persistent bleeding, or any injury person cannot fully assess due to altered state.

Scenario 4: Psychological Crisis/Suicidal Ideation

1. Immediate Safety: Remove access to potential means of self-harm (medications, sharp objects, weapons). Do not leave person alone.
2. Crisis Communication: Ask directly about suicidal thoughts: "Are you thinking about hurting yourself?" Listen without judgment. Take all statements seriously.
3. Hotline Contact: Immediately call Fireside Project (62-FIRESIDE) or National Suicide Prevention Lifeline (1-800-273-8255). Put on speaker if person is willing to talk.
4. Grounding & De-escalation: Use calm, reassuring voice. Remind person that feelings are intensified by substance and temporary. Avoid arguing or being dismissive.
5. Physical Comfort: Ensure person is in comfortable, safe space. Offer water, blankets, gentle music. Physical proximity (sitting nearby) without crowding.
6. Professional Evaluation: If person expresses immediate plan or intent to harm themselves, or cannot be de-escalated, call 911. Clearly state "mental health crisis" to ensure appropriate response team.
7. Post-Crisis Care: Once acute crisis passes, do not leave person alone for at least 6-8 hours. Arrange professional mental health follow-up within 24-48 hours.

Outdoor Emergency Scenarios & Responses

Scenario 1: Getting Lost/Disoriented

1. Immediate Stop: As soon as disorientation recognized, STOP moving. Sit down in safe spot. Moving while disoriented increases danger.
2. Whistle Signal: Blow whistle in series of 3 (universal distress signal). Wait and listen for response. Repeat every few minutes.
3. Phone Communication: Call trip sitter immediately. If no answer, call emergency contact. Share exact GPS coordinates if phone capable (iPhone: compass app; Android: Google Maps shows coordinates).
4. Landmark Description: Describe surroundings in detail - distinctive trees, rocks, water bodies, sounds. This helps rescue team locate you.
5. Stay Put Protocol: Once location is communicated, DO NOT MOVE. Sitters/emergency services will come to you. Moving makes you harder to find.
6. Comfort & Safety: If waiting extended period, use emergency blanket for warmth, stay hydrated, and sit in visible clearing if possible.
7. Emergency Services: If trip sitter cannot locate within 30 minutes, or if weather deteriorating, call 911. Explain situation honestly (medical emergency, lost person, substance-affected judgment).

Scenario 2: Weather Emergency (Hypothermia/Hyperthermia)

Hypothermia Response:

1. Recognition: Signs include severe shivering, confusion, slurred speech, drowsiness, weak pulse. Person may insist they feel fine (judgment impaired by cold).
2. Immediate Shelter: Move to dry, wind-protected area. Remove any wet clothing immediately. This is priority #1.
3. Gradual Warming: Wrap in emergency blanket, dry clothes, sleeping bag. Apply warm (not hot) compresses to neck, armpits, groin - DO NOT rub extremities.
4. Warm Fluids: If person is alert and can swallow, provide warm (not hot) sweet beverages. No alcohol or caffeine.
5. Body Heat Transfer: If available, have another person (in dry clothes) provide body heat through direct contact under blankets.
6. Emergency Services: Call 911 if: person stops shivering (severe hypothermia), becomes unresponsive, has difficulty breathing, or condition doesn't improve after 30 minutes of warming.

Hyperthermia/Heat Stroke Response:

1. Recognition: Symptoms include hot dry skin (sweating may stop), confusion, rapid heart rate, headache, dizziness, body temp above 103°F/39.4°C.
2. Immediate Cooling: Move to shade immediately. Remove excess clothing. This is life-threatening emergency.
3. Aggressive Cooling: Apply cool (not ice) water to skin - focus on neck, armpits, groin. Use wet cloths, continuous water spray. Fan to increase evaporation.
4. Hydration: If person conscious and can drink, provide cool water in small amounts (4 oz every 15 minutes).
5. Temperature Monitoring: Check temperature every 10 minutes. Goal is to reduce to below 102°F/38.9°C.
6. Emergency Services: Call 911 immediately for suspected heat stroke. Continue cooling while waiting for help. This is medical emergency requiring hospital treatment.

Scenario 3: Fall/Physical Injury in Remote Area

1. Scene Safety: Ensure area is safe before approaching (no ongoing rockfall, unstable ground). Approach carefully.
2. Initial Assessment: Check consciousness, breathing, severe bleeding. If unconscious or not breathing, call 911 immediately and begin CPR if trained.
3. Spinal Precautions: If fall was significant (>6 feet) or person has neck/back pain, minimize movement. Stabilize head and neck manually.
4. Bleeding Control: Apply direct pressure to wounds with cleanest material available. Elevate injury above heart if possible. Apply pressure for minimum 10 minutes without checking.
5. Fracture Management: Immobilize injured limb using splint (sticks, rolled clothing). Pad splint with soft material. Secure above and below injury site.
6. Emergency Communication: Have secondary sitter call 911 immediately. Provide: exact GPS coordinates, nature of injury, vital signs if known, trail access point for emergency vehicles.
7. Victim Stabilization: Keep person warm with emergency blanket. Reassure calmly. Monitor consciousness level every 5 minutes. Do not give food or water if abdominal injury or surgery possible.
8. Evacuation Decision: Only move person if: immediate danger at current location (rockfall, rising water, exposure), person can walk with assistance, or trained team performs litter carry. Otherwise, wait for professional rescue.

Scenario 4: Wildlife Encounter

1. Prevention: Make noise while moving through terrain (talk, sing, clap). Wildlife typically avoids humans. Store food in sealed containers away from resting area.
2. Bear Encounter: Stand still, speak calmly, back away slowly while facing bear. DO NOT run. If attacked: fight back aggressively for black bears; play dead for grizzlies (curl in ball, protect neck).
3. Snake Bite: Move away from snake immediately. Keep bitten area below heart level. Remove rings/tight clothing near bite. DO NOT cut wound, apply tourniquet, or ice. Call 911 immediately - antivenin needed within hours. Note snake appearance for medical team.
4. Insect Swarm/Bees: Run away quickly in straight line while covering face. Get to enclosed space or underwater if possible. If stung multiple times, seek medical help (risk of allergic reaction or venom load).
5. Large Cat (Mountain Lion/Cougar): Maintain eye contact, appear large (raise arms, open jacket), back away slowly. If attacked, fight back aggressively - target eyes and nose.
6. Post-Encounter: Even if injury seems minor, wildlife bites/scratches require medical evaluation for infection risk (rabies, tetanus). Seek medical care within 24 hours.

Festival Emergency Scenarios & Responses

Scenario 1: Separated from Group/Lost in Crowd

1. Immediate Stop: Stop moving as soon as you realize separation. Moving while disoriented in crowd increases danger and distance from group.
2. Move to Edge: Carefully move to edge of crowd/main thoroughfare. Find landmark (info booth, art installation, specific stage area).
3. Phone Communication: Immediately call or text group members. Send photo of current location/landmark. Share "pin" or location if phone capable.
4. Stay Put Protocol: Remain at identified landmark. Send detailed description: "At main stage, left side, near red sculpture." Don't keep moving to "find" group.
5. Use Designated Meeting Point: If no phone contact possible, go to pre-arranged meeting spot. Wait there for minimum 30 minutes.
6. Seek Official Help: If can't reach group after 30 minutes, go to information booth or medical tent. Staff can make announcements or provide safe waiting area.
7. Home Base Contact: Contact designated home base person who stayed in known location. They can coordinate meeting.

Scenario 2: Sensory Overload/Panic in Crowd

1. Recognition: Signs include hyperventilation, extreme anxiety, feeling trapped, visual/auditory overwhelm, desire to flee. May communicate as "I need to get out NOW."
2. Immediate Extraction: Buddy guides person out of crowd immediately. Move toward quieter area - away from speakers, lights, dense crowds. Don't argue or delay.
3. Find Quiet Zone: Locate designated chill/quiet areas (many festivals have these). If not available, find edge of venue, behind structures, or wooded area.
4. Sensory Reduction: Help person sit or lie down. Offer earplugs, eye mask/sunglasses. Create physical barrier from stimuli (jacket over head if needed).
5. Grounding Techniques: Guide through breathing (4-7-8 pattern). Have person describe 5 things they can see, 4 they can hear, 3 they can touch, 2 they can smell, 1 they can taste (5-4-3-2-1 technique).
6. Hydration & Cooling: Offer water in small sips. Apply cool cloth to neck and wrists. Check for signs of overheating.
7. Harm Reduction Services: If available, seek out Zendo Project, Kosmicare, or similar harm reduction tents. Staff trained in psychedelic crisis support.
8. Duration Management: Stay in quiet area for 30-60 minutes minimum. Don't rush return to festival. Person may need to rest for remainder of peak experience.

Scenario 3: Dehydration/Heat Exhaustion in Festival Environment

1. Recognition: Symptoms include excessive thirst, dizziness, weakness, headache, decreased urination, confusion. Skin may be cool and clammy. Often develops gradually.
2. Immediate Action: Move person to shaded, cool area immediately. Remove from sun and crowds. Sit or lay person down.
3. Hydration Protocol: Offer water in small amounts (4-6 oz every 15 minutes). If available, provide electrolyte drinks (sports drinks, Pedialyte). Don't force rapid consumption - can cause vomiting.
4. Cooling Measures: Apply cool, wet cloths to neck, wrists, armpits. Use fan or fanning motion. Remove excess clothing layers.
5. Monitor Progression: Check mental status (name, date, location). If confusion worsens or person can't keep fluids down, seek medical help immediately.
6. Medical Tent Assessment: If symptoms don't improve within 20-30 minutes, or if person develops rapid heart rate, fainting, or nausea, go to medical tent. May need IV fluids.
7. Rest Period: Person should rest for minimum 1-2 hours after symptoms resolve. Gradual return to activity. Continue regular hydration.

Scenario 4: Medical Emergency at Festival

1. Initial Assessment: Determine severity - is this life-threatening emergency (unconsciousness, seizure, chest pain, severe breathing difficulty) or urgent but stable situation?
2. Call for Help: Have one person stay with patient, another go to nearest medical tent or call festival medical team (may have dedicated phone number in program).
3. Provide Information: Tell medical staff: what substance taken (type, dose, timing), symptoms observed, any relevant medical history (allergies, medications, conditions), events leading to emergency.
4. Truth is Essential: Be completely honest about substances. Medical staff need this for proper treatment. Most festivals have amnesty policies - they care about health, not criminal consequences.
5. Support Role: Friend should stay with person during medical care if allowed. Provide calm presence, advocate for person's needs, take notes on instructions given.
6. Hospital Transport: If person transported to hospital, someone from group should accompany if possible. Bring ID, phone, insurance information if available.
7. Group Communication: Immediately inform rest of group about situation. Designate someone to coordinate communication with person's family/emergency contacts if necessary.
8. Follow-up Care: After release from medical care, person should not be alone for at least 12 hours. May need to leave festival early for proper rest and recovery.

Therapeutic Setting Emergency Scenarios

Scenario 1: Cardiovascular Event Concerns

1. Continuous Monitoring: In therapeutic settings, vital signs should be checked: baseline, 30 minutes post-dose, peak (90-120 min), and any time patient reports physical discomfort.
2. Recognition: Patient reports chest pain, pressure, or discomfort; shortness of breath; pain radiating to arm/jaw; severe headache; or vital signs show: HR >130 bpm sustained, BP >180/110, irregular heart rhythm.
3. Immediate Assessment: Check vital signs, assess pain quality/intensity (1-10 scale), observe skin color and breathing pattern. Keep patient calm and seated/reclining.
4. Medical Consultation: On-site or on-call physician consulted immediately. Provide: vital signs, symptoms, time of dose, amount of psilocybin/substance, relevant medical history.
5. Intervention Protocol: If physician determines emergency: call 911, begin oxygen if available, provide aspirin if suspected MI and no contraindications, prepare medication list for EMS.
6. Benzodiazepine Administration: Under physician order, may administer benzodiazepine to reduce anxiety-driven sympathetic response (can lower BP and HR). Typical: lorazepam 1-2mg sublingual or diazepam 5-10mg oral.
7. Documentation: Precise documentation of timeline, symptoms, vital signs, interventions. Critical for emergency department care.

Scenario 2: Severe Psychological Distress/Ego Dissolution Crisis

1. Recognition: Patient experiences extreme fear, feels they're dying, complete loss of self, paranoid beliefs, or displays signs of intense distress (crying, shouting, physical agitation).
2. Non-Intervention Principle: In therapeutic settings, initial approach is often supportive presence without intervention. Many challenging experiences are therapeutically valuable if patient can process them.
3. Verbal Support: Therapist provides calm, reassuring presence: "You're safe, I'm here with you, this is temporary, breathe with me." Use patient's name to ground them.
4. Physical Comfort: Offer blanket, adjust lighting, temperature. Physical touch (hand-holding) only if previously consented and welcomed. Some patients prefer no physical contact during intense experiences.
5. Escalation Assessment: If distress continues >30 minutes without any decrease in intensity, or patient becomes potentially dangerous to self (attempting to leave, removing IV lines, extreme physical agitation), consider intervention.
6. Pharmacological Intervention: Under physician supervision, may administer benzodiazepine to reduce intensity: lorazepam 1-2mg sublingual (onset 10-20 min) or diazepam 5-10mg oral (onset 30-60 min). Document decision rationale.
7. Post-Intervention Support: After administering medication, continue supportive presence. Medication typically reduces intensity but doesn't fully terminate experience. Patient may experience disappointment about intervention - address in integration.

Scenario 3: Persistent Psychosis/Break from Reality

1. Recognition: Patient expresses delusional beliefs that persist beyond typical psychedelic experience patterns, shows disorganized thinking, exhibits paranoia with possible risk behaviors, or displays symptoms lasting beyond expected duration (>8-10 hours for psilocybin).
2. Safety Establishment: Ensure environment is safe - remove potential hazards, maintain calm atmosphere, have multiple staff present if patient is agitated.
3. Medical Evaluation: Physician assesses for: organic causes (fever, head injury), substance interactions, pre-existing psychiatric vulnerability, need for pharmacological intervention.
4. Benzodiazepine Trial: Administer benzodiazepine first line: lorazepam 1-2mg. If insufficient response after 30-45 minutes, may repeat dose. Monitor for respiratory depression.
5. Antipsychotic Consideration: If benzodiazepines insufficient and psychosis persists, physician may administer antipsychotic: haloperidol 5mg IM or olanzapine 10mg oral/IM. Risk-benefit assessment required.
6. Hospitalization Decision: Consider psychiatric hospitalization if: symptoms persist >12 hours post-dose, patient poses safety risk, inadequate support for outpatient monitoring, or symptoms worsen despite interventions.
7. Family Notification: With patient consent or in emergency, notify family/emergency contact. Provide information about situation, expected course, follow-up plan.
8. Follow-up Protocol: Daily check-ins for first 3 days, psychiatric evaluation within week, assessment of whether psychedelic therapy should continue.

Scenario 4: Medical Emergency During Session (Seizure, Allergic Reaction)

Seizure Protocol:

1. Patient Safety: Clear area around patient, place cushioning under head, turn patient on side (recovery position), loosen tight clothing around neck.
2. Do Not Restrain: Never restrain person having seizure or place objects in mouth. Allow seizure to occur while protecting from injury.
3. Time the Seizure: Note exact start time. Seizure lasting >5 minutes is medical emergency (status epilepticus).
4. Call 911: If seizure lasts >5 minutes, this is second seizure in session, or patient has no history of seizures. If known epileptic with history of short seizures, may not require EMS if seizure self-terminates <5 minutes and patient returns to baseline.
5. Post-Seizure (Postictal) Care: Patient will likely be confused/drowsy. Keep on side, monitor breathing, provide calm reassurance. Don't offer food/drink until fully alert.
6. Medical Evaluation: Even if seizure self-terminates, patient should receive medical evaluation same day to rule out complications and adjust medication if needed.

Allergic Reaction Protocol:

1. Recognition: Mild: itching, hives, mild swelling. Severe (anaphylaxis): difficulty breathing, throat tightness, severe swelling of face/throat, rapid progression of symptoms.
2. Mild Reaction: Administer oral antihistamine (diphenhydramine 25-50mg). Monitor closely for progression. If symptoms worsen, treat as anaphylaxis.
3. Anaphylaxis Response: Call 911 immediately. Administer epinephrine auto-injector (EpiPen) if available: 0.3mg IM to outer thigh. Can repeat after 5 minutes if no improvement.
4. Position Patient: If breathing difficulty, sit upright. If feeling faint, lie flat with legs elevated. Monitor continuously.
5. Hospital Transport: All anaphylaxis cases require emergency department evaluation even if symptoms improve with epinephrine. Biphasic reactions can occur hours later.
6. Documentation: Record timing of reaction, symptoms, interventions, response. Patient should be informed this represents contraindication to future use of this substance.

Public Emergency Scenarios & Responses

Scenario 1: Unexpected Strong Effects in Public

1. Immediate Recognition: Person realizes effects are stronger than expected or comfortable to manage in public. Act quickly before peak intensity.
2. Find Immediate Safe Space: Priority is reducing public exposure. Options: hotel room (book immediately), friend's home (call for pickup), mall restroom family/companion room (temporary), quiet cafe booth, library, hospital waiting room.
3. Call for Extraction: Contact trusted person not present to come pick up. Provide exact location (GPS coordinates, business name). "I need help, can you come get me at [location]? I'm not in physical danger but need to get somewhere safe."
4. Minimize Public Attention: Put on sunglasses, headphones. Avoid making eye contact. Sit quietly. Appear tired/resting rather than intoxicated. The goal is to avoid drawing attention that leads to unwanted interactions.
5. Stay Put: Once in relatively safe location, don't keep moving. Moving through public while disoriented increases danger and attention. Wait for help to come to you.
6. Simple Communication: If must interact with people, use simple explanation: "Not feeling well," "Need to rest," "Waiting for friend." Don't over-explain or provide details about substances.
7. Crisis Hotline Support: Call Fireside Project (62-FIRESIDE) while waiting. They can provide calm guidance for managing experience until safe location reached.

Scenario 2: Law Enforcement Contact

1. Remain Calm: Police contact doesn't automatically mean arrest. Appearing cooperative and non-threatening is crucial. Speak slowly and clearly.
2. Basic Information: Provide name and ID if requested. You're generally required to identify yourself. Be polite and respectful - "Yes officer," "No officer."
3. Medical Frame: If asked about behavior/condition: "I'm not feeling well," "I think I had a bad reaction to something," "I need medical help." This frames situation as health issue, not criminal.
4. Do Not Admit to Crime: You have right to remain silent. Don't volunteer information about substance use, possession, or illegal activity. Simply state: "I want to speak to a lawyer."
5. Do Not Consent to Search: If asked to search person, bag, or vehicle: "I do not consent to a search." If they search anyway without consent, do not physically resist - you can challenge it legally later.
6. Medical Evaluation Request: If feeling genuinely unwell or situation escalating, request medical evaluation: "I need to go to the hospital, I'm not feeling right." This can move you from criminal justice to medical setting.
7. Emergency Contact: If detained/arrested, use phone call to contact lawyer or trusted person who can arrange lawyer. Don't discuss case details on jail phone (recorded).
8. Hospital vs. Jail: If given option between hospital evaluation and arrest, choose hospital. Medical setting is safer and provides care. Hospital visit is not admission of guilt.

Scenario 3: Emergency Medical Need in Public

1. Assess Urgency: Life-threatening emergencies (unconsciousness, breathing difficulty, chest pain, seizures) require immediate 911 call regardless of legal concerns. Your life is more important.
2. Call 911: If calling yourself: "Medical emergency at [location], person is [symptoms], send ambulance." If you don't want to identify yourself, you don't have to - just provide essential information and location.
3. Good Samaritan Principles: Many jurisdictions have Good Samaritan laws protecting people who seek emergency help for drug-related medical issues. EMS and emergency departments prioritize medical care over criminal prosecution.
4. Be Honest with Medical Staff: Tell emergency responders and hospital staff exactly what substance was taken, dose, and timing. They need this for proper treatment. Medical information is protected by HIPAA and generally not shared with law enforcement.
5. Focus on Medical: When police are present (often standard with EMS calls), direct your communication to medical staff. Answer medical questions honestly. You can decline to answer police questions: "I'm not answering questions, I need medical care."
6. Hospital Admission: Once in emergency department, you're a patient, not a suspect. Medical staff's priority is your health. Fully disclose substance information for proper care.
7. Post-Care Legal: If police issue citation or arrest after medical care, do not make statements. Contact attorney before discussing case with anyone.

Scenario 4: Stranded/Unable to Get Home

1. Assess Situation: Current location, time of day, financial resources available, people who can help, duration until effects subside enough to travel safely.
2. Contact Network: Call friends/family who can provide pickup or send ride service. Be direct: "I need help getting home from [location], can you help?"
3. Ride Service: Use Uber/Lyft only if: effects are manageable, destination is close (under 20 minutes), you can appear relatively composed. Tip driver well for patience.
4. Public Transit: Generally not recommended while under strong effects. If necessary: stay on one train/bus (no transfers), set phone alarm for your stop, wear headphones and sunglasses to minimize interaction.
5. Temporary Safe Space: If cannot get home immediately, secure safe place to wait: hotel room, trusted friend's place, 24-hour cafe/diner, hospital waiting room (if no medical emergency, just safe place to sit).
6. Time Management: Most psilocybin effects subside significantly after 4-6 hours. Plan to wait until navigating public spaces is safer and easier.
7. Emergency Shelter: If stranded overnight with no resources, some cities have crisis shelters. Call 211 for local resources. Homeless services or crisis centers may provide temporary safe space.