In the U.S. approximately 1 in 88 children are born with some level of autism, according to the CDC. In the U.K. recent studies have shown the rate could be as high as 1 in 60, with an even higher rate for boys. All of which means EMS providers will come in contact with pediatric patients who have autism.
Prevent-Educate.org is aiming to teach all first responders—be they firefighters, EMTs, paramedics, police officers or emergency room personnel—how to effectively interact with individuals with autism. The non-profit organization offers training which gives providers the tools needed to effectively communicate with autistic individuals, as well as help reduce or eliminate dangerous behaviors. The training includes a pre-test and participants can earn up to 5 CEUs in most states.
John Sokol, PhD, program coordinator/executive director of Prevent-Educate.org and captain of the Pembroke (IL) Fire Protection District, offers some basic advice for providers when handling pediatric autism cases.
In the absence of any outward physical markers of the disorder, EMS providers need to be cognizant of the child’s behaviors. According to Sokol, some traits you might observe with a patient with some level of autism include hand flapping; repetition of what is said (also known as echolalia); lining up objects; pacing back and forth; avoiding eye contact; rocking, spinning, jumping or bouncing; limited, delayed or no language; and a high pain threshold.
Ideally, a 9-1-1 caller will inform dispatch that the individual involved has autism, but knowing in advance which behaviors are common indicators will help. Also be sure to look for Autism Awareness stickers in windows or magnets on a vehicle, as well as ID bracelets on the individual.
Sokol says a large majority of calls for a patient who has autism are for accidental injury. “These are kids who typically have no sense of pain or danger. And they’re wanderers.” Additionally, as many as 25% of patients with autism may develop epilepsy or other seizure disorders during their adolescence.
When dealing with a pediatric patient who has autism, providers should make full use of parents or caregivers on scene, says Sokol. Ask the parent or caregiver key questions, such as: Is the individual verbal or non-verbal? How does the individual react under stress? What usually works to calm them down? Where might the individual hide if they are scared and want to be left alone? Knowing the answers to these questions can save valuable time and let you know the best approach to take with the patient.
Because individuals with autism may not experience cold, heat or pain in the way most people do, they may not express any pain even with apparent injuries present. Signs the patient with autism may be in pain include laughter, humming or singing, and removing their clothes. While some patients with autism may be averse to touch, it’s important to watch for these signs and do a thorough exam to find any injuries which may be otherwise overlooked.
Patients with autism may become overly stressed or frustrated, at which point they may shut down or have a total meltdown. Meltdowns are not the same as a temper tantrum, stresses Sokol. During a meltdown, individuals with autism aren’t able to process how their actions affect others. They may scream, kick, bite, swear and throw things. The best way to deal with a meltdown is to remain calm, lower your voice or stop talking altogether, and let the situation play itself out. Back up to give the patient space. Open your palms and put your arms at your sides. And always be quietly reassuring and never threaten any consequences, Sokol emphasizes.
Restraining a patient with autism should only be a last resort. If calming techniques aren’t working or there is no time, says Sokol, explain exactly what you’re doing and then do it. Restrain the patient with as many people as you can. If necessary, put the patient’s arms at their sides and wrap them in a blanket. They may feel more secure in a close, tight space, and the provider will be safe from any thrashing. Always restrain the patient face up.