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Program created to help EMTs with autistic patients

The training gives first responders an understanding of autism, how to identify it and to how to calm a patient down

By Kirstin Kennedy
The Beaver County Times

BEAVER COUNTY, Pa. — As both the mother of a son with Asperger’s syndrome and a mental health professional, Kimberly Stanford finds herself in a unique position of understanding.

Her job as supervisor of family partnership support at Glade Run Lutheran Services in Zelienople is to educate and advocate for all of the families the organization serves, something she regularly does for her teenage son, Brandon.

Like any parent of a child on the autism spectrum, Stanford has concerns about her son’s ability to respond in an emergency and communicate his needs to other people. If he were involved in a car accident, would he be able to tell medics he was hurt? Would the flashing lights and sirens cause him anxiety? Would the medics know how to interact with him?

Those are questions Stanford posed to her husband, Mike, one night over dinner at their Vanport Township home. As an emergency medical technician for Medic Rescue in Bridgewater, he has answered calls to help people with autism, either for a medical emergency or a behavioral issue that requires medical support.

Stanford said her son, who attends Beaver Area High School, is highly functional and very smart. However, when it comes to dealing with a forced social interaction, like a medical emergency, he might not react like a typical patient, she said. He also might not tell responders that he has Asperger’s syndrome and needs their patience and understanding.

“You get him in a situation like that, and he would say, ‘I’m fine,’ just so that he wouldn’t have to deal with anything,” Stanford said.

A lot of people with Asperger’s syndrome and autism have that in common with her son. Stanford and her husband discussed the lack of education for EMTs, who largely don’t receive training on how to interact with people on the autism spectrum when responding to a call involving them.

Stanford started researching autism and emergency-response protocols, and she learned that those with Autism Spectrum Disorder are more likely to have an encounter with emergency responders than a person without it. Stanford said that’s because, in many cases, there are “comorbid conditions” in those with the disorder, such as recklessness and wandering.

An emergency situation is stressful for everyone, especially those with ASD who might be sensitive to sounds and anxiety. In some cases, being touched is unpleasant for a person on the autism spectrum, so interacting with a medic who is trying to treat them can cause added agitation.

“Everything is out of routine, chaotic. There’s lots of sensory overload,” Stanford said. “So (EMTs) are set up to fail basically.”

Stanford discussed her concerns with her co-workers and her husband. Across the board, everyone agreed EMTs could benefit from additional training about ASD and how to minimize the impact of their interactions. Soon after she worked with Mike Hartle, operations supervisor at Medic Rescue, to develop a training and get it credentialed for continuing-education credits.

Stanford worked with several other Glade Run officials to create the presentation. She provided the first training to Medic Rescue employees April 27 at the Beaver Community Room. About 30 people attended.

The objectives of the training are to give responders, including paramedics, EMTs and firefighters, a brief understanding of autism and how to identify it. Stanford said she gives the participant tools to assist the patient in calming down from the stress of the situation, including “verbal de-escalation” and crisis intervention techniques they use at Glade Run.

She hopes the program will help “reduce dangerous behaviors so that (medics) don’t have to restrain (the patient).” The goal is to provide an understanding of “how to keep everybody safe,” she said.

“The response was overwhelmingly positive,” she said.

Hartle agreed. He said he is “pretty certain” he has had interactions with patients who have autism and did not know it at the time. He has also treated people who he knows have ASD, he said.

It’s important to recognize how to work with a special population, like those on the autism spectrum, he said.

“I think it’s a really good program,” Hartle said. The training helped him to understand that the behaviors a person with autism expresses in a “meltdown” are largely out of their control.

Learning techniques to interact with ASD patients provided the participants with “methods to diffuse those situations in a more effective manner,” Hartle said.

In the process of creating the training, Stanford toured the Medic Rescue ambulances.

“I need to see what they’re seeing and feeling and hearing and smelling,” she said. She put herself in her son’s shoes and considered all of the ASD clients she works with to determine what could help keep them calm in an emergency situation.

She also had students who are on the autism spectrum tour the ambulance and meet with medics.

Several students talked to Hartle when he brought an ambulance to Glade Run. He showed them the inside of the ambulance and hooked them up to some of the devices, like a heart monitor.

This gave the students a sample of “all of the sounds and sense that they would experience on the ambulance,” Stanford said. Afterward the group talked about some experiences they had with EMTs and first responders. Hartle and others from Medic Rescue told the students what was hard for them as EMTs, such as out-of-control behaviors and meltdowns.

“It is awesome to see those moments when you’ve got a crew sitting in a classroom drinking coffee with a couple of young men that were telling all about times when they’ve had to have an interaction with a first responder,” Stanford said. “None of them were good; they were all scary. It’s not a positive (thing), no one wants to see an ambulance coming, but they definitely turned it into something.”

Hartle asked them what was difficult for them as patients, and the students explained what causes them stress and causes them to lose control of themselves.

“I think for us and for the students there it was positive both ways,” Hartle said.

In order to help mediate and relieve some of the stress of an emergency, Stanford created a prototype for a sensory kit that ambulances can carry and use with patients on the autism spectrum.

The kits contain a headset to block noise, weighted pads, soft things to chew on for those that are very oral and several toys. The kits are meant to help distract the patient from what is upsetting them, Stanford said.

They also have laminated images of the body so that patients who cannot express what is wrong can point to the affected part of their body.

“They don’t register pain the same way (and) have difficulty communicating, so I thought how about we throw in some communication pieces to help them,” Stanford said.

She also created an element to help EMTs identify someone who might have autism, such as autism awareness pins or magnets and identification cards, which some people carry.

Stanford hopes educating ambulance companies will carry into eventually providing extra training to police departments and emergency room personnel.

Responders, including police, may think a person with ASD is acting disrespectfully or intentionally ignoring instructions.

“They have no concept of authority. Everybody’s on the same playing field,” she said.

Police and EMTs are often called together for behavioral issues, such as a patient having a “meltdown” or wandering and not responding.

Stanford said EMTs sometimes get hurt while on these calls, so in her course she talks about self-injurious behavior and the medical reasons for that.

“Pain is an issue,” she said. “They self-injure to try to cope with the pain.”

Stanford has recently applied for a grant to help fund the program and provide it to other ambulance companies. The prototype sensory kit was cost about $150, and Stanford believes individual companies can create their own either at their cost or through a grant.

She said she isn’t trying copyright the kits, she just wants to raise awareness of these situations and is willing to help departments create their own sensory kits.

“I don’t know where this is going to go, but I’m very excited with the fact that a population of 30 can then take that out, even if they’re with someone who hasn’t been trained that night,” Stanford said.

Copyright 2016 the Beaver County Times