This article was originally posted Aug. 3, 2011. It has been updated.
By Fire Captain John M. Sokol
Prevent-educate.org
Knowing that an emergency situation involves an individual with autism is important from the dispatcher to the first responders on scene. When the dispatcher includes “the individual has autism,” what is going to be your reaction?
Is autism something you just heard about or are you prepared for a situation that will be unique and unpredictable? The answer could mean the difference of injury or death to the first responder or individual, or an emergency situation with a safe outcome for everyone involved.
Individuals with autism are seven times more likely to come in contact first responders than neurotypical individuals. If you haven’t already met someone with autism, you soon will.
First, to understand how to properly interact with an individual with autism, it may help to know a little about it. Approximately 1-100 children born today have some level of autism. Brain function is affected interfering with reasoning, communication and social interaction. Approximately 25% of individuals with autism have epilepsy as well.
To an individual with autism, it is like going in to a sports bar with all the TVs on and noise everywhere. Instead of hearing one TV, they hear all of them at once and cannot focus on one TV.
Individuals with autism may look like you and me, so a firefighter or EMT might not be able to tell if the individual is autistic right away. There are many characteristics of the disorder, and each person may only display a few of those.
Observe behaviors
The best way to diagnose autism is to observe behaviors. Traits that you may experience when an individual has some level of autism may include hand flapping, repetition of what is said (also know as Echolalia or parrot back), lining up objects, pacing back and forth, avoiding eye contact, rocking, spinning, jumping or bouncing, limited, delayed or no language and high pain threshold “I get hurt. I’m ok.” These will cause challenges for you, the first responder.
When you are first discover that a situation involves an individual with autism, first and foremost, when possible arrive on scene without the use of sirens or flashing lights. Sound and light sensitivity is common in autism and may trigger a seizure or cause the individual to shut down or hide, making the situation worse.
Next, there are key questions you should ask a parent or caregiver ranging from “Is the individual verbal or non-verbal? How does the individual react under stress? What usually works to calm them down?” Knowing the answers can save you valuable time by letting you know what to expect and what approach to take.
Both children and adults with autism are likely to hide in a fire situation. Your search should include any tight out of the way place you would least expect to find someone. Upon finding the individual the first responder should speak slowly, with clear directions, not with force causing the individual to possibly shut down further.
Proper tools
Please bring the proper tools for the situation. Forced entry or exit will be most likely. Families often need to lock doors, including interior doors, to keep individuals with autism from wandering. Barred, nailed or locked windows along with Plexiglas or Lexan windows can make access or escape a problem for rescues.
Some individuals with autism may be sensitive to touch while others do not have a normal range of sensations and may not feel cold, heat or pain in a typical manner. In fact, they may fail to acknowledge pain in spite of significant pathology being present. This could cause you to overlook an injury. The individual may show an unusual pain response that could include laughter, humming, singing and removal of clothing.
Restraining the individual may become an issue and should only be used as a last resort.
If calming techniques don’t work or there is no time, explain exactly what you are doing and then do it. Restrain the individual with as many people as you can, as this will make the situation safer for you and the individual. When moving an individual with autism quickly, wrap them in a blanket with their arms inside. This will give them a secure feeling and may help calm them during a rescue, this will also prevent thrashing while trying to escape an emergency situation. Proper restraining position is face up.
In case of seizure
I mentioned earlier that approximately 25%-30% of individuals with autism develop epilepsy or other seizure disorders in their adolescence. This means that the potential for seizures should always be expected. Remember what you learned about seizures in basic training: remove any dangerous objects that the patient may hit during movement. Protect their head from hitting anything hard, such as the floor, and place patient on their side to allow saliva/drool to “drain.” If trained and able and the seizure continues, use medication to stop the seizure.
When transporting an individual with autism to the hospital, allow a primary caregiver to accompany the individual. Communicate with the hospital before arrival, and request a quiet, isolated room for patient. Let them know the individual is autistic. When possible, get rid of all light and sound off to minimize sensory overload.
Don’t let patients with autism out of your sight. They may be a bolt risk after rescue. Someone must stay with the individual at all times. Because they don’t comprehend danger in the same way, the individual may run out into traffic or back into a place they were just rescued from.
Individuals with autism running out of the house unattended (called elopement) is a serious issue. Drowning as well as prolonged exposure remain top causes of death in the autism population. Having no real fear of danger, individuals with autism may also go to a favorite place that they know, wander into traffic or along railways, or attempt to enter nearby homes.
In closing, being ready and knowing how to handle these situations is the only thing you can do to aid in these moments when interacting with an individual with autism. We challenge all first responders to take the pre-test at www.Prevent-Educate.org to see just how prepared you really are. Remember, their lives are in your hands.
The purpose of this article is to make you aware of the importance of understanding the situation you may encounter and not to be a replacement for proper training. For references used on this article, more information on autism awareness training and receiving state continuing education hours, please visit www.Prevent-Educate.org or contact John at preventeducate@gmail.com.