Editor’s note: Want to know what EMS documentation really looks like across the U.S.? Don’t miss this insightful on-demand webinar breaking down the results of the first-ever National EMS Documentation Survey. Learn what your peers are doing right (and wrong), uncover common pitfalls in reporting, and find out how better documentation leads to better care — especially for patients with complex conditions like sensory processing disorder. Watch now and level up your documentation game.
By Jenelle Abnett PhD, BCASE
Sensory processing disorder (SPD) affects about 5% to 16.5% of the general population, with higher rates seen in individuals with autism or ADHD/ADD. For EMTs, understanding sensory processing disorder is essential effective patient care. The stress of any emergency is overwhelming, but for those with SPD, it can be unbearable. By understanding SPD, EMTs can turn challenging calls into safer, more accurate patient care.
Sensory processing disorders affect how the nervous system receives and responds to sensory input. Neurological differences can alter how someone responds to unfamiliar situations. SPD presents in two primary types:
- Hypersensitivity
- Hyposensitivity
What is hypersensitivity?
Hypersensitivity means certain sensory inputs are perceived more intensely, causing pain or overwhelming feelings. Those with hypersensitivity may describe injuries as more severe and have a fight-or-flight reaction to the situation.
What is hyposensitivity?
Hyposensitivity presents as the opposite. These individuals have reduced awareness of sensory input and seek strong stimuli interactions. They often have high pain thresholds and may mask injuries due to diminished sensations. Hyposensitive individuals have an impaired awareness of sensory input, creating hidden dangers in emergency assessment.
EMS training must account for these differences that can skew results from common assessment tools. Pain threshold scales may be ineffective, visual cues require adaptation, and standard practices may increase distress and pain rather than provide relief.
The 8 sensory systems every EMT should know
Most people think of the five senses, but there are eight sensory systems. Each of these can present unique challenges in emergency care for those with SPD.
1. Visual system (light sensitivity): Hypersensitive patients may try covering their eyes or show distress in bright lighting. Hyposensitive individuals may stare directly into bright lights.
2. Auditory system (sound sensitivity): Individuals may cover their ears from sirens or become agitated by too many voices. Some may struggle with silence or may need louder communication to process information.
3. Tactile system (touch avoidance or desire): This SPD causes extreme reactions to any medical procedure. Small touches can cause big reactions, or one may not feel any pain from an injury. Any pain assessment scale may be skewed by extreme reactions either way.
4/5. Gustatory/olfactory systems (taste and smell sensitivities): Individuals may react to strong smells, or have no reaction to hot, cold or spicy tastes. Try to avoid exposure to the smell of chemicals. The taste of medicines or sizes of pills can be difficult for someone with SPD to take.
6/7. Vestibular/proprioceptive systems (balance and movement awareness): Individuals with SPD in these systems may struggle lying down, have a feeling of being confined, or panic at sudden movements. Vertigo and dizziness may not present in a person with hyposensitivity differences. Using deep pressure may calm the nervous system.
8. Interoceptive system (internal body signals): With either hyper- or hypo-SPD, these individuals cannot accurately report pain levels, nausea, hunger or issues with internal systems. This also relates to body temperature, causing difficulty in feeling hypothermia, burns or fevers appropriately. This can skew emergency assessments and cause misdiagnosis of the patient.
Mixed sensory profiles: The complex reality
Most individuals with SPDs don’t fit neatly into one category. They may be hypersensitive to some stimuli, while hyposensitive to others, leading to incorrect assumptions about the patient. EMTs will have to rely on other indicators when medically assessing these individuals. For example, they might be stimming by headbanging (proprioceptive hyposensitivity) while being unable to tolerate gentle touch by another (tactile hypersensitivity). This isn’t contradictory behavior; it is consistent with mixed sensory processing differences.
Six sensory-informed strategies for EMTs
To determine whether a patient has an SPD and how to assess them accurately, EMTs and other first responders will have to use other strategies to assess the patient for injury.
- Assess and modify the sensory environment. For hypersensitive patients, try to dim or turn off any unnecessary lights, turn down the radio and approach them slowly. For hyposensitive patients, you may have to speak louder or make visual cues more obvious. Provide care using big gestures and firm touch. Watch for sensory seeking behaviors, like staring at lights, head banging or self-harm. They may need more sensory input.
- Adapt communication to sensory needs. EMTs should speak in slow, simple sentences. For hypersensitive patients, speak quietly and reduce background noise. For hyposensitive patients, speak clearly and show what you’re doing by using visuals and hand cues. When safe, allow the patients to see and touch equipment before using it. This can reduce fear and gives them needed sensory information.
- Recognize sensory regulation behaviors. Stimming, which is repetitive movement to process energy, helps their nervous system regulate. Hand flapping, spinning and rocking motions are common stimming behaviors. Don’t stop stimming unless it’s dangerous to the patient or others. Try working around the movements, or use sensory tools like weighted blanket for deep pressure or simple fidget toys for focus.
- Understand sensory driven fight-or-flight instincts. Meltdowns are not tantrums. Meltdowns are neurological responses to sensory overload. When overwhelmed, processing questions become nearly impossible for patients with SPDs to answer because their brain has gone into survival mode. Reduce sensory input first, then try to communicate with the individual.
- Use literal language. Skip abstract concepts and idioms that require extra thought processing. Instead of “This will just take a second and won’t hurt,” say, “I’m putting this cuff on your arm. It will squeeze tight for 30 seconds and then release.” Concrete language is easier to process.
- Allow extra processing time. Sensory processing disorders can slow someone’s response time. Their brain processes sensory input first, then processes questions, before they formulate an answer. Rushing or repeating the questions adds stress and reduces understanding. Time is a helpful tool.
Understanding those with neurodivergent minds and SPDs can drastically improve emergency encounters. Instead of relying solely on the patient to communicate their injuries and needs, EMTs can use other ways to gauge the situation.
Sensory processing disorder training can help EMTs provide more accurate assessments, reduce patient distress and improve care. Every emergency response team should seek training on sensory processing differences for those with autism spectrum disorder (ASD), ADHD/ADD and other differences under the neurodiversity umbrella. This type of training can create safer encounters for all.
REFERENCES
- CDC Autism Data. (2025). Autism Spectrum Disorder prevalence statistics. Available: https://www.cdc.gov/autism/data-research/index.html
- Cheung V, McCarthy ML, Cicero MX, et al. Emergency Medical Responders and Adolescents with Autism Spectrum Disorder. Pediatr Emerg Care. 2019 Apr;35(4):273-277. doi: 10.1097/PEC.0000000000001322.
- Improving Emergency Medical Services (EMS) Care for People with Autism in the Prehospital Setting Through Sensory and Communication Aids. (2024). PMC.
ABOUT THE AUTHOR
Dr. Jenelle Abnett is owner and trainer, Neurodiverse & Autism Training Solutions and professor of special education at Neumann University. She specializes in training first responders on autism and neurodivergent individuals to create safer encounters.
