By Fire Captain John M. Sokol
Knowing that an emergency situation involves an individual with autism is important, from the dispatcher to the first responders on scene. When the dispatcher includes the phrase "the individual has autism," what is going to be your reaction?
Is autism something you just heard about or are you prepared for a situation that will be unique and unpredictable? The answer could mean the difference of injury or death to the first responder or individual, or an emergency situation with a safe outcome for everyone involved.
A first responder is seven times more likely to come in contact with an individual with autism than the average person. If you haven't already met someone with autism, you soon will.
First, to understand how to properly interact with an individual with autism, it may help to know a little about it. Approximately one in 100 children born today have some level of autism. Brain function is affected, interfering with reasoning, communication and social interaction.
Approximately 25 percent of individuals with autism have epilepsy as well. For an individual with autism, it is like going in to a sports bar with all the TVs on and noise everywhere. Instead of hearing one TV, they hear all of them at once and cannot focus on one TV.
Individuals with autism may look like you and I, so a firefighter or EMT might not be able to tell if the individual is autistic right away. There are many characteristics and each person may only display a few of those.
The best way to diagnose autism is to observe behaviors. Traits that you may experience when an individual has some level of autism may include hand flapping, repetition of what is said (also know as Echolalia or parrot back), lining up objects, pacing back and forth, avoiding eye contact, rocking, spinning, jumping or bouncing, limited, delayed or no language and high pain threshold. These will cause challenges for you, the first responder.
When you are first made aware a situation involves an individual with autism, first and foremost, when possible arrive on scene without the use of sirens or flashing lights.
Sound and light sensitivity is common in autism and may trigger a seizure or cause the individual to shut down or hide, making the situation worse.
Next, there are key questions you should ask a parent or caregiver ranging from, "Is the individual verbal or non-verbal? How does the individual react under stress? What usually works to calm them down?" Knowing the answers can save you valuable time by letting you know what to expect and what approach to take.
Both children and adults with autism are likely to hide in a fire situation. Your search should include any tight, out-of-the way place you would least expect to find someone.
Upon finding the individual the first responder should speak slowly, with clear directions and not with force, which could cause the individual to possibly shut down further.
The proper tools
Please bring the proper tools for the situation. Forced entry or exit will be most likely. Families often need to lock doors, including interior doors, to keep individuals with autism from wandering. Barred, nailed or locked windows along with Plexiglas or Lexan windows can make access or escape a problem for rescues.
Some individuals with autism may be sensitive to touch, while others do not have a normal range of sensations and may not feel the cold, heat or pain in a typical manner.
In fact, they may fail to acknowledge pain in spite of significant pathology being present. This could cause you to overlook an injury. The individual may show an unusual pain response that could include laughter, humming, singing and removal of clothing.
When transporting an individual with autism to the hospital, allow a primary caregiver to accompany the individual. Communicate with the hospital before arrival. Request a quiet isolated room for the patient. Let them know the individual is autistic. When possible turn lights and sounds off to minimize sensory overload.
Don't let individuals with autism out of your sight — they may be a bolt risk after rescue. Someone must stay with the individual at all times as, not comprehending danger, the individual may run out into traffic or back into a place they were just rescued from.
Individuals with autism running out of the house unattended (called elopement) is a serious issue. Drowning as well as prolonged exposure remain top causes of death in the autism population.
Having no real fear of danger, individuals with autism may also go to a favorite place that they know, wander into traffic or along railways, or attempt to enter nearby homes.
In closing, being ready and knowing how to handle these situations is the only thing you can do to aid in these moments when interacting with an individual with autism. We challenge all first responders to take the pre-test at www.Prevent-Educate.org to see just how prepared you really are. Remember, their lives are in your hands.
The purpose of this article is to make you aware of the importance of understanding the situation you may encounter and not to be a replacement for proper training. For references used on this article, more information on autism awareness training and receiving state continuing education hours, please visit www.Prevent-Educate.org or contact John at firstname.lastname@example.org.