Safety monitoring and emergency awareness

The manuals converge on the need for active safety monitoring and rapid response to medical problems during sessions. Across the extracts, they emphasise readiness to recognise urgent issues, monitor participants during the session, and escalate care when needed. This includes monitoring vital signs or physiological status, maintaining emergency access, and being prepared to respond to complications such as cardiovascular reactions, unstable arrhythmia, bradycardia, cardiac arrest, or other acute medical events. They also overlap in stressing practical preparedness before the session begins. The manuals recommend having emergency plans, first aid knowledge, and the necessary equipment or support available on site. Examples include access to BCLS and ACLS, nursing supplies, oxygen delivery materials, basic medications, an emergency trolley, and checks on materials and structural supports before the session. The manuals differ mainly in emphasis and level of specificity. The MDMA manual focuses on session monitoring issues such as blood pressure, heart rate, hydration, fluid intake, hyponatremia risk, and fall prevention. The ayahuasca guide is broader and more general, highlighting first aid knowledge, emergency planning, and knowing how to ask for help and delegate. The Rocha et al. guidance is the most equipment and procedure specific, especially for clinical settings and ibogaine sessions, where multiparametric monitoring and electrocardiography are named, along with competence in managing unstable arrhythmia, bradycardia, and cardiac arrest.