About 1 in 110 U.S. children have autism, a number that’s been rising over the past two decades, according to recent studies. To help responders better understand how to interact with autistic children and adults, researchers at Indiana University of Pennsylvania (IUP) have developed a half-hour training DVD.
In addition to language, social and communication difficulties, many autistic children are prone to “wandering” or running away unexpectedly. For reasons doctors don’t fully understand, they’re often attracted to bodies of water such as lakes and pools, posing a drowning risk.
In addition, some with autism can’t or won’t ask for help, may not respond to their name if called, may become agitated if approached, may hide or run away, or may engage in repetitive behaviors, such as hand-flapping or repeating back whatever is asked of them instead of answering questions. Many are also prone to seizure disorders.
“The unique behavioral characteristics are often misconstrued,” says Joann Migyanka, an assistant professor of special education at IUP. “If you attempt to interact with them or touch them, they go into a flight or fight mode. They may become a little more aggressive in trying to escape or avoid that touch. They might become verbally or self-abusive, and putting them into restraints makes things worse by increasing the anxiety and the combativeness.”
But responders can take steps to ease these patients’ anxiety, she says. For example, if you have to collar a patient, demonstrate it on yourself first. Explain what you’re going to do in simple terms, one step at a time.
The DVD covers several scenarios targeting police, fire and EMS, including a man trapped in a vehicle after an auto accident. To access the training free of charge, go to the Pennsylvania Department of Public Welfare, Bureau of Autism website: bastraining.tiu11.org/. You’ll be asked to create a username and password; then click on the “First Responder Training” link. After completing the training and test, you will receive a certificate of completion, which you may be able to use for continuing education credits.
Or, to purchase the DVD for $20, write to Joann Migyanka, IUP–Special Education, 213 Davis Hall, Indiana, PA 15705; or e-mail her at migyanka@iup.edu. Migyanka says she can send the materials in a format that’s compatible with most learning management systems.
LAFD Closes Stations, Beefs Up EMS
Seeking to bolster its EMS capabilities in an era of staff and budget cuts, the Los Angeles Fire Department has announced a new deployment plan that simultaneously closes some fire stations while adding firefighter/paramedics to others.
Since 2008, the department’s budget has been cut by some $110 million. In 2009, the LAFD began closing fire companies on a rotating basis, including 10 engine companies, five light forces and nine BLS ambulances daily, among other reductions. In 2011, with the budget crisis as bad as ever, the department saw additional closures and reductions, and it must make more budget cuts of $51 million for the 2011–2012 fiscal year, according to a report from Fire Chief Millage Peaks.
To determine how to spread its resources where they’re most needed, the LAFD analyzed three years of 911 calls and found that about 83 percent of more than 1,000 daily responses are EMS-related, says LAFD Battalion Chief Ronnie Villanueva. Of those, 63 percent require an ALS response.
The new deployment plan is not without pain. There won’t be any layoffs, but several stations with low call volumes will close permanently. At the same time, a firefighter/paramedic will be added to 10 fire companies “in order to focus the fire companies on the EMS incident workload,” according to Peaks’ report.
To do the analysis, the LAFD used software made by Deccan International.
Baltimore Targets Frequent 911 Callers
The Baltimore City Fire Department, along with the nonprofit Baltimore HealthCare Access, are reporting success with a pilot program aimed at reducing the number of frequent 911 callers. In 2007, researchers identified the city’s top 25 most frequent callers to 911. Together, they made 520 calls in a single year, including one person who called 110 times and another who called a whopping 147 times. In 2008, “Operation Care” was launched as a three-month pilot program involving 10 patients who agreed to receive weekly sessions with a case manager who assessed their medical needs, taught them how to navigate the health care system, put them in touch with primary care physicians and specialists, referred them to various support programs and educated them on ways to limit 911 calls to true emergencies. (The other 15 frequent callers could not be located or had died, been hospitalized or been incarcerated.)
During the pilot, the results of which were published in the April issue of The American Journal of Emergency Medicine, participants made only 57 calls—about half what they’d be expected to make if they’d kept up the pace from the prior year, says lead author Michael Rinke, M.D., a pediatrician and quality/safety expert at Johns Hopkins Children’s Center. That represents a savings of $14,300 over and above the cost of the program, including the case manager’s salary. The real savings are probably greater if money saved from unnecessary trips to the emergency room and freeing up ambulances for other callers were to be factored in, Rinke says.
“The original idea was to help these frequent callers get better access to medical and other care and, in doing so, Baltimore City ended up saving money and resources, a welcome side effect,” he adds.
Though Rinke and his colleagues expected that many frequent callers would be uninsured, they found that nine of the 10 studied had insurance, mainly Medicare, but had difficulty navigating the health care system. All 10 patients had two or more chronic conditions, including hypertension, diabetes and heart disease. Seven had either a mental health or a substance abuse problem or both. The average age was 60, though the range was 39 to 89.
The case manager referred patients to insurance assistance programs, medical specialists, adult-care services, food services like Meals on Wheels, psychiatric evaluation and support groups for substance abuse. Nearly 70 percent of the referrals were to non-medical services.
None of the patients reported that they hesitated to call 911 in true emergencies and said they experienced no adverse health effects as a result of the program.
Since the pilot ended, the fire department, which responds to nearly 150,000 emergency calls each year, has continued to fund the program, providing a nurse care coordinator and a case manager for repeat 911 callers. About 33 people are enrolled—about what the staff of two can handle, says Traci Kodek, MPH, vice president of programs for Baltimore HealthCare Access. One challenge has been locating people referred by the fire department. “Approximately 50 percent of our referrals lately have been for homeless/transient clients,” she explains.
Kodek has asked for $165,000 in fiscal 2012 to keep the program going. Funds will be used to pay the salaries of the nurse coordinator and case manager; maintenance of the agency van used to transport clients to appointments; and client-related services, such as emergency prescription vouchers, bus tokens and food vouchers.
