Improving response to emergencies involving autistic children
Educating EMS providers about autism symptoms can help them identify behaviors and special needs, and modify their response
By Leischen Stelter, editor of In Public Safety
First responders are increasingly likely to respond to an incident involving a person with autism. Autism spectrum disorder (ASD) is the fastest-growing developmental disability affecting about 1 in 68 children in the United States. On a global scale, approximately 1 percent of the world population has ASD.
How can first responders adapt their response when interacting with someone with autism?
Dr. Kevin Kupietz, who teaches Emergency and Disaster Management courses at American Military University and is also a volunteer firefighter with the Roanoke Rapids (NC) Fire Department, conducted in-depth research on best practices for responding to incidents involving autistic individuals.
During his research as part of the United States Fire Administration’s Executive Fire Officer Program, Kupietz found that statistically, an autistic individual is seven times more likely to need the service of responders than a non-autistic individual. Combined with growing numbers of autistic persons, first responders have an increasingly higher chance of encountering an autistic individual during an emergency situation. Despite this, many responders don’t know how to identify a person with autism or how to modify their response to better accommodate an autistic person’s needs.
Know the signs of autism
Identifying an autistic individual can be difficult because the spectrum is so wide. Children who have ASD display mild to severe impairments in social interaction and communication. Behavior can be vastly different as well. For example, one autistic child may run away at the sound of a loud siren, whereas another autistic child may be attracted to the loud noise. There have been numerous cases of autistic children running back into a burning building and hiding because the scene outside was interpreted as too chaotic.
While it is difficult to generalize autistic behavior, there are a few commonly cited tendencies:
- An affinity for water. Many autistic individuals are attracted to water, even when they cannot swim. Studies have found that autistic children are at a higher risk of drowning than non-autistic children. Many autistic children are fearless when it comes to water and have little regard for the temperature or the depth.
- Tendency to wander. These children are at high risk of injury from the environment. Even more challenging, autistic children are difficult to locate because they hide, do not seek help, and do not respond verbally when called. Some of the parents Kupietz interviewed for his research said they had to install deadbolts on interior doors of their homes in order to keep their child from wandering, which also poses an additional safety concern.
- Limited ability to communicate. Communicating directly with an autistic person can be extremely difficult and frustrating for first responders. Many autistic children communicate visually rather than verbally. Many can understand what a person is saying, but are unable to communicate in return.
- High thresholds of pain. Autistic individuals often have higher-than-normal thresholds for pain, which can mask serious medical issues, Kupietz found. Just because an individual is not displaying signs of pain does not mean they aren’t injured.
How to adjust your EMS response
There are several steps that first responders can take to adapt their procedures when dealing with an autistic individual:
- Work directly with a parent or caregiver. Many autistic children will only respond to their caregivers and are often frightened by unfamiliar people.
- Speak clearly, slowly and use literal, direct language. It often appears that an autistic child is not paying attention because they are not making eye contact, but many do. Do not get frustrated. Remain calm, be patient and use soft, calming tones. Responders should also provide the individual plenty of time to process information and provide an answer.
- Minimize stimulation. Limit the use of sirens, horns and lights, and reduce the number of responders present. If autistic children need to be taken to a shelter, first responders should try to provide the child with his or her own space. Even marking off an area with chairs can help the child establish boundaries. Headphones can also help the child remain calm during chaotic or loud situations.
- Minimize physical contact. Be aware that many autistic children have sensory issues where even common things, like the application of bandages, may cause distress.
- If a physical exam is necessary, start at extremities and work towards the trunk and head. This helps gain the trust of an autistic individual. It can also help to use a favorite toy or item for comfort.
- Be cautious during restraint. If an autistic person must be restrained, first responders need to be aware that many of them have underdeveloped chest muscles. If they are held in place too long, they can suffer from mechanical asphyxiation.
- Do not underestimate their strength and determination. The more an autistic person is restrained, the harder they fight because they do not understand the situation.
Prepare autistic children for an emergency
One of the best ways to avoid problems during an emergency is to familiarize autistic children with first responders. Parents should be encouraged to bring their child to the firehouse and introduce them to responders. Firefighters should put on full gear and show the child some of the equipment. This effort could potentially alleviate an autistic child’s fear during an emergency and help them feel more comfortable with responders.
Firefighters should also encourage parents to practice how their child should respond during an emergency. There are many technology solutions that can help as well. For example, parents may want to consider installing an alarm system capable of recording a parent’s voice. This recording not only alerts the child, but also instructs the child what to do (i.g. “Go outside and wait by the mailbox”). For children who wander, parents can equip them with GPS devices. Some parents also use jewelry, temporary tattoos, cards or tags stitched in clothing to alert others that their child is autistic.
By working together, first responders and the families of autistic persons can better prepare a child for an emergency situation.
About the Author
Leischen (Stelter) Kranick is the editor of In Public Safety, an American Military University sponsored website. She has spent six years writing articles on issues and trends relevant to professionals in law enforcement, fire services, emergency management and national security. To contact her, email IPSauthors@apus.edu. For more articles featuring insight from industry experts, subscribe to In Public Safety’s bi-monthly newsletter.