Educating Responders on Populations with Special Needs

Capt. Skyler Phillips, EMT-P, of the Chattanooga (Tenn.) Fire Department, presented a session with personal meaning during the EMS Today conference Feb. 22 in Charlotte, N.C.

Phillips has a unique perspective when it comes to treating patients with special needs. Phillips' son Noah was diagnosed with autism at 3 years old. Phillips' presentation "Best Approaches to Special Needs Patients: Providing Better Care for Patients and Their Families" sought to instruct EMS responders about what people with special needs experience, how emergency situations can become particularly overwhelming for them, and strategies for EMS providers to de-escalate the situation.

"Unless you live in this world, you're not going to get it," said Phillips of his daily life with Noah. "Raising a child with special needs is like living on an island."

When Phillps' community rallied to raise the significant funds for his family to acquire a service animal, he sought a way to give back. "I was flabbergasted" at the outpouring of support, he said. So Phillips and co-author Lisa Mattheiss, director of Lifeline Inc. in Chattanooga, developed the Special Needs Awareness Program (SNAP), currently being taught to first responders all over Tennessee.

SNAP has two key components—first responder training and parent/caregiver training on what to expect during an EMS or fire call. The objective is to make the call run more smoothly and safely.

Prevalence

Phillips began his talk by explaining that the prevalence of disability among those who require first responder services is growing.

Not too long ago, "we didn't see the people having the meltdowns at the mall," since people with disabilities were frequently ostracized or instititutionalized, Phillips said. Today, "inclusion is the buzzword." This means more EMS calls that have a special needs component.

Regarding autism prevalence, the currently cited statistic is 1 in 68 people in the United States; updated numbers are due soon, but the best current guess is 1 in 50, said Phillips. One in 10 families in the United States "are directly affected [by intellectual disabilities during] some point in their lifetime," according to www.acl.gov.

Spina bifida, Down syndrome, epilepsy/seizures, cerebral palsy and other conditions add to the frequency of first responders interacting with citizens who have special considerations during responses.

Assessment

Service animals (becoming more prevalent) and medical ID alert bracelets can tip off responders to a special needs scenario, Phillips explained. If you ask a patient a question and he or she repeats it back to you, it can be another clue. "Scripting," in which phrases are repeated from a movie or television show; unsteady gait and awkward movements; speaking too loud or low; and constant hand motion are other markers of potential intellectual or developmental disability.

"Stimming" includes flapping, jumping, swinging, rocking, clapping, tics or chewing, and are methods to self-calm in the case of overstimulation, Phillips added.

Etiquette

If you suspect that the person you're called to assist has a disability or special needs, Phillips offered suggestions. Speak in person-first language: Noah is a "boy with autism," not an "autistic." Don't define the person by their condition.

Eliminate the word "retarded" from your vernacular forever. It's never OK in any scenario, Phillips stressed. Similarly, people don't want to be identified as "handicapped," "brain damaged," or "confined" to a wheelchair. Also refrain from using the word "normal" to refer to people without disabilities; use "typical" instead.

Phillps presented the "10 Commandments" of encountering people with special needs:

• Speak directly to the individual, addressing only family or caregivers can be disrespectful
• Shake hands if appropriate
• Identify yourself and your position, which will put them at ease
• Offer assistance and wait for instructions; don't walk up and grab someone's wheelchair
• Treat adults as adults
• Respect wheelchairs and guide dogs
• Listen attentively and ask them to repeat if you don't understand
• Place yourself at eye level; standing over someone is a sign of dominance
• Face a person who has a hearing impairment
• Relax. Don't be embarrassed to use normal language and phrases
• Assume competence until you know the person's abilities

Further pointers pertinent to EMS responders include reducing unnecessary stimuli (sights and sounds) and extraneous personnel from scenes, asking one question at a time, using social stories to convey information, working with patients to solve issues collaboratively, offering choices within parameters, and assembling a de-escalation kit to carry on ambulances including stickers, coloring books, and small toys to place young people at ease.

SNAP launched in January 2017 with its first fire department training sessions. Its mission is to "equip police officers, firefighters, and emergency medical services to respond with the greatest level of support and dignity when they encounter an opportunity to serve someone living with a disability."

For more information about SNAP visit https://lifelinefamilies.org/snap-special-needs-awareness-program/