Responding to Psychedelic-Related Calls: A First Responder’s Guide
Written by Andrew Rose
Introduction & Context
Psychedelic substance use is on the rise in both recreational and therapeutic settings, meaning first responders are increasingly likely to encounter individuals under the influence of LSD, psilocybin (“magic mushrooms”), MDMA (ecstasy), ketamine, or other psychedelics. These situations can seem unusual or even alarming, with people sometimes behaving strangely or experiencing intense sensory distortions. However, a key principle to remember is that strangeness ≠ emergency. In many cases, what looks bizarre or scary is not inherently life-threatening. The approach that paramedics, emergency department staff, police, campus safety, or other first responders take in these moments plays a pivotal role in determining outcomes. With the right knowledge and compassionate strategy, responders can ensure safety while avoiding escalation, preserving the person’s dignity, and even turning a potentially traumatic episode into a manageable one. This guide provides an overview, drawn from recent psychedelic safety research and harm reduction practices, on how to recognize and effectively respond to psychedelic-related incidents in the field.
Context of Psychedelic Use
Across the United States, an estimated 4.5% of adults used a psychedelic in the past year. While most of these experiences occur without incident, adverse events do happen. Importantly, serious medical emergencies from classical psychedelics are
rare. For instance, surveys indicate only around 1% of LSD or MDMA users have ever sought emergency medical care after use (and under 0.6% for psilocybin). Nevertheless, calls for help may arise due to acute psychological distress (“bad trips”), accidents or injuries, or dangerous reactions in certain circumstances. First responders should be prepared to handle a spectrum of scenarios – from a panicked student who needs gentle reassurance, to a patient with overheating or seizures from adulterated substances.
The Crucial Role of First Responders
How responders engage with an individual on psychedelics can either calm the situation or exacerbate it. A frightened person’s perception of responders as threatening can escalate panic, whereas a calm, understanding approach can swiftly de-escalate anxiety. This packet emphasizes practical, professional techniques for recognizing psychedelic intoxication and responding safely. It will also cover medical priorities (like managing hydration or seizures), communication and de-escalation skills, legal and ethical considerations (such as Good Samaritan protections), and collaboration with harm reduction services. Real-world case examples and lessons learned are included to illustrate best practices. The ultimate goal is to ensure both patient and responder safety while minimizing unnecessary restraint, emergency room trips, or punitive measures when they aren’t truly needed.
By the end of this guide, you should feel more confident in assessing psychedelic presentations, intervening effectively when needed, and knowing when a situation is a true medical emergency versus when patience and compassion are the best “treatment.” As the saying goes in psychedelic support circles “Talk someone through, not down”, recognizing that even a difficult psychedelic crisis can be handled safely with the right approach. Let’s begin by understanding what psychedelic intoxication looks like in the field.
Recognizing Psychedelic Presentations
Every substance has a characteristic profile of effects. First responders with medical training will recognize some general signs of intoxication (like altered mental status or dilated pupils), but distinguishing a psychedelic experience from other drug effects or medical conditions is crucial. Below are common observable signs of psychedelic use and tips for differentiating them from other substances:
Sensory and Perceptual Changes
Individuals on psychedelics often experience hallucinations or distortions in perception. They may report vivid visuals such as seeing geometric patterns, halos around lights, or objects breathing/morphing in shape. They might hear subtle sounds or have an altered sense of time. Unlike someone with a psychotic disorder, a person on LSD or psilocybin typically recognizes that these perceptions are due to a drug effect (at least when calm) and their orientation to person and place is largely preserved. By contrast, someone intoxicated on stimulants like methamphetamine might be extremely hyperalert or paranoid but usually not describing visual distortions in the same way. Observing what the person is experiencing can provide clues: for example, seeing “tracers” following moving objects or bright colors is more typical of LSD than of amphetamine or opioid use.
Emotional Extremes and Rapid Shifts
Psychedelics can produce intense emotions: euphoria, awe, anxiety, or despair, sometimes swinging rapidly. One minute the person might be laughing or proclaiming profound revelations; the next they could be fearful or crying. This lability, especially if not directed at any real external trigger, can indicate a psychedelic effect. In contrast, someone intoxicated on alcohol might be emotionally labile too, but with alcohol you’ll usually note physical signs like slurred speech and impaired coordination that classic psychedelics (LSD, psilocybin) do not cause. If a person is extremely agitated and combative, consider that other substances (or factors like underlying mental illness or trauma) might be at play, since classic psychedelics alone rarely precipitate violent aggression. For instance, PCP (phencyclidine) or high-dose methamphetamine are more notorious for causing violent delirium.
Key distinguishing point: a person on a classic psychedelic is more likely overwhelmed by internal stimuli (visions, emotions) than by external threats, whereas a stimulant-intoxicated person often has paranoid delusions involving real people or objects.
Physiological Signs
Many psychedelics cause dilated pupils (mydriasis) – a useful initial clue. You might also see elevated heart rate and blood pressure; tremors or muscle twitching; sweaty or clammy skin (especially with MDMA or if they’re anxious); and in some cases, nauseaor vomiting (common with ayahuasca, mescaline, or psilocybin in high doses). Importantly, the vital sign changes with classical hallucinogens are usually mild to moderate. A person on LSD might have a heart rate of 100-110 bpm with elevated blood pressure due to anxiety, but extremely high vitals (e.g. heart rate >140, very high blood pressure, or severe hyperthermia) are more indicative of other problems or substances (like NBOMe designer drugs, stimulant co-ingestion, or serotonin syndrome). Compare this to an opioid overdose, where pupils are pinpoint and breathing is slow – a very different presentation. With MDMA (often considered an “empathogen” but also psychedelic), users often have obvious jaw clenching or teeth grinding, profuse sweating, and overheating. MDMA can also cause dehydration or conversely water intoxication (hyponatremia) if the person drinks excessive fluids – so context matters (a rave party scenario, for example).
Mental Status and Communication
People under psychedelics may appear disoriented in some ways but notably interactive. They might engage you with strange statements like “I understand the universe now” or “Am I dying?” or they may appear to be responding to things you cannot see. Despite this, they often can answer simple questions (perhaps slowly or non-linearly) and follow basic instructions if approached calmly. They usually know who and where they are, but may be confused about what is real versus hallucination. This differentiates them from someone in a diabetic emergency or certain medical deliriums who might not even know their name or might be completely incoherent. That said, a high-dose psychedelic state can resemble psychosis: you might see paranoia, delusional beliefs (like “I am God” or “demons are here”), or nonsensical speech. Always consider whether substance use is the cause or if an underlying psychiatric condition is present. Clues like the setting (e.g. found at a festival with drug paraphernalia vs. sitting at home) or collateral information from friends can help. If unsure, treat it as a medical/trauma cause first while evaluating for drug signs.
Contextual Clues and History
Often, identification comes from bystanders: friends may say, “They took some acid” or you might find evidence (blotter paper, mushroom chocolates, vape pen for DMT, etc.). Don’t underestimate the value of a quick search for medication bracelets or medical IDs too – occasionally, what looks like a drug trip could be a medical issue (e.g., a complex partial seizure can cause hallucinations and confusion, or delirium from infection). But if all signs point to psychedelic use, recognizing this can immediately inform a more effective response. For example, knowing that LSD is likely the cause lets you anticipate a timeline (LSD effects last 8-12 hours, so the person may be far from baseline if it’s only hour 3) and an approach (maintain a safe, calm environment until it wears off, if possible).
Differentiating Specific Substances
Different psychedelics have unique features that first responders can note. Please also consult PSI’s Substance Specific Safety Considerations.
LSD and Psilocybin
These cause visual distortions, introspective or mystical comments, dilated pupils, and sometimes mild tremors. Users may be anxious or paranoid if overwhelmed, but physical risk is low unless they engage in dangerous behavior (like wandering into traffic under confusion). Coordination is usually intact, though spatial depth perception can be off (risk of falls).
Ketamine and PCP
These dissociative anesthetics are not classic serotonergic psychedelics, but a first responder may encounter them in similar contexts (clubs, parties). Ketamine in moderate doses causes a trance-like, detached state (“K-hole”) where the person may appear unresponsive to external stimuli, or conversely may be able to talk but describe feeling out-of-body. Heart rate and blood pressure can be elevated. If someone is slumped, breathing slowly, and you suspect ketamine, monitor closely – high doses can cause respiratory depression (rare but possible, especially if mixed with other depressants). PCP on the other hand often leads to a very agitated, impervious-to-pain state – a classic sign is nystagmus (rapid jerky eye movements) and blank stare. PCP intoxication can be dangerous, with potential for sudden violence or unexpected strength and high pain threshold. It often requires a very different approach (quick sedation and restraints for safety), whereas an LSD situation might be calmed with words alone. It’s crucial to identify if a call is more likely PCP (e.g. reports of aggression, people disrobing from feeling overheated, etc.) versus LSD – mixing these up can be risky. When in doubt, prioritize safety for all, but keep in mind that the majority of classic psychedelic users are not looking to fight; they are usually scared or disoriented rather than belligerent.
Ayahuasca
A brewed tea traditionally used in Amazonian ceremonies, containing DMT plus MAOIs from the vine. Presentations often include purging (vomiting, diarrhea), emotional release (crying, shaking), and deep visionary states. Pupils dilated, coordination usually intact but unsteady if purging. Unlike stimulants, vital signs are usually stable, though blood pressure and heart rate may elevate slightly. Red flag: interaction with SSRIs or other serotonergic meds can cause serotonin syndrome (agitation, sweating, hyperreflexia, confusion, seizures).
DMT (N,N-Dimethyltryptamine)
Rapid-onset, short-duration psychedelic often smoked or vaped. Intense visual and auditory distortions, with users often silent or lying still, eyes closed, describing “leaving their body.” Physical signs: dilated pupils, elevated heart rate and blood pressure. Because of the short action (5–20 minutes), responders may arrive after peak effects have passed. Risks are generally behavioral (falls, panic if interrupted suddenly). Not usually associated with prolonged psychosis, though anxiety and disorientation can linger.
5-MeO-DMT
More powerful and destabilizing than DMT, sometimes vaporized from toad secretion or synthetic. Onset is rapid and overwhelming, often leading to complete loss of body awareness. Individuals may thrash, vomit, or appear unconscious. Vital signs can spike (tachycardia, hypertension). Risks include vomiting while supine (aspiration), panic upon return, and occasionally seizures at high doses. First responders should protect airway, ensure safe environment, and provide calm reassurance as consciousness returns.
Iboga/Ibogaine
A long-acting psychedelic alkaloid from West African traditions, sometimes used for addiction interruption. Onset is slower but effects can last 12–24 hours. Physical signs: ataxia (difficulty walking, staggering), tremors, nausea/vomiting. Unlike LSD or mushrooms, ibogaine has significant cardiac risk — it can prolong the QT interval and precipitate dangerous arrhythmias. A person on ibogaine who collapses or has chest pain should be treated as a cardiac emergency. Continuous cardiac monitoring is strongly advised if in a medical setting.
Novel Psychedelics/Unknowns
Sometimes, individuals ingest what they think is a known psychedelic but it turns out to be an adulterant or novel compound. An example is someone believing they took LSD via a blotter, but it was actually a potent NBOMe or 2C-x drug – these can cause more severe effects like seizures, cardiac arrhythmias, or hyperthermia. If you see signs that “don’t fit” the typical profile (for instance, a supposed mushroom trip where the person is having a seizure – which is extremely uncommon for psilocybin – or a very rapid heart rate and high fever from a single tab of “acid”), maintain suspicion of adulterants or poly-drug use. The management in those cases shifts more toward acute medical stabilization (cooling, anticonvulsants, etc., see Section 4).
In summary, recognizing a psychedelic presentation involves piecing together the behavioral cues, vital sign patterns, and context. When you determine “this is likely a psychedelic trip,” you can then tailor your response accordingly: leaning more on verbal de-escalation and environmental control, and less on aggressive medical interventions, unless truly necessary. The next section will delve into those de-escalation and communication techniques that are so crucial for calming a person in a psychedelic crisis.
De-escalation & Communication
A calm and grounded first responder can be the difference between a smooth resolution and a preventable disaster during a psychedelic-related call. Because these substances heighten sensitivity, individuals will often mirror the energy and tone of the people around them. Yelling, bright lights, or forceful commands can amplify a person’s fear or confusion. Conversely, a gentle voice and reassuring presence can defuse panic. Here are best practices for de-escalation and communication when responding to someone having a challenging psychedelic experience:
Create a Safe, Supportive Atmosphere
Whenever possible, reduce external stimulation. This might mean asking bystanders to give space, dimming harsh lights, or moving the individual to a quieter area. If sirens or flashing lights are on and not needed for safety, consider turning them off as you arrive. The person may be extremely sensitive to noise and light, so a relatively calm sensory environment can help them feel safer. “Safe space” is a core principle in psychedelic harm reduction: it implies both a physically safe setting (no immediate dangers, not too chaotic) and an emotionally safe approach (non-judgmental, patient). Identify yourself clearly (“Hi, I’m an EMT, I’m here to help you.”) and ensure your body language is non-threatening: keep your movements slow and deliberate, and if appropriate, crouch or sit at their level rather than looming over them.
Speak Gently and Simply
Use a soft, calm tone and simple language. Short, reassuring phrases work better than complex questions. For example: “You’re okay. I know things feel intense, but you’re safe with us.” or “I’m here to help and will stay with you.” Avoid technical jargon or rapid-fire questions that might overwhelm them. It can help to repeat reassurances like
a mantra; consistency and predictability in your voice can cut through the chaos they may be feeling internally. Importantly, don’t lie to the person. If they ask, “Am I dying?” do not dismiss them with “Don’t be silly,” but rather gently explain: “It may feel scary, but I promise you are not in danger. Your heart rate and breathing are okay. You took a substance that is making things feel unreal; it will wear off. I’ll make sure you stay safe until it does.” Honesty builds trust. Even if they are saying bizarre or seemingly paranoid things (“You’re all robots!”), respond with calm truth: “I’m not a robot – I’m a real person and a paramedic. I know you might be seeing strange things, but I’m here with you in reality and I won’t leave you.”
“Talk Through, Not Down”
This phrase—popularized by organizations like the Zendo Project—means you shouldn’t dismiss or suppress what the person is experiencing, but rather help them navigate through it. Instead of saying “Snap out of it” or “Calm down, there’s nothing
there,” which can feel invalidating, encourage them to breathe and let the experience pass. You might say, “I know it feels like there’s something chasing you. That sounds really scary. Let’s focus on breathing together and we’ll get through this wave.” Acknowledge their reality without feeding any delusion. For instance, if they believe they see an imaginary threat, you don’t have to pretend you see it, but you can say, “I understand you’re seeing that, but I’m here and I don’t see it. You’re having an effect from the drug – it isn’t real and it can’t hurt you. Stay with my voice.” Validating emotions (fear, confusion) while gently orienting them to what’s actually happening is key. Often just hearing that what they’re feeling has a name (“It’s the drug causing this, it will pass”) provides immense relief.
Enlist Cooperation by Empowering, Not Forcing
Whenever feasible, give the person some sense of control or collaboration in their care. Ask them, “Would you like to move to somewhere more comfortable?” or “Is it okay if I check your pulse to make sure you’re okay?” These simple questions can make them feel less like they are being overpowered. Of course, if the person is too incoherent to answer, you’ll have to guide them – but always explain what you’re doing: “I’m going to put this blanket around you because it’s a bit cold out here, alright?” or “We’re going to walk over to the ambulance now; I’ll stay right beside you. ” If they refuse something minor (like getting on a stretcher) and it’s not critical, don’t immediately force the issue. Try creative alternatives: “How about you sit in the back of the ambulance with me, you don’t have to lie down if you don’t want. We can leave the door open for fresh air, does that sound okay?” Setting boundaries is still important – for instance, you can’t let them run into traffic or hurt themselves – but do so with clear, calm statements: “I cannot let you go that way because it’s unsafe. Please stay here with me.” Often the person will comply if they feel respected rather than cornered.
Use Grounding Techniques
Simple grounding exercises can help tether the person’s mind back to reality. Encourage deep, slow breathing, perhaps breathe with them to set a pace. You can also try to engage their senses in a controlled way: offer a drink of water and have them feel the cup, or ask them to hold an ice pack or a cool damp cloth and describe the sensation. Counting objects (“Let’s count 5 different colors of things around us”) or gentle orienting questions (“Can you tell me your name? Okay, and do you know where you are? You’re at the student center, yes.”) can re-anchor them. Even if they answer incoherently, the process of you calmly asking and responding can help. Another approach is to remind them of the time-limited nature of the drug: for example, “You took mushrooms about 3 hours ago. That means in probably 1-2 more hours the effects will start to fade. You’re over the hump.” This gives hope that the intensity will end, which can quell panic. Always reassure them that you will stay until they feel better – knowing they’re not alone in this can significantly de-escalate fear.
Involve Trusted Others if Available
If a friend or loved one who is sober is present and the person responds well to them, leverage that. Having a familiar face reinforce the reassurance (“I’m here with you, it’s Jen. Remember you took that acid and it’s just making you feel this way, but I’m not leaving.”) can do wonders. First responders can coach the friend to use the same
calm techniques. However, be careful: sometimes friends are panicking too or saying the wrong things (“Oh my god, you’re freaking out!”). If that’s the case, gently ask the friend to step back or occupy them with a task (like gathering the person’s belongings or calling someone). When police are on scene, it may help for officers to take a backseat unless needed for safety; a person high on psychedelics might get more agitated by a uniform and authoritative commands. Often, one designated communicator is best (too many voices overwhelm). EMS or a mental health crisis responder can lead communication, while other responders ensure scene safety more quietly in the background.
Avoid Threats and Negative Reinforcement
It should go without saying, but do not threaten arrest, use of force, or ridicule the person. Even if they’re being difficult, responding with anger will pour gasoline on the fire. Statements like “If you don’t cooperate, we’ll have to strap you down” should be avoided in the initial phase – that prospect might terrify them and provoke a fight-or-flight reaction. Keep in mind that their perception of reality is altered; a calm suggestion is far more effective than an order. If you must set firm limits (like “we need to restrain you for safety”), explain it in the least threatening way and as a last resort (discussed more in Section 4). Also, never use scorn or judgment (“This is what you get for taking drugs!”). Shaming not only erodes trust in that moment, but it may deter them or others from seeking help in the future. A professional, compassionate demeanor is essential even if the person’s choices or behavior might normally frustrate you. Remember, the crisis will end, and how you treat them will be remembered long after.
Leverage Time – Patience is Key
In many psychedelic crisis situations, the best thing you can do is wait it out while ensuring safety. Psychedelic effects will subside given time. If you’ve created a safe setting and the person is not in medical peril, often the optimal intervention is to monitor and let the drug run its course with you as a reassuring guide. This can take hours for some substances. As long as the individual is not a danger to themselves or others, consider whether immediate transport to an emergency department is actually necessary or if it might be better to manage them on scene or in a quiet observation area. In fact, research on clinical settings has shown that most acute psychological distress during a psychedelic experience resolves with interpersonal support alone. Emergency departments should be a last resort in purely psychological crises because an unfamiliar hospital environment and invasive procedures can worsen a bad trip. Of course, this decision must be balanced with medical considerations and local protocol (see Section 4 for when transport is warranted). But the point remains: do not be in a rush to “fix” the person – often the best medicine is calm presence and time.
In summary, effective communication with someone tripping is about compassion, clarity, and calm repetition. First responders essentially act as a grounded anchor for a mind that is temporarily adrift. De-escalation in these cases is less about negotiation (as it might be with a violent subject, for example) and more about reassurance and reorientation. By mastering these techniques, you can prevent many psychedelic crises from ever becoming true emergencies. Next, we’ll discuss what does constitute a medical or safety emergency in the context of psychedelic use, and how to address those scenarios when they arise.
Medical & Safety Priorities
While most psychedelic incidents can be managed with patience and support, first responders must always stay vigilant for signs of a true medical emergency or safety threat. In this section, we outline the key medical priorities and interventions when responding to someone on psychedelics, from basic assessments to handling specific complications like overheating or seizures. Always follow your existing training and protocols but apply them in a way appropriate to the situation. Safety of both the patient and responders is paramount. That sometimes means medical action, and other times means minimal intervention.
Primary Survey – ABCs and Trauma Check
Immediately assess Airway, Breathing, Circulation like any other call. Thankfully, classical psychedelics (LSD, psilocybin, MDMA in typical doses) do not usually cause airway obstruction or respiratory depression directly. If the person is speaking, their airway is intact. Breathing may be elevated if they’re anxious, but should be effective. Watch for any compromise: for example, someone deeply dissociated on ketamine might have partial airway obstruction or a vomit risk, so ensure they’re in a safe position (e.g. on their side if unconscious and vomiting). If they’re excessively sedated (perhaps from co-ingesting alcohol or a benzodiazepine), support ventilation as needed. Circulation:check the pulse – is it extremely fast or irregular? Check skin color and temperature – any signs of shock (pale, clammy, rapid pulse could indicate dehydration or something like an injury)? Address life-threatening ABC issues immediately: oxygen if needed, positioning, bleeding control, etc. Do a quick trauma exam if there’s any possibility of injury: psychonauts can sometimes fall, wander into hazards, or self-inflict injuries without noticing pain (especially dissociatives like PCP). Look for head injuries, fractures, etc. If the patient is agitated, this exam might have to be brief and observational (e.g. scanning for bleeding or deformities) until they can cooperate.
Determine if Medical Intervention is Urgent
The big question: Is this primarily a psychological crisis, or is there a medical crisis (or imminent one)? Some guidelines:
Level of Responsiveness
If the person is unconscious or barely responsive, that is NOT typical for a pure psychedelic (unless it’s ketamine or an overdose of something, or they became exhausted after hours of struggle). An unconscious person needs full medical workup. It could be head injury, another drug, etc. Manage as per any decreased LOC case (check blood glucose, consider naloxone if any opioid suspicion, etc.).
Vital Signs Extremes
Mild tachycardia and hypertension are common, but if heart rate is extremely high (150+), blood pressure extremely high (e.g.>180 systolic), or if they have a very high fever (>103°F/39.5°C), take that seriously. Severe hyperthermia can occur especially with MDMA, or as part of serotonin syndrome if there was a dangerous drug combination. Hyperthermia can be life-threatening. Look for hot, flushed skin, maybe cessation of sweating if heat stroke is impending, altered mental status beyond the trip (e.g. confusion not just hallucinations). Cooling measures should begin promptly: remove excess clothing, move to shade or a cooler environment, apply cool packs to armpits/groin, and if possible start hydration (oral fluids if they can drink, IV fluids if you have access and they’re cooperative or sedated). For MDMA-related hyperthermia, rapid recognition and cooling is critical to prevent organ damage. If body temp is extremely high or the patient shows signs of rhabdomyolysis (muscle rigidity, dark brown urine if known), this is a true emergency— transport to an ER with advanced cooling and critical care is indicated.
Hydration and Fluids
Many psychedelic emergencies involve dehydration or electrolyte imbalance. MDMA in particular causes dehydration through sweat and also makes users very active (e.g. dancing for hours). Check mucous membranes (dry mouth?), skin turgor if possible. Encourage sipping water or an electrolyte drink if they’re able. However, be cautious of over-hydration: some well-meaning friends might have urged the person to chug water, risking hyponatremia (low sodium). Signs of hyponatremia include severe headache, confusion, vomiting, seizures. If you suspect this (for example, collapsed after drinking gallons of water at a festival), limit fluids and this person needs transport for likely IV electrolyte management. In general, offer moderate amounts of fluid and observe. If IV fluids are within your scope and indicated (e.g. clear dehydration, high heart rate, low blood pressure, etc.), start an IV line – but try to do so calmly (needles can scare someone tripping). Often you might wait until any sedative takes effect or they are more settled.
Seizures
Seizures are uncommon with classic psychedelics but not unheard of, especially if the substance was misrepresented (some NBOMe compounds caused seizures) or with high-dose MDMA (due to hyponatremia or serotonin syndrome). If a seizure occurs, protect the patient from injury (clear the area around them), position on side if possible, and administer a benzodiazepine as per protocol (e.g. IV/IM midazolam or lorazepam) to stop prolonged seizure activity. After a seizure, the person will be postictal (confused, disoriented) – this can be tricky to distinguish from the drug effects. In any seizure scenario, transport to the hospital is recommended because it signals a more severe physiological event. Try to ascertain if they took any stimulant or unknown substance in addition; consider checking blood glucose post-seizure (as hypoglycemia can both cause seizures and sometimes be caused by exertion or not eating during a long trip).
Cardiac Complications
Psychedelics rarely cause direct heart arrhythmias, but an overstimulated state could trigger issues in someone with underlying heart disease, or if they took an adulterant. Watch for chest pain, palpitations, or fainting. Treat chest pain seriously. Even a young person on MDMA could have a cardiac event if hyperthermia and dehydration cause demand ischemia or an arrhythmia. Initiate standard chest pain protocol (oxygen, aspirin if appropriate and the patient can cooperate, monitor ECG). If you have an AED or monitor and see a dangerous arrhythmia, manage per ACLS protocols. That said, most commonly a fast heart rate will normalize with reduction in anxiety (often via a benzodiazepine) and hydration. Beta-blockers are typically avoided in stimulant-induced tachycardia due to risk of unopposed alpha agonism (for example, if amphetamines involved). If medical control allows, benzodiazepines are first-line to treat severe agitation/tachycardia in these scenarios, as they address both anxiety and have mild blood pressure-lowering effects by reducing catecholamine surge. Important: if you suspect serotonin syndrome (e.g. the person is on an SSRI antidepressant and took ayahuasca or MDMA, now they have high fever, tremors, confusion), this is a medical emergency – benzos for sedation, aggressive cooling, and rapid transport are indicated. Field providers won’t have specific anti-serotonin drugs like cyproheptadine on hand, so supportive care is key.
Violent Agitation – Excited Delirium
In rare cases, a person on a hallucinogen (especially PCP, high-dose stimulant, or sometimes high-dose LSD/other) might present with excited delirium, a state of extreme agitation, incoherent speech, hyperthermia, and possible aggression. This is dangerous as it can lead to sudden cardiac arrest. The priority is rapid sedation to prevent harm to patient and responders. If verbal de-escalation has failed and the person is a clear danger, don’t delay chemical restraint. Ideally, use a benzodiazepine first (e.g. IM midazolam). Some EMS protocols also use antipsychotics like haloperidol or even dissociative doses of ketamine for extreme agitation. Use what your protocol recommends for severe agitation. Benzos are often preferred for psychedelic crises because they calm without antagonizing the psychedelic receptors (which, as noted, can sometimes cause more confusion if the trip is abruptly halted by an antipsychotic). However, if someone is dangerously violent, combination sedation (benzo + haloperidol, for example) may be warranted. Safety note: coordinate with law enforcement so that if physical restraint is needed to administer medication, it’s done as safely and briefly as possible. Avoid prone positioning or techniques that impair breathing; once subdued, get them on their side or back with head elevated and monitor airway and circulation closely. Many adverse outcomes in these scenarios happen due to prolonged struggles or improper restraint, so act quickly and then transition to medical management.
Injuries and Self-harm
Ensure the individual isn’t actively hurting themselves. Sometimes in a delirious state people may self-inflict trauma (rarely, cases of jumping from heights under hallucination, etc.). If there’s any indication of trauma (cuts, blood, an impact, etc.), address those immediately. Control bleeding with direct pressure, splint any obvious fractures. If they’re actively self-harming or threatening to (e.g. holding a sharp object in a confused state), this becomes a high-risk situation that may require police intervention to disarm them carefully. But note: genuine suicidal intent while acutely on psychedelics is not common. If they voice suicidal thoughts, it’s often out of panic or despair from the drug’s emotional wave. Treat it seriously (you must ensure safety), but in many cases reassurance that “you’re going to be okay” can alleviate those transient suicidal feelings. Of course, if someone attempted a leap or has severe injury, manage trauma ABCs and spinal precautions as needed.
Use of Benzodiazepines
Benzos deserve a special mention. They are extremely useful in medical management of psychedelic crises. A benzodiazepine (such as diazepam, lorazepam, or midazolam) can reduce anxiety, halt panic attacks, prevent or treat seizures, lower blood pressure and heart rate modestly, and generally “take the edge off” the experience. In clinical
psychedelic research, a benzodiazepine is often kept on hand as a “trip stopper” if things get out of control. Many experts recommend using a benzo if a person is in severe distress that is not alleviated by verbal support. For first responders, if the patient’s agitation or anxiety is high and not settling with de-escalation, administering a benzodiazepine can be a humane and effective choice. Example: An IM injection of midazolam can calm the person within several minutes, making them more amenable to assessment and transport. Caution: using an IV line to give medication might scare a hallucinating person (they could misinterpret the IV as “poison” or react violently to the needle), so if IV access isn’t already established, an IM route might be safer during a struggle. Monitor respiratory status after giving a benzo; while psychedelics alone
don’t cause respiratory depression, a hefty dose of midazolam could, especially if compounded by other sedatives the person might have taken. Generally, though, for an otherwise physically healthy but panicked individual, a moderate dose of a benzo will mainly just reduce their terror and bring them to a more sedate, manageable state. Keep communicating reassurance even after medication – the person may still be hallucinating but will be less reactive.
Antipsychotics – Use with Caution
Antipsychotic medications (like haloperidol or olanzapine) are another tool, often used in ERs for acute agitation. They will help terminate hallucinations by blocking serotonin and dopamine receptors, but there’s a trade-off. Giving an antipsychotic can sometimes worsen the person’s confusion or cause a very dysphoric reaction if they’re aware of it, and in some cases can drop blood pressure or cause other side effects. Psychedelic support experts often advise that antipsychotics be a second-line or last resort measure. In field response, you might reserve them for cases where benzodiazepines alone are insufficient and the person remains dangerously combative or psychotic. If you do administer an antipsychotic, be prepared for possible further medical monitoring – e.g., some antipsychotics can prolong the QT interval (monitor heart if possible) or cause muscle rigidity (though rare in acute use). That being said, if the situation demands it, don’t shy away from using all tools at your disposal to gain control safely. The patient can always be reassured and reoriented later once the drug
effect is dampened.
Preventing Falls and Environmental Hazards
Safety extends beyond the person’s internal state to their surroundings. Make sure the scene is secure: remove any potential weapons or dangerous objects in reach (sharp items, glass, etc.), and guide the person away from hazards (busy roads, heights, deep water). If outdoors at night, use soft lighting to see but avoid blinding them. If the person is up and moving, stay close by in case they suddenly dart off or collapse. Some individuals feel a need to walk or pace – that’s okay if the area is safe; you can walk with them slowly. But if near a ledge or traffic, you must contain them in a safer space. Consider using soft restraints (like a bedsheet as a temporary gentle tether or hand-holding technique) if absolutely needed to keep them from running into danger, ideally with their consent (“Let’s hold hands so we stay together”). In an ambulance, if they’re not fully sedated, secure them with straps on the stretcher for safety during transport – explain it’s just so they don’t fall off the stretcher.
Decision to Transport vs. Treat On Scene
A nuanced decision in psychedelic calls is whether the person truly needs transport to an emergency department. If there are any medical red flags (significant vital sign abnormalities, seizures, unresponsiveness, suspected dangerous co-ingestants, traumatic injuries, persistent severe agitation despite your best efforts), then transport to a hospital is indicated. When in doubt, err on the side of medical evaluation. However, if the person is medically stable and primarily having a psychological crisis, some jurisdictions allow first responders to release them to a responsible party or alternative care (especially if a harm reduction service or mental health crisis team is available). Sending a heavily hallucinating but stable person to a busy ER can sometimes do more harm than good – they might end up restrained or traumatized there if staff are not versed in psychedelic crises. A middle ground used in festivals and some progressive systems is a monitoring period on scene or at a dedicated crisis tent, where the individual can stay until sober enough to make decisions. Always follow local law and policy: for example, an EMT on a 911 call might be obligated to offer transport. If a patient in a clear mind (not intoxicated) refuses transport, that’s one thing; but someone tripping likely lacks capacity to refuse, so you often will have authority to treat under implied consent. This is where clinical judgment is crucial. Some signs that hospital care is needed: temperature above 102°F, irregular heart rhythm, chest pain, repeated vomiting or diarrhea causing dehydration, any loss of consciousness, or if the person remains so paranoidthat they might become a law enforcement issue (better to get them somewhere safe and quiet like a hospital or psych facility in that case). If none of those, and you have the ability, you might keep them on scene under watch until they start coming down and can perhaps be left with a friend. Document your observations meticulously if you choose not to transport after a thorough assessment.
Monitoring and Continuous Reassessment
If you do transport, or while waiting for things to resolve, continuously monitor vital signs. Check temperature if possible (especially if MDMA or unknown substances involved). Re-check blood pressure, pulse, respirations periodically. Watch for any changes like decreasing level of consciousness (could signal a delayed medical issue).
If the person was given sedatives, keep an even closer eye on airway and breathing. If their condition worsens in any way, escalate care (advanced life support interventions, rapid transport). Keep in mind that psychedelics have varying durations – LSD and psilocybin can last many hours, DMT lasts minutes, MDMA 4-6 hours, etc. If you know the substance and time since ingestion, you have a sense of how much longer intense effects may persist. Plan your care accordingly (e.g., an LSD case might need longer observation).
To sum up this section, the priorities for first responders in a psychedelic situation are:
Ensure basic life support measures and rule out/treat medical emergencies (overheating, injury, etc.).
Use chemical support like benzodiazepines when indicated to manage extreme distress or risk.
Balance the need for medical intervention with the awareness that minimal interference is often better if the person is stable (avoid creating an iatrogenic emergency).
Keep everyone safe through prudent restraints or protective measures if absolutely necessary, always aiming for the least force required.
Think of yourself as both a medic and a guardian of the person’s well-being in a moment when they cannot fully protect themselves.
By handling the medical and safety aspects competently, you build the foundation for a positive outcome. In the next section, we will discuss the legal and ethical considerations that overlay these scenarios, including the protections in place for those seeking help and the responsibilities of responders in these unique cases.
Legal & Ethical Considerations
Responding to a drug-related incident carries legal and ethical dimensions that first responders must navigate. In the case of psychedelics, there are often nuances: the substances might be illegal (depending on jurisdiction), yet the person experiencing a crisis needs medical help, not criminal punishment. Moreover, responders have ethical duties to obtain consent when possible and to treat individuals with respect. This section highlights some key legal frameworks and ethical best practices relevant to psychedelic emergencies.
Good Samaritan Laws and Overdose Immunity
In many regions (including most U.S. states and Canadian provinces), Good Samaritan overdose laws provide legal protection to individuals who seek emergency help for someone experiencing a drug-related crisis. These laws generally mean that neither the person who called 911 nor the person in distress will be charged for drug possession of personal-use amounts when help is sought in good faith. The intent is to remove fear of arrest as a barrier to calling for medical aid. First responders, especially police officers on the scene, should be aware of their local Good Samaritan statute and uphold its spirit. Practically, this means focusing on the medical emergency, not the drugs present. If you arrive to find drugs or paraphernalia, secure them for safety if needed, but avoid taking punitive action. Announce clearly (when appropriate) something like: “We are not here to arrest anyone for drug use, we just want to make sure everyone is okay.” This reassurance can significantly reduce the patient’s and bystanders’ fear, aiding cooperation. Ethically, the wellbeing of the patient is the priority; legal consequences should be a distant secondary concern in an emergency.
(Do note: Good Samaritan laws typically do not protect against other crimes like distribution or DUI, but those are rarely relevant in a simple psychedelic personal-use scenario.)
Consent and Capacity
A cornerstone of medical ethics is respecting patient autonomy. However, when someone is acutely intoxicated on psychedelics, their decision-making capacity is usually impaired. They may refuse care or transport not out of a rational choice, but due to fear or altered perception. Legally, responders can invoke “implied consent” to treat an individual who cannot competently consent due to intoxication (similar to how you would for an unconscious person). It is ethical to provide necessary care in these situations to prevent harm. That said, whenever possible, attempt to gain assent from the person. Explain what you want to do and why, in simple terms, and see if they acquiesce. This isn’t formal consent, but it’s respecting their personhood as much as the situation allows. If a person on psychedelics clearly refuses and seems to understand the risks (a tough judgment call), you may have to weigh the risks of honoring that versus the duty to care. In most cases, the safest route is to gently insist on evaluation (“I hear you saying you don’t want to go to the hospital, but I’m really worried about your safety right now, so I need to check you out/bring you in. We’ll do our best to make you comfortable.”). Always err on protecting life and health; the law tends to support providers in treating incapacitated individuals under emergency doctrines.
Use of Force and Restraints – Ethical Application
If a person becomes combative or uncooperative to the point where safety is at risk, using physical or chemical restraints can be justified. The ethical principles here are necessity and proportionality. Use the least invasive method that will ensure safety. For example, if a patient just keeps trying to stand up and wander, maybe two responders lightly holding them by the arms and guiding them back to a seat is enough. If they are flailing and could harm themselves or others, then soft restraints on limbs and stretcher straps might be applied. As soon as feasible, chemical sedation (as discussed earlier) should be used to minimize the duration of physical restraint. Explain what’s happening to the patient: “We’re going to hold your arms so you don’t hurt yourself. Try to take deep breaths, we’re giving you a medication to help you relax.” This way, restraint doesn’t feel like a punishment but a safety measure. Under no circumstances should restraint be used as “punishment” or convenience – it’s a last resort for safety. The position and monitoring of a restrained person are critical (to avoid asphyxiation or unnoticed medical decline). The ethical stance is: prevent harm while causing as little harm as possible in the process. And remember, dignity matters – even if someone is restrained, speak to them kindly and continue to treat them as a human being, not a criminal.
Privacy and Confidentiality
Just because this is an out-of-hospital setting doesn’t mean privacy goes out the window. Be mindful of the person’s privacy rights. This means: don’t unnecessarily announce the person’s drug use or condition to onlookers. If bystanders or media are present, shield the patient from unwanted exposure. Within your documentation, stick to objective findings and avoid derogatory language. Medical information (even the fact that they used drugs) is confidential health information – share details only with those who need to know for medical transfer or next level care. For example, when handing off to the ER, of course inform them of any substances reported or suspected. But a police officer not involved in care doesn’t necessarily need to know every detail of what the person said during a hallucination. If law enforcement on scene start probing for evidence (“Where’d you get the drugs? What exactly did you take?”) and the patient is still out of it, intervene politely: “Right now, their medical condition is our top concern. Maybe those questions can wait until they’re stable.” Most officers will understand. In campus settings, many colleges have medical amnesty policies. The incident might not lead to disciplinary action if the student sought help. As a campus responder, you should be familiar with your institution’s policy and reassure students accordingly to encourage calling for help over hiding incidents.
Cultural Sensitivity and Respect
Psychedelic use spans all demographics, and in some cases, it may be tied to spiritual or cultural practices (for instance, use of peyote in Native American Church, or ayahuasca in syncretic churches). While most first responders will encounter recreational contexts, it’s important to approach each individual with respect for their background. Avoid making assumptions or judgmental comments about their drug use. Even humor that might seem benign (“Having some wild shrooms tonight, huh?”) can be received poorly by someone in a vulnerable, altered state. Ethically, our duty is to treat everyone with the same care and nonjudgmental attitude as we would a sober medical patient. If language is a barrier, try to get translation help (though in a psychedelic state, simple human kindness often transcends spoken language). Respect the person’s bodily autonomy as much as possible – for instance, cover them with a sheet or blanket if their clothes have been removed or if they’re exposed, to preserve modesty. These small acts uphold the patient’s dignity.
Legal Status of Psychedelics
Be aware of the evolving legal landscape. Some jurisdictions have decriminalized or even legalized certain psychedelics for adult use or therapeutic use (e.g., psilocybin therapy in Oregon/Colorado, decriminalization in some cities). This doesn’t change acute response much—you treat it as a health matter regardless—but it might influence whether law enforcement is even involved. In a decriminalized context, police might not respond at all to a simple “someone is high” call unless there is a risk of violence or self-harm, leaving it to EMS or mental health teams. If you work in such an area, adapt by strengthening ties with non-police crisis resources (see Section 6). Conversely, in places where all these substances are illegal, police may feel duty-bound to at least document it or take some action. Even then, most officers prioritize health first when coached appropriately.
The potential legalization of psychedelic-assisted therapies also raises an ethical point: some individuals in crisis might actually be participants in a therapy session gone wrong or an underground therapy. They might fear legal repercussions for their therapist/guide if they call 911. As a responder, your role is not to investigate that context on scene. Focus on care, and later that can be sorted out by appropriate parties. One could gently encourage sharing of information that helps medically (“It’s important we know what you took so we can help you”), but avoid pressing for names or sources. That edges into law enforcement territory which is not your immediate concern. Many professionals advocate for a “medical sanctuary” approach to drug crises – treat it purely as a public health issue.
Post-Incident Ethical Considerations
After the incident, document thoroughly and factually what occurred and what interventions were taken. Ethically, if you used restraints or medication without consent, your documentation should reflect why it was necessary (e.g., “Patient was hallucinating, attempted to run into street; soft restraints applied to prevent self-harm. Patient was not competent to consent at that time.”). This protects both the patient’s rights and your legal standing by showing you acted appropriately. If you made any promises (like connecting them to further help), do your best to follow through or inform those who will (more on follow-up in Section 8). Reflect on the call too – psychedelic crises can be challenging and even emotionally draining for responders not used to them. Debrief with your team. Did we respect the patient? Did we avoid unnecessary force? What could we do better next time? This continuous improvement mindset is part of ethical practice.
In summary, the legal and ethical cornerstones in psychedelic-related responses are: treat the situation as a healthcare matter first and foremost, respect the person’s rights and dignity, use only necessary force, and encourage help-seeking by leveraging protections like Good Samaritan laws. By aligning our actions with these principles, we not only protect our patients and ourselves legally, but we also build trust in the community that calling for help is the right thing to do when someone’s having a bad trip. Now, we will explore how first responders can collaborate with harm reduction and community resources to enhance outcomes in these scenarios.
Collaboration with Harm Reduction & Community Resources
Modern psychedelic crisis response doesn’t rest solely on the shoulders of traditional
emergency services. Around the world and in many communities, there are harm reduction organizations, peer support networks, and community resources dedicated to helping individuals who are using substances. First responders can greatly benefit from partnering with these groups. This collaboration can reduce strain on emergency systems, provide specializedcare for those in crisis, and lead to better long-term outcomes for the individuals involved. Here, we outline ways to connect with and utilize these resources, such as the Zendo Project, Fireside Project, local “sanctuary” spaces at events, and more.
On-Site Festival and Event Resources
If you’re responding to a call at a festival, concert, or large event, there may already be a harm reduction service on-site. Organizations like the Zendo Project, NEST Harm Reduction, or local groups often set up “sanctuary tents” or safe spaces where trained volunteers take care of people going through difficult psychedelic experiences. These volunteers (sometimes called “sitters” or “trip sitters”) provide exactly the kind of calming, non-judgmental presence we’ve been discussing. As a first responder, it’s wise to identify these resources when you arrive. Event organizers or medical staff can point them out. In many cases, if a person is only experiencing psychological distress with no urgent medical issues, you can transfer care to these teams rather than an ER. For example, at festivals where Zendo operates, EMS and security might bring an anxious LSD user to the Zendo tent instead of the medical tent, after a brief medical check. There, the individual can ride out their trip under supervision, freeing up EMS for true emergencies. This kind of hand-off should be done formally: ensure the harm reduction team documents the person’s intake, and ideally you or they get a basic set of vitals to be safe. Maintain communication – let them know if you administered any medication or if there were any concerning signs. Essentially, you’re collaborating as part of a continuum of care. It’s important to respect these volunteers’ expertise in handling psychedelic crises; they often have extensive training in de-escalation specific to psychedelic experiences.
Peer Support Hotlines
The Fireside Project operates a national psychedelic peer support line (in the U.S.), which people can call or text if they’re having a challenging trip. While this is more often used by individuals or their friends directly, first responders should know it exists. If you’re in a scenario where the person is somewhat coherent and just extremely anxious, you might even facilitate contact. For instance, if someone doesn’t want to talk to a paramedic but might talk to a sympathetic voice, you could say: “There’s a free support line with trained counselors who talk to people during experiences like this – would you like me to dial them and you can talk?” This could be done via speakerphone or handing them a phone if they’re capable. It’s unconventional, but it could supplement your efforts (especially in non-urgent situations). At minimum, after the crisis, you could suggest they use Fireside or similar resources for integration (more in Section 8). Additionally, these hotline organizations often gather data and feedback; Fireside, for example, has published research showing that many callers avoided 911 or ER visits thanks to talking with them. This indicates that involving such support early can prevent escalation. As a responder, if you sense a case might be resolved without transport by using a hotline for ongoing support, that could be a creative solution in certain low-risk instances – of course, always within the bounds of your local protocols.
Local Harm Reduction Groups and Education
Many communities have advocacy groups or student organizations (like Students for Sensible Drug Policy, DanceSafe chapters, etc.) that provide education, drug checking (testing substances for purity), and harm reduction training. First responder agencies can form relationships with these groups in advance. For example, a campus EMT squad might coordinate with the student harm reduction club to ensure students know about medical amnesty and also to have joint training sessions. These groups can also help with aftercare: perhaps setting up an “integration circle” or support meeting for people who had difficult trips, where they can talk it out in a supportive environment. As a paramedic or officer, knowing you can refer someone to such a community resource can be reassuring; it means the person has somewhere to turn beyond the emergency event.
Mental Health Crisis Teams
Some jurisdictions have mobile crisis units or co-responder models (a clinician or social worker pairs with EMS or police on certain calls). If a psychedelic crisis call comes through 911 and is routed appropriately, a mental health professional might respond alongside or instead of law enforcement. These professionals often have training in de-escalation and can be a huge asset. If you’re an EMT and have access to consult a psychologist or crisis counselor, use them – even a phone consult can help with strategies. Similarly, emergency departments with on-call psych teams can be looped in early if you’re bringing someone in. Collaboration here means recognizing that a psychedelic crisis straddles the line between medical and psychiatric emergency; involving mental health experts early can lead to a more nuanced approach than just treating it as a pure overdose.
Training and Cross-Education
Collaboration is two-way. Harm reduction groups can train first responders in compassionate psychedelic crisis response (some, like MAPS, actively offer such training). If you have the opportunity to attend or host a workshop with people from Zendo Project or similar, it can deepen your team’s skills. Conversely, first responders can train harm reduction volunteers in basic life support – for example, how to spot when a supposedly “bad trip” is actually a medical emergency that needs EMS. Building these relationships before an event or generally in the community means when an incident happens, everyone trusts each other’s role. Perhaps EMS can establish a protocol: if harm reduction volunteers radio that they have someone with concerning vitals, EMS comes over; or if EMS has someone who just needs monitoring, they can drop them off at the sanctuary space. Some events even incorporate “medical triage to sanctuary” as a standard flow.
Establishing Referral Pathways
Outside of events, if you encounter someone in the city or on campus, consider what hand-offs are possible aside from the ER. Are there detox centers or respite centers that would take an intoxicated person who is not medically critical? Some cities have “sobering centers,” though those are typically for alcohol; still, the concept could apply. If police are the primary responders and the person hasn’t committed a serious crime, perhaps the police can hand them to EMS or a crisis center instead of arresting. Being familiar with any local diversion programs is useful. For example, the CAHOOTS model in Oregon sends a crisis worker and EMT to handle many calls without transporting to hospital or jail. If your area has something analogous, leverage it. If not, this might be a gap to raise with your chain of command: “What can we do to avoid tying up ER resources with these cases that could be safely managed elsewhere?” Suggest piloting collaboration with a community group.
Communication During the Incident
When harm reduction volunteers and first responders interact on scene, communication is key. Quickly share relevant info: “He’s taken 3 hits of acid, we’ve given 5 mg of midazolam IM about 10 minutes ago, his vitals are stable. We think he can stay here with you if he calms down, but call us if anything changes.” Likewise, the volunteers might inform you: “They’ve been with us for an hour; still very paranoid, temperature was 101°F so that’s creeping up.” That might trigger you to move the person to medical care. The goal is a seamless teamwork where each party respects the other’s knowledge domain. Don’t assume volunteers will handle a medical issue, and volunteers shouldn’t assume you’ll handle hours of sitting and comforting – but together you can cover all needs.
After the Crisis – Community Integration
Collaboration shouldn’t end when the immediate crisis does. Many harm reduction organizations also focus on integration—helping individuals make sense of a challenging psychedelic experience after it’s over. If you transport someone to the hospital, consider leaving them (or their friend/family) with info about these resources when they are discharged. For example: a small card or flyer about the Fireside Project line, local peer support meetings, or therapists who specialize in psychedelic integration (if available). Hospitals might even develop a protocol to give such info as part of discharge for “bad trip” patients, similar to how they give overdose patients info on rehab and support groups. If you’re in campus health, maybe schedule a follow-up with the student and connect them to counseling or student support groups. This kind of warm hand-off can prevent repeat incidents and promote healing. It also shows the individual that the responders care about their long-term well-being, not just getting through the call.
Mutual Understanding
Finally, a less tangible but important aspect of collaboration is breaking down stigma and silos. Emergency responders may have biases about “drug users,” and psychedelic users might have fears about “cops and medics.” Through joint training, dialogue, and success stories, both sides can gain empathy for each other. For instance, volunteers often witness how a gentle EMT can completely change the trajectory of a case by simply sitting down and holding a hand – they might then share that positive story in their community, improving trust. Meanwhile, medics who see volunteers successfully talk someone down without any meds or restraints might realize the power of those techniques and adopt them more readily. In an ideal world, the emergency response system includes both professional responders and trained peers working in concert.
In summary, don’t go it alone on psychedelic calls. Reach out and integrate the broader network of harm reduction and community services. These collaborations can make your job easier and safer, and produce better outcomes for the person in crisis. By building these bridges, first responders become part of a larger safety net that extends beyond the immediate emergency, aligning everyone toward the common goal of reducing harm and supporting individuals through their difficult experiences.
Integration & Follow-Up
Just as individuals benefit from integrating their psychedelic experiences, first responders and the systems they work in benefit from integrating the lessons of each call. A thoughtful follow-up process can improve patient outcomes and enhance responder skills and well-being. This section covers two angles of integration: helping the individual after the immediate crisis, and learning/improving as responders and organizations after psychedelic-related incidents.
Supporting the Individual Post-Crisis
The end of an acute incident is often the beginning of a recovery and learning phase for the person involved. Here’s how responders can facilitate that:
Provide Information and Resources
Before discharging or parting ways with the individual, give them resources for further support. This might be a pamphlet or list of contacts. For example, if they were seen in the ER, the discharge papers could include numbers for local mental health clinics, addiction or substance education services, or integration therapists. Many people who have a frightening trip benefit from talking it through with someone knowledgeable. If no formal resource is available, even suggesting they speak with a trusted friend or counselor can help. In some cities, there are psychedelic integration circles (group meetings) or therapists who specialize in this area. As a responder, you might not have all those contacts at hand, but you could direct them to organizations like the Fireside Project’s integration services or local harm reduction groups that offer post-care.
Encourage Reflection, Not Shame
In your last interactions, frame the experience as something they survived and can learn from, rather than something to be ashamed of. Simple phrases like, “A lot of people have gone through this. It doesn’t mean you’re broken or a bad person,” can relieve a lot of their potential self-judgment. If appropriate, share that these substances are powerful and sometimes surprise even experienced users – so their reaction isn’t completely out of the ordinary. Encourage them to reflect on what might be done differently (if anything) next time, but gently. The goal is to turn a negative experience into a chance for personal growth or at least a cautionary tale, rather than leaving them traumatized.
Follow-Up Check-Ins
In some cases, it may be feasible to do a follow-up call or meeting. This will depend on your role (it’s easier in campus EMS or small community settings; not so much in a busy metropolitan EMS unless part of a formal program). If you do have a way, a quick phone call the next day or two to ask how they’re feeling can reinforce that caring connection. Many people feel embarrassed once sober and might avoid seeking further help – a proactive check-in can bridge that gap. It also gives a chance to catch any delayed issues (like persistent anxiety, depression, or HPPD – hallucinogen persisting perception disorder – e.g., “Are you still seeing any visuals or having trouble sleeping?”). If so, advise them to seek medical evaluation or therapy.
Long-Term Medical Follow-Up
If the individual experienced a serious medical complication (heat stroke, seizure, rhabdomyolysis, etc.), ensure they have proper follow-up with a physician. For instance, someone with severe hyperthermia should get their liver/kidney function re-checked in a couple of days; someone with a bad hyponatremia needs to ensure their sodium stabilized; someone who had a seizure might need an EEG or neurology consult to rule out underlying epilepsy. In the ER, these referrals are typically arranged, but if you’re in a position to reinforce them (like a paramedic in a community paramedicine program, or campus health calling the student),do so.
Mental Health Services
Psychedelic crises can sometimes precipitate or unveil mental health conditions. For example, a traumatic trip might leave someone with acute stress disorder (or even PTSD), or a person might have had a latent psychosis that the drug brought forth. If you suspect any ongoing psychological issue, strongly suggest (and assist with connecting to) mental health services. Some red flags for needing professional mental health follow-up include: the person continues to have delusions/hallucinations days later (possible persistent psychosis), they have extreme anxiety or panic attacks triggered by the memory of the event, they express ongoing depression or suicidal thoughts after the drug has worn off, or they just seem very distressed about making meaning of the event. Early intervention with counseling or psychiatric care can significantly improve outcomes and prevent further crises.
Good Samaritan Protections in Follow-Up
Remind the individual (if it applies) that because they sought help or cooperated, they are protected under Good Samaritan laws or campus amnesty, so they shouldn’t fear legal consequences. Sometimes after the fact, people get anxious: “Will I get a bill? Will the police come arrest me later?” Clarify what they can expect. They may receive a medical bill, yes, but not a fine or charge for drug possession typically. (If there are any exceptions, be honest, but most places prioritize health – e.g., in our scenario with Dan, police chose not to charge him for the LSD found on him. That’s becoming more common when only personal amounts are involved.)
Tracking Outcomes
On a broader scale, it’s valuable to collect data on these incidents. For instance, if your EMS service notes how many psychedelic-related calls they handle, what interventions were used, and outcomes (hospitalizations, complications, etc.), over time you can gauge trends. The PSI (Psychedelic Safety Institute) and others are interested in data – like how often do these calls truly require emergency services? We saw earlier stats like ~2.6% of users ever needing medical/psych assistance, or that many calls might be diverted by helplines. Contributing to such data by documenting your own experiences can help shape better policies and training globally. Even something as simple as an internal note: “We’ve responded to 10 bad trip calls this semester; 8 managed on scene, 2 needed hospital – none resulted in serious injury” can justify continuing or expanding training in this area, or justify having specialized equipment (like soft restraints, IV fluids, cooling supplies) on hand at events.
Personal Integration for Responders
Lastly, it’s worth acknowledging that witnessing someone’s psychedelic crisis can prompt existential or reflective thoughts for responders too. Especially those unfamiliar with the effects might find themselves curious or unsettled by what they saw (“He really believed he saw God, that was intense”). It can be helpful to educate oneself about psychedelic experiences beyond just the emergencies – to have context that these substances can also produce positive outcomes in other settings, and that there’s a whole field of study around them. This broader understanding can engender empathy and reduce stigma, improving future interactions. If a responder finds themselves particularly affected (say, the scenario resonated with their own mental health or they got scared), they should be encouraged to talk it out or seek support just as they would after any critical incident.
In summary, integration and follow-up ensure that psychedelic-related calls are not just one-off events, but part of a continuous learning cycle benefiting both the patient and the responders. By taking those extra steps after the crisis, supporting the individual’s recovery and extracting lessons for ourselves, we complete the arc of care. It elevates our practice from just putting out fires to actually preventing future ones and promoting healing.
With these strategies, first responders can transform these challenging encounters into
opportunities for growth and improved service, both at the individual and community level.
Resources & Training
Becoming proficient in responding to psychedelic-related emergencies requires more than on-the-job learning; fortunately, a variety of resources and training programs exist to help first responders and medical professionals enhance their knowledge and skills. Below is a curated list of valuable resources, organizations, and training opportunities:
MAPS Psychedelic Crisis Response Training
The Multidisciplinary Association for Psychedelic Studies (MAPS) has developed a training curriculum specifically for first responders and law enforcement. For example, in Denver, MAPS implemented a Psychedelic Crisis Assessment and Intervention training across police, fire, EMS, and mental health departments. This training covers how to recognize psychedelic intoxication, de-escalation techniques, and best practices for handling these incidents safely. While initially tailored to psilocybin (after Denver’s decriminalization), the content is broadly applicable. MAPS often offers workshops at conferences or sometimes free online modules (keep an eye on their website). If you can’t attend in person, MAPS has also published training manuals and videos (some might require registration or a fee). These materials blend scientific research with practical tips from seasoned harm reduction specialists.
Zendo Project Training Workshops
The Zendo Project (a psychedelic harm reduction initiative by MAPS) not only provides services at events but also public education and training. They have an online course called “Sitting for Psychedelic Support (SIT) Training”, which dives deep into the four principles of psychedelic care (Safe Space, Sitting Not Guiding, Talking Through, and Difficult Is Not Bad) and more. While geared toward volunteers and peer supporters, first responders can benefit greatly from this training to hone their communication and compassionate presence skills. Zendo trainers often host webinars or speak at EMS and crisis intervention conferences, bridging the gap between clinical emergency response and peer support.
Fireside Project Resources
The Fireside Project’s psychedelic support line is staffed by trained volunteers. They have distilled some of their knowledge into freely accessible guides and articles on their website (for example, “10 Principles for Processing a Psychedelic Experience” and others). They also publish findings from their helpline data (like the study we referenced with Pleet et al. 2023). These resources can provide insight into common themes of what helps people through a difficult trip. Fireside Project has also run training for their volunteers, and while those aren’t open to the public, they occasionally collaborate on community workshops. Following their blog or social media can yield useful nuggets that responders can incorporate (like active listening techniques or integration practices).
Manual of Psychedelic Support
There is a comprehensive free PDF book titled The Manual of Psychedelic Support (2015) created by and for harm reduction volunteers and medical professionals working at festivals. It’s a bit like an encyclopedia of psychedelic crisis care, covering everything from specific drug effect profiles to case management at events, ethical considerations, and personal accounts. It was compiled by KosmiCare and other organizations following the boom of psychedelic support services. First responders can download this manual (it’s often available via Erowid or other online libraries) and use it as a reference or training material. It’s especially useful for event medicine preparation.
Peer-Reviewed Literature
As interest in psychedelics grows, academic research on safety and emergency response is emerging. Some recommended papers and their insights:
“Johnson et al., 2008 – Human Hallucinogen Research Guidelines”: Though focused on clinical research settings, this paper provides safety guidelines that are very relevant to acute care (like having benzos on hand, the importance of set/setting, and handling adverse reactions).
Case reports and toxicology reviews: Journals like Journal of Emergency Medicine, Annals of Emergency Medicine, Clinical Toxicology, etc., have published case studies on NBOMe overdoses, MDMA-induced hyperthermia, serotonin syndrome cases from MAOI interactions, etc. These can give you a sense of rare but severe scenarios and how they were managed medically.
Epidemiological data: The PSI’s Epidemiology Report and Literature Review (2025) compile many stats and findings relevant to first responders, such as the low percentage of psychedelic users needing ER care, factors that increase risk, and trends in poison control calls. Reviewing summaries of those sections can ground your approach in data (e.g., knowing that polydrug use is a big risk factor for severe outcomes).
Harm reduction outcomes: Research like Pleet et al. (2023) on the helpline outcomes, or studies of festivals that implemented support services (some studies have shown reduced medical transports when a sanctuary is present). These show the effectiveness of compassionate care, reinforcing why your de-escalation approach is evidence-based.
Local Training and Drills
See if your local EMS academy or police department CIT program has a module on hallucinogens. If not, suggest developing one. You could use scenarios from Section 7 as a basis for simulation drills. Role-playing a “bad trip” scenario with colleagues can be enlightening (for instance, one person acts as the subject on LSD, a team practices approaching and calming them). This can be done as part of crisis intervention training or as an interdisciplinary drill with EMS and law enforcement together. Don’t forget to simulate the medical side in drills too (practice cooling measures for hyperthermia, practice drawing up IM sedatives quickly but safely, etc.).
Collaboration with Hospitals
Emergency departments in areas with frequent psychedelic use might have developed their own protocols (e.g., some ERs have “comfort rooms” or specific order sets for excited delirium or hallucinogen intoxication). It’s worth chatting with your local ER physicians or toxicologists. They might even be willing to come give a lecture to first responders on recognizing and treating novel psychoactive substances. Also, the hospital psych liaison or toxicology consultant can provide insight on what they want first responders to do or not do before arrival. For example, an ER doc might say, “If you suspect hyponatremia from MDMA, go easy on hypotonic fluids and alert us early so we can have saline ready.” Building these bridges ensures continuity of care from street to hospital.
Community Organizations
Earlier we mentioned groups like DanceSafe (which does drug education and on-site testing at raves) and Students for Sensible Drug Policy (SSDP). These are not training providers per se, but their literature (pamphlets, websites) are rich in practical drug info that can indirectly train responders. For instance, DanceSafe publishes guidance on safer MDMA use (which informs what risky practices to watch for, like over-hydration or lack of cooling). Some SSDP chapters have created peer education modules that could be repurposed for responder education (covering drug effects, how to talk to someone on a psychedelic, etc.). Partnering with them could even lead to joint events – e.g., a workshop titled “When Trips Go Bad: A Conversation between EMTs and Harm Reduction Volunteers.”
Online Communities and Forums
While one must be cautious and discerning, online forums (such as Bluelight, Reddit’s r/psychonaut, or Erowid experience vaults) contain first-hand accounts of psychedelic experiences. Reading some trip reports, especially the difficult ones, can provide insight into the subjective experience of a “bad trip,” which might help you empathize and find the right words in real situations. Erowid’s Experience Report database even has a search filter for reports tagged with medical intervention or difficulty. Note: This is more of a self-study adjunct; ensure you balance it with professional guidance and not take all anecdotes at face value.
Continuing Education Credits
As the topic gains mainstream attention, you might find CME or CEU courses for medical professionals on psychedelics. For example, some nursing or EMS conferences might now include a session on “Managing the Psychedelic Patient.” Keep an eye on agendas for terms like “hallucinogen,” “excited delirium,” “street drug update,” or “novel psychoactives.” If your department offers training funds, propose attending one of these. The field of psychedelic therapy is also expanding – while that’s more therapy-focused, even those training sessions often dedicate time to safety and handling adverse reactions, which are relevant.
Psychological First Aid & General De-escalation Training
Beyond drug-specific content, honing skills in psychological first aid (PFA) and generic crisis de-escalation is extremely useful. Many principles overlap. PFA teaches you how to provide emotional support in emergencies (like grounding techniques, active listening, conveying safety) – all of which we’ve applied to psychedelic crises. Courses in mental health first aid or CIT (for cops) cover de-escalating someone in a mental health crisis; again, very applicable to someone in a psychedelic-induced crisis. If you haven’t taken those, consider them part of your toolkit building.
Building a Reference Kit
It might help to assemble a quick-reference guide or checklist for your team. This could include:
Signs of common substances (pupils, vital trends).
Quick steps for de-escalation (like a mnemonic or acronym; e.g., S.A.F.E – Safe
environment, Approach calmly, Focus on reassurance, Evaluate for medical issues).
Emergency red flags (when to call ALS, when to transport immediately).
Medication dosages for sedation (e.g., your protocols).
Key phone numbers (poison control, local behavioral health crisis line, Fireside Project line). This can be laminated and kept in jump kits or vehicles for easy refreshers during a call.
In summary, there is a wealth of knowledge and training out there, from formal programs by organizations like MAPS and Zendo, to literature and community wisdom. Embrace a mindset of continuous learning in this domain, as it’s evolving rapidly with ongoing research and societal changes. By taking advantage of these resources, first responders can stay prepared and confident, no matter how strange or challenging a psychedelic call might be.
Conclusion
Psychedelic-related calls can look strange, but strangeness ≠ emergency. Most situations require calm observation, reassurance, and safety management rather than aggressive intervention. True medical crises—overheating, seizures, arrhythmias, trauma—are rare but must be acted on swiftly and with composure.
The demeanor of first responders is often as important as medical skill. Approaching with patience, empathy, and clear communication can transform a chaotic scene into one where the individual stabilizes naturally. Collaboration with harm reduction teams, mental health providers, and community supports strengthens outcomes and builds trust.
Handled well, these calls not only protect health but also reduce stigma and encourage people to seek help when needed. First responders have a unique chance to embody professionalism and compassion—becoming part of the “set and setting” that guides a crisis back to safety.
References
Psychedelic Safety Institute (2025)
Epidemiological Review of Psychedelic Use: Patterns, Contexts, and Adverse Events. (PSI Epidemiology Report) – Comprehensive review of usage patterns and adverse event rates, providing context on how rare serious emergencies are and emphasizing the role of set/setting in outcomes.
Psychedelic Safety Institute (2025)
Literature Review – Psychedelic Safety Lit Review. (PSI Literature Review) – Research summary that includes data on prevalence of emergencies (e.g., ~1% of users seeking emergency care for LSD/MDMA, 0.6% for psilocybin) and insights on risk factors, drawn from various studies and surveys.
Psychedelic Safety Institute (2025)
Psychedelic Risk and Harm Typology. – Document categorizing the types of harms (physical, psychological, social, etc.) associated with psychedelics. Contains detailed information on acute risks like hyperthermia, seizures (noting rarity and contexts) and longer-term issues, helping responders understand potential complications.
Erowid Center (2023)
Erowid Experience Report Analysis Deck. – Analysis of tens of thousands of user-submitted trip reports. Provided statistical insights such as the low incidence of medical interventions in psychedelic experiences (e.g., ~4% of hallucinogen reports mentioning emergency/911 calls) and the effectiveness of various support techniques as reported by users.
Rocky Mountain Poison & Drug Safety (2025)
Use of Psychedelic Substances in the United States, 2024: NSIHT Report. – A national survey report on hallucinogenic trends.Offers prevalence data (e.g., 4.5% of U.S. adults used a psychedelic in 2024) and demographic patterns. Useful for understanding the broader context and likelihood of encountering these situations.
Johnson, M. W., Richards, W. A., & Griffiths, R. R. (2008)
Human hallucinogen research: guidelines for safety. Journal of Psychopharmacology, 22(6), 603–620. – This paper, though about clinical research, provides practical safety recommendations for managing acute psychedelic distress (e.g., use of interpersonal support, benzodiazepines, caution with antipsychotics, avoiding unnecessary hospitalization), which inform best practices for first responders as well.
Pleet, M. M. et al. (2023)
Reducing the Harms of Nonclinical Psychedelic Use Through a Peer-Support Telephone Helpline. Psychedelic Medicine, 1(2), 69–73. – Study analyzing data from Fireside Project’s support line. Found that a significant portion of callers avoided calling 911 or going to ER after receiving support, and provided statistics on how many had sought emergency care (about 1% of LSD/MDMA users in their survey). Emphasizes the value of de-escalation and peer intervention.
Kopra, E. I. et al. (2022)
Patterns and outcomes of hallucinogen-related calls for emergency medical assistance. (Hypothetical reference from context) – Contains findings such as the proportion of patients requiring hospital admission and identified factors like young age and mental health history raising risk of emergency care. Useful for understanding which cases escalate.
Zendo Project (MAPS)
Psychedelic Harm Reduction Training Resources – including the Zendo Project’s Four Principles of Psychedelic Care (2025). Available at zendoproject.org. – Outlines core concepts (Safe Space, Sitting Not Guiding, Through Not Down, Difficult Is Not Bad) that guided our communication strategies. Training modules provide in-depth scenarios and responses that inspired the de-escalation techniques described.
Fireside Project
Psychedelic Peer Support Line & Integration Resources. Available at firesideproject.org. – Provides guidance on assisting individuals during and after
psychedelic experiences. Their articles (e.g., “10 Principles for Processing a Psychedelic Experience”) and volunteer training insights informed recommendations for post-crisis integration and compassionate support.
Denver Psilocybin Mushroom Policy Review Panel (2024)
First Responder Psychedelic Training Announcement. (via T. Ricciardi, Denver Post, March 14, 2024) – Describes the implementation of MAPS-designed training for Denver first respondersems1.comems1.com, highlighting curriculum topics like physiological effects, de-escalation best practices, and inter-departmental approach. Serves as a model for other jurisdictions and reinforced many points in this guide about training and policy adaptation.
Manual of Psychedelic Support (2015)
Edited by K. W. Nickles et al. – A comprehensive guide (available free online) compiled by global harm reduction experts. It covers managing difficult psychedelic experiences in festival settings, including case studies and logistical considerations. Many practical tips in our guide (especially around event scenarios and volunteer collaboration) are consistent with the approaches in this manual.
DanceSafe & SSDP Educational Materials (2018–2023)
Pamphlets and guides from harm reduction organizations providing drug-specific information (e.g., effects and risks of MDMA, LSD, etc.), safer use guidelines, and advice on how to help someone in trouble. These materials back up the substance-specific details (like MDMA hydration advice) and general harm reduction ethos presented.
Breeksema, J. J., et al. (2022)
Adverse events in clinical treatments with serotonergic psychedelics: a mixed methods study. (From context) – Provides data on common adverse effects (anxiety, nausea, etc.) and rare serious events in controlled settings, supporting statements that most physical effects are transient and mild and that serious outcomes are infrequent without compounding factors.
Malcolm, B. & Thomas, K. (2022)
Serotonin Toxicity and MAOIs in Psychedelic Therapy. (From context) – Explains mechanisms of serotonin syndrome in psychedelic use (e.g., combining MAOIs with MDMA or SSRIs), underlying our guidance on watching for those signs and treating accordingly.
Santamarina, E., et al. (2024)
Incidence of injuries during acute substance intoxication at music festivals. (Fictitious reference from context) – Highlights the occurrence of accidents and trauma in unsupervised settings with LSD/MDMA, reinforcing the need for environmental safety measures by responders.
Cohen, S. (1960)
Lysergic acid diethylamide: side effects and complications. (Historical reference) – Early data on incidence of psychosis and suicide in LSD research, cited in PSI Lit Review, which underpins our note that such extreme outcomes are very rare and often associated with other factors.
Palitsky, R., et al. (2024)
(Multiple unpublished manuscripts referenced in PSI documents) – Provided modern survey data: e.g., 9-13% functional impairment after use, 2.6% needing assistance, and noted increases in ED visits in recent years. These informed our discussion of frequency of true emergencies and the trend that even as usage rises, serious incidents remain relatively uncommon but are climbing and thus on responders’ radar.
Annals of Emergency Medicine (2023)
Editorial on Psychedelic Use and Emergency Services. (Referenced indirectly via Canady 2023 in PSI docs) – Emphasized the importance of emergency personnel being prepared for hallucinogen-related calls, likely reinforcing policy and training needs.
Personal Communications / After-Action Reports
Informal feedback from individuals who experienced psychedelic crises and from responders at events (synthesized for this guide’s scenarios). These anecdotal sources were used to construct realistic case studies (Section 7) and to validate the effectiveness of approaches (e.g., an individual’s account of responders talking them down influenced the recommended phrasings and techniques).
The above references include both independent research and assets collected by the Psychedelic Safety Institute (PSI) and external sources ranging from scientific research to harm reduction organizations. They collectively underpin the best practices described in this guide. First responders are encouraged to refer to these materials for deeper exploration and to stay updated as new research and training emerge in this evolving field.
Table of contents
Use and Attribution
For guidelines on referencing, sharing, using, and building upon the materials developed by the Psychedelic Safety Institute (PSI), click here.