What you don’t know can hurt you!The First Responder vs. Autism

This article is not intended to be a replacement for first responder autism awareness training; its purpose is to show the need for such training. There is an old saying “A little knowledge is dangerous”. It would be hard to even scratch the surface in a short article. If you knew that one out of every 68 calls could go deadly wrong because you were not properly trained for the situation, would you take that training?

Just a few years ago, the autism rate was 1-88. This year the CDC announced that 1 in every 68th child born in the USA had some level of autism¹, a 30% increase. This means of the 4 million children born each year in the United States, 58,000 will have ASD (Autism Spectrum Disorder). More than 3.5 million people currently live with some level of autism in the United States². It is also 5 times more common in boys than girls.

As a first responder you may ask, how does this affect me? Let’s first ask, do you know someone with autism, a family member or a friend? Wouldn’t you want to know that no matter where they end up in their life, every member of their fire district knew how to protect them? If you have never met someone with autism, you soon will. Individuals with autism are seven times more likely to have an interaction with a first responder than the average person. Another scenario, maybe you did have an encounter with an individual with autism and the call did not go as expected, because you were not able to recognize the signs.

Let’s start with explaining first what autism is. This will help you better understand the situation when it is presented to you. The simple answer – a mental condition, present from early childhood, characterized by difficulty in communicating and forming relationships with other people and in using language and abstract concepts.³

Next let’s discuss some traits of autism and how they can affect you as a first responder.

1. Lack of or poor speech or verbal communication – On scene is stressful enough but now you may not be able to communicate with the patient.
2. Sensitive to touch and loud sounds – This means that your lights and sirens can cause seizures, and simple examinations can become complicated or even impossible.
3. Difficulty with change in routine – Emergency situations break routine and can cause stress, shutdown and meltdowns. Rescues may not be as easy as “listen to what I say and do it”. They may have been taught not to leave the house or vehicle or to use only a certain exit way and only with a caregiver, thus creating confrontation.  
4. Lack of eye contact – Is the patient understanding what I am saying; are they even listing to me at all?
5. Lack of danger awareness – This can put them in some compromising rescue situations that can be dangerous to them and you.
6. High tolerance to pain – Couple this with lack of communication skills and this can cause you to miss serious injuries. 
7. Lack of Interaction – They want no part of you or what you are doing or need to do.
8. Meltdown or total shutdown – During a meltdown they lose control of many functions. As a first responder there is not much you can do until it plays itself out. Valuable time is wasted. They can be a danger to themselves and you during this period. Grabbing them and carrying them out is not an option!
9. Elopement or wandering – This is the largest cause of death in the autism population. Roughly 48% of individuals with autism attempt to wander from a safe environment.⁴ Their lack of awareness to danger increases the risk.
10. Attached to objects – Taking away a favorite item to treat the autism patient can cause a communication breakdown or worse a meltdown.
11. Lining up of items – This one may not be as obvious. Things have to be perfect and structured. Things like wadded up EKG cables and other disorganization can cause agitation or shutdowns. Even simple things like going from a smooth payment to a diamond plated bumper can cause issues.

A few quick points when an individual with autism is involved that go against what we are normally taught:

1. As first responders we are taught to clear the scene: “we got this, every move back”. Your biggest asset is the caregiver; do not send them away, utilize them. They know what, where, how and what, when it comes to that individual with autism.
2. We normally take away from the individual any object that may get in our way. These items may comfort the patient and be the key to a successful call.
3. Grabbing an individual with autism during a meltdown or standoff may seem logical and the solution, since it would take them out of danger. The problem is they are not aware of the danger and they may feel safe where they are. During a meltdown they have lost control of their senses including reasoning. A battle will occur and chances are you will get hurt, making a bad situation even worse.
4. We are taught to always have an alternative exit strategy when entering a building. What we do not know is that due to the high risk of wandering, doors may have deadbolts that require keys from both sides and windows may be barred or made of this thick Plexiglas or other unbreakable material. Gates may be secured with locks and chains.

I have addresses many of the challenges we face as a first responder when the call involves an individual with autism. There is nothing routine about it. When you have met one individual with autism, you have met one individual with autism. Each call will be as unique as the individual themselves, but being prepared and having a better understanding going into the call will increase your chances of having a better outcome.

Prevent-Educate.org is an all-volunteer non-profit organization that offers donation-based online and onsite autism awareness training for first responders. The program has been approved for 2-5 hours of continuing education for EMT, AEMT and paramedic certification and licensure renewals in all states.

We challenge you to take the pretest @ www.Prevent-Educate.org and see how well you do.

Unfortunately, the failure rate is pretty high.

YOU CAN HAVE THIS TRAINING @ YOUR STATION!!

We are approved for EMS Continuing Education in all 50 US states.

The training is instructor/video based and covers understanding autism, communication techniques, seizures, proper restraints, wandering (elopement), effectively handling a meltdown, fire search and rescue, EMS on scene, proper emergency room etiquette, dispatching techniques, and preparing your station for a field trip involving individuals with autism. With Q & A, the training is about 2 hours per session. We can schedule as many sessions as needed in one day or over several consecutive days.

We just need a classroom, and a projector and screen with sound. We will supply the laptop. If you are interested please contact me @ [email protected]

For more information, watch www.Prevent-Educate.org

References

1. http://www.cdc.gov/ncbddd/autism/data.html
2. http://www.autism-society.org/about-autism/facts-and-statistics/
3. Google Dictionary
4. http://nationalautismassociation.org/resources/autism-safety-facts/