🚨 Emergency Procedures During Psychedelic Experiences

Step 1: Assess the Situation

Before taking any action, take three seconds to assess. Is this a medical emergency or psychological distress?

• Medical emergency indicators: Unresponsive, not breathing normally, seizure, very high fever, chest pain, extreme physical rigidity, uncontrolled vomiting with airway risk, signs of serious injury.
• Psychological distress indicators: Extreme anxiety or panic, confusion, frightening hallucinations, crying, erratic behavior — but person is responsive, breathing, and physically stable.

If medical emergency: go to Step 2 immediately. If psychological distress: skip to the crisis management section and call Fireside Project for support.

Step 2: Call 911 for Medical Emergencies

Do not delay calling 911 out of fear of legal consequences. In most US states, Good Samaritan laws protect people who call for help during drug-related emergencies.

When you call, state clearly:

1. Your exact location (address, floor, apartment number)
2. "I need emergency medical help. Someone is [describe what you observe — unconscious / having a seizure / not breathing normally]."
3. "They have taken psilocybin mushrooms approximately [X hours] ago, approximately [X grams or amount]."
4. Any other substances involved
5. The person's approximate age and any known medical conditions or medications
6. Your name and callback number

Stay on the line. The dispatcher will give you real-time instructions. Do not hang up until told to do so.

Step 3: Stay With the Person

Do not leave the person alone unless you need to unlock a door for emergency responders. Your presence is critical both for safety and for providing information to paramedics when they arrive.

• If unconscious and breathing: place in recovery position (on their side)
• If unconscious and not breathing: begin CPR if trained and wait for dispatcher instructions
• If conscious and distressed: remain calm, speak reassuringly, do not restrain physically
• Clear the area of hazards if you can do so without leaving the person

Step 4: Provide Information to Paramedics

When emergency responders arrive, give them all relevant information immediately:

• Substance: psilocybin mushrooms (or specify if other substances were also taken)
• Approximate dose and time of ingestion
• Current symptoms you have observed
• Person's known medical history and medications if known
• Any allergies
• Timeline of events leading up to the emergency

Accurate information allows paramedics to choose the right interventions. Withholding substance information can result in inappropriate treatments. Paramedics are focused on health outcomes, not law enforcement.

Step 5: Post-Emergency Support

After the immediate emergency is resolved, ongoing support is important:

• Ensure the person has a trusted person with them after discharge if they were hospitalized
• Follow up with a mental health professional, particularly if the experience was traumatic
• Connect with integration support — see crisis-support resources
• Debrief with other people who were present — witnessing an emergency is also distressing
• Document what happened while it is fresh, including what worked and what didn't

Drug Interaction Emergencies: Serotonin Syndrome

Serotonin syndrome is a medical emergency that can occur when psilocybin is combined with certain medications, particularly SSRIs, SNRIs, MAOIs, or other serotonergic substances. It requires immediate 911 response.

Signs of Serotonin Syndrome

• Agitation, confusion, and rapid behavioral change
• Rapid heart rate (tachycardia)
• High blood pressure
• Dilated pupils
• Muscle rigidity or spasms, particularly in legs
• Heavy sweating and fever
• Shivering or goosebumps
• Diarrhea
• In severe cases: very high fever (above 41°C / 106°F), seizures, irregular heartbeat

Tell emergency responders about all substances taken, including any prescription medications. Serotonin syndrome is treated with benzodiazepines for agitation, cooling measures for fever, and supportive care.

What to Tell Emergency Responders

Use clear, calm, factual language. Example script: "My friend took approximately 3 grams of dried psilocybin mushrooms about two hours ago. They also take [medication] daily. About 30 minutes ago they became unresponsive. They are breathing but I cannot wake them. I am at [address]."

FAQ

Will I be arrested if I call 911 because someone took psilocybin?

In most US states, Good Samaritan drug overdose laws provide legal protection when you call 911 for a drug-related emergency. These laws vary by state and do not provide blanket protection for all offenses, but the intent is to remove fear of legal consequences as a barrier to seeking help. The person's life is always worth prioritizing over legal concerns. Many paramedics and emergency departments operate without contacting law enforcement for simple drug-related emergencies.

What if I don't know the exact dose taken?

Provide your best estimate to the dispatcher and paramedics: "We believe it was approximately 2-3 grams" is fine. Also describe the time elapsed since ingestion, the route of ingestion (eaten, tea), and any other substances known to have been taken. An approximate answer is better than no answer.

At what point should I escalate from peer support to 911?

Escalate to 911 immediately if you observe: unconsciousness or inability to rouse, seizure activity, breathing problems, very high fever, signs of serotonin syndrome, uncontrolled violent behavior posing injury risk, or any situation where you genuinely fear for physical safety. If you are unsure, calling 911 is never the wrong choice when physical safety may be at risk. You can also call the Fireside Project (1-623-473-7433) for real-time guidance on escalation decisions.

What should I not do while waiting for emergency services?

Do not leave the person alone, do not give them food or water if they are not fully conscious, do not physically restrain them unless they are about to cause immediate physical harm, do not give them other substances, and do not move them unless they are in immediate physical danger from the environment. Do not hang up with the 911 dispatcher.

Is serotonin syndrome common with psilocybin?

Serotonin syndrome from psilocybin alone is extremely rare. It becomes a risk primarily when psilocybin is combined with other serotonergic medications or substances, particularly MAOIs. The combination of psilocybin with harmala alkaloids (like in ayahuasca analogs) and simultaneous SSRI or SNRI use increases risk. Always research drug interactions before combining substances.

How can I prepare emergency information in advance?

Before any session, write down on a card or phone note: the substance and dose taken, the time, any medications the person takes, emergency contacts, and your location. Keep this accessible. Some harm reduction kits include a "medical information card" that can be handed directly to paramedics. The Fireside Project also recommends having a designated emergency contact who knows the session is happening.

What is the recovery position and when should I use it?

The recovery position keeps an unconscious but breathing person on their side to prevent aspiration if they vomit. Use it any time someone is unconscious but breathing. Roll them onto their side, ensure the airway is clear and open, and monitor breathing until help arrives. Do not use on someone with a suspected spinal injury.

What happens at the hospital for a psychedelic-related emergency?

For most cases of psychedelic distress, treatment is supportive: a quiet, calm environment, monitoring of vital signs, and sometimes benzodiazepines for severe anxiety. Medical staff are not typically focused on legal issues but on patient welfare. For true medical emergencies (seizures, serotonin syndrome), more intensive treatment may be needed. The person is usually observed until the acute effects resolve, which for psilocybin is typically within 6-8 hours.

How do I support someone emotionally after a psychedelic emergency?

After an emergency, the experience may feel traumatic — for both the person who had it and those who witnessed it. Provide a calm, safe space for rest and recovery. Do not immediately process or analyze the experience; give it time. Encourage professional follow-up with a mental health provider, ideally one familiar with psychedelic experiences. Integration support resources (Zendo Project, MAPS-trained therapists, Psychedelic Support directory) can be valuable in the weeks following.

What post-emergency documentation should be kept?

Writing down what happened — timeline, symptoms observed, actions taken, and outcomes — while events are fresh helps with personal reflection, potential future medical care, and learning from the experience. This is private personal documentation. If you witnessed a serious medical event, documentation may also be relevant to any medical follow-up the person needs.