Emergency Response Flowchart

Quick decision-making guide for psychedelic emergencies.

⚠️ WHEN TO CALL 911/Emergency Services

Call immediately if person exhibits:

  • Loss of consciousness / unresponsive
  • Seizures
  • Difficulty breathing or stopped breathing
  • Chest pain or irregular heartbeat
  • Severe confusion lasting >1 hour after ingestion
  • Violent behavior endangering self/others
  • Signs of poisoning (suspected wrong mushroom species)

Decision Tree: Is This An Emergency?

START HERE

❓ STEP 1: CHECK BREATHING & CONSCIOUSNESS

Is the person breathing normally and conscious?

  • ✅ YES → Go to STEP 2
  • ❌ NO → CALL 911 IMMEDIATELY

If not breathing: Start CPR. If unconscious but breathing: Recovery position (side-lying).

❓ STEP 2: CHECK FOR PHYSICAL DISTRESS

Does the person have any of these symptoms?

  • Chest pain or pressure
  • Severe difficulty breathing
  • Seizures or convulsions
  • Uncontrollable vomiting (>30 minutes)
  • Extremely high heart rate (>140 BPM sustained)
  • Loss of motor control (can't stand/walk)
  • ✅ YES to any → CALL 911
  • ❌ NO to all → Go to STEP 3

❓ STEP 3: CHECK FOR PSYCHOLOGICAL CRISIS

Is the person experiencing:

  • Extreme panic lasting >30 minutes
  • Psychotic symptoms (delusions, hallucinations causing distress)
  • Self-harm ideation or attempts
  • Violent or aggressive behavior
  • Complete disorientation (doesn't know who/where they are)
  • ✅ YES to any → Go to STEP 4 (Crisis Support Protocol)
  • ❌ NO to all → Go to STEP 5 (Bad Trip Management)

🚨 STEP 4: CRISIS SUPPORT PROTOCOL

Immediate Actions:

  1. Ensure Safety: Remove dangerous objects, secure environment
  2. Stay Calm: Speak slowly, reassuringly. "You're safe. This will pass."
  3. Call Crisis Hotline: Fireside Project (62-FIRESIDE / 623-473-7433) for psychedelic crisis support
  4. Consider 911 if: Person is a danger to self/others despite calming efforts
  5. Do NOT: Restrain physically unless absolutely necessary for safety

When to call 911: If crisis hotline recommends it, or if person becomes violent/self-harming.

💚 STEP 5: BAD TRIP MANAGEMENT (Non-Emergency)

The person is having a difficult experience but is NOT in immediate danger.

Actions:

  1. Change environment: Move to quieter, calmer space
  2. Reassure: "You took a substance. This is temporary. You're safe."
  3. Breathing exercises: Guide slow, deep breathing (4 in, 4 hold, 6 out)
  4. Comfort items: Blanket, water, soft music
  5. Stay present: Someone should remain with them until effects subside
  6. Avoid: More substances, crowds, loud/chaotic environments

Monitor: Re-evaluate every 30 minutes. If symptoms worsen, return to STEP 2.

Detailed Protocols by Situation

Protocol A: Unconscious Person

  1. Check responsiveness: Shake shoulders, shout "Are you okay?"
  2. Check breathing: Look for chest rise/fall, listen for breath sounds
  3. If breathing: Place in recovery position (on side)
  4. If NOT breathing: Call 911, begin CPR
  5. Stay with person: Monitor breathing continuously
  6. When paramedics arrive: Tell them what substance was taken, how much, when

Protocol B: Seizure

  1. Call 911 immediately
  2. Protect head: Place something soft underneath
  3. Clear area: Remove sharp/hard objects nearby
  4. Do NOT: Restrain, put anything in mouth, or try to stop the seizure
  5. Time the seizure: Note duration (if >5 min, emphasize to 911)
  6. After seizure: Place in recovery position, monitor breathing

Protocol C: Chest Pain / Heart Issues

  1. Call 911 immediately
  2. Keep person calm and still: Sitting or lying position (whatever is most comfortable)
  3. Loosen tight clothing
  4. If person has prescribed nitroglycerin: Help them take it
  5. Do NOT give: Food, water, or other substances
  6. Monitor: Be prepared to perform CPR if they lose consciousness

Protocol D: Suspected Poisoning (Wrong Mushroom)

  1. Call Poison Control: 1-800-222-1222 (US) or local equivalent
  2. Call 911 if: Person is unconscious, seizing, or in severe distress
  3. Gather information:
    • What was consumed?
    • How much?
    • When?
  4. Save samples: If possible, save remaining mushrooms for identification
  5. Do NOT induce vomiting: Unless instructed by Poison Control
  6. Follow Poison Control instructions exactly

Protocol E: Violent/Aggressive Behavior

  1. Prioritize safety: Get others to safe distance
  2. Do NOT confront or restrain: Unless absolutely necessary to prevent harm
  3. Call 911: Inform them of drug-induced psychosis
  4. Speak calmly: Use non-threatening body language, slow movements
  5. Remove weapons/dangerous objects: If safely possible
  6. Wait for professionals: Police/paramedics trained in crisis intervention

Crisis Resources (Quick Reference)

Service Contact When to Use
911 (US Emergency) 911 Life-threatening medical/safety emergency
Fireside Project 62-FIRESIDE
(623-473-7433)		 Psychedelic crisis support (non-emergency)
Poison Control (US) 1-800-222-1222 Suspected poisoning/wrong mushroom
SAMHSA Hotline 1-800-662-4357 Mental health/substance use crisis
Crisis Text Line Text "HELLO" to 741741 Text-based crisis support

What to Tell Paramedics/ER

Be honest and specific:

  • "They consumed psilocybin mushrooms."
  • Approximate dose (grams consumed)
  • Time of ingestion
  • Any other substances (alcohol, medications)
  • Pre-existing medical conditions
  • Timeline of symptoms

Note: Medical professionals need accurate information to provide proper care. Honesty will not result in arrest—saving a life is the priority.

Printable Emergency Card

✂️ Cut and keep with you during psychedelic experiences ✂️

🚨 EMERGENCY QUICK REFERENCE 🚨

CALL 911 IF:

  • ☐ Unconscious / Not breathing
  • ☐ Seizures
  • ☐ Chest pain
  • ☐ Severe confusion >1 hour
  • ☐ Violent behavior

CRISIS SUPPORT:

Fireside Project: 62-FIRESIDE (623-473-7433)

Poison Control: 1-800-222-1222

BAD TRIP? Try:

  1. Change environment (quiet, calm space)
  2. Breathe: 4 in, 4 hold, 6 out
  3. Remind: "This is temporary. You're safe."

Post-Crisis Follow-Up

After the immediate crisis has passed:

  • Medical Follow-Up: See a doctor within 24-48 hours, even if symptoms resolved
  • Integration Support: Consider therapy or integration coach
  • Avoid Future Use: If severe reaction occurred, reconsider psychedelic use
  • Document: Write down what happened for medical records