When Autism Has an Emergency

This presentation was presented at the 2016 Chattanooga Autism Conference and for CAC Conference attendees to view on the CAC website Please do not disseminate and/or reproduce Thank You!

Discuss characteristics of Autism, and how to effectively gather information during An Autism Emergency Discuss the different challenges faced during an emergency Discuss strategies to help Telecommunicators, Responders and family members be prepared before and during an emergency

Telecommunicators, Law Enforcement Personnel, Firefighters and EMTs are trained to handle emergencies. When the world changes around us, we modify training to meet these changes Now there is a new type of training that needs to be addressed—training for an Autism Emergency

Autism is one of the fastest growing disabilities in the world and its not going away New statistics show that at least a million children and adults have a diagnosis of autism or related disorder

1 out of every 68 children in the U.S. is born with some level of autism (CDC 2014) That is up 30% since 2012 when a 78% increase seen in the past decade

If Public Safety Responders are not aware of this disorder and the vast spectrum of symptoms it encompasses, we will not be ready to handle these emergencies effectively Individuals with autism are so unique and their actions so unpredictable that it's not only for their safety, but Law Enforcement, Firefighter’s and EMTs as well.

Learning how to effectively interact with an individual with autism is the one training we can't afford to overlook Knowing what to do and how to approach individuals with autism is the first step in effectively handling any emergency situation.

What is Autism? Why is it difficult to describe?

Wikipedia: Autism is a neurodevelopmental disorder characterized by social interaction, verbal and non- verbal communication, and by restricted and repetitive behavior Brain function is affected interfering with reasoning, communication and social interaction

The best way to diagnose autism is to observe an individuals behaviors, look at traits Typically appears in the first 3 years Higher functioning autism is harder to diagnose 4 times as many boys as girls will have autism

There are many characteristics of autism each person may only display a few of them No 2 persons with autism are alike or will present the exact same characteristics

It is said that when you have met one person with autism you have met 1 person with autism

Eye Contact May look through the corner of eyes rather than direct Sensitivity to light (Emergency Lights )

Ears Sensitivity to different sounds (Sirens, Vacuums)

Skin High pain thresh hold but may not want soft touch

Nose Smells are intensified

Hand Flapping / Stemming Repeating what one says / Echolalia Pacing back and forth, rocking, jumping, spinning Lining up objects

As Telecommunicators there are several things we should know when dealing with patients and family members during an Autism Emergency

When the caller provides with details that the individual has autism… this should become pertinent information for dispatch Parents may become reluctant at times to give information that their child or loved one has autism

Asking the parent or caller if there is anything we should know about the individual that will help us better manage the emergency situation, may yield helpful information

If missing; is the child attracted to water? if so can they swim? Has the child wandered away before; If so where was he or she found? Where does the child like to go? Does the child have a favorite place?

Does the child have any specific dislikes, fears, or behavior triggers? Does the child have any sensory, medical, or dietary issues or requirements, or do they rely on any life-sustaining medications?

Dispatchers relaying information should alert responders before they arrive on scene that the individual has autism Not relaying this information can make a situation worse and possibly cause harm to the First Responders or the individual involved and is a LOSS of valuable time

Individuals with autism, in many cases, may have been taught how to call in an emergency situation Unfortunately “their emergency” may not be an emergency to others

It is IMPORTANT not to discourage the individual from calling The individual calling may have autism and may have trouble conveying the message (the emergency)

It is IMPORTANT not to dismiss the call as someone on drugs or under the influence of alcohol Give enough time to answer questions (10 seconds) Give praise and encouragement

Voice Recognition – Robot or Sing Song Repeating or Echolalia Speak in short literal phrases

A person with Autism is 7 times more likely to come in contact with Law Enforcement and First Responders

Knowing and understanding some of the challenges Law Enforcement and First Responders face when responding to an Autism Emergency will help you (the Telecommunicator) know how important it is to gather as much information as you possibly can

Difficulty communicating Lack of reasoning No real sense of danger Not understanding why or what the responders are doing Total shut down

Be prepared with proper tools Approach without sirens Ask key questions to better understand the situation Speak slowly with clear directions / allow time for response

Ask key questions to better understand the situation a. Is the person verbal or non verbal? b.How do they react to stress; do they run and hide if so where; or do they get confrontational or shut down?

c.What usually calms them down? d.How to approach or who should approach e.What item do they like or are they attached to? and can it be found ASAP KNOWING CAN SAVE TIME

Exterior Alerts (Decals – License Plates – Signs) Interior/Exterior barrier devices Additional Apparatus to dedicate to individual

On Oct. 4 th 2013 Avonte Oquendo, a 14 year-old boy from queens with autism managed to slip away from his school on Long Island even though he was a known wanderer The day Avonte went missing, a 12 year-old boy with Autism in Oakland Calif. Had wandered from his mother in a parking lot and entered onto an Interstate and was struck by a vehicle

A 5 year-old, Devonte Dye, wandered from his grandparents home in Missouri, found the next day in the St. Francis River

Since 2011, 41+ American children with autism have died from wandering, or “bolting” from caregivers. Water is often the draw for these children. Since April of 2013 to the day of Avonte missing 14 out of 16 deaths were from drowning

Kentucky — A 7-year-old autistic girl who died in a mobile-home fire in Jackson County escaped her mother's grasp and hid in a closet in the burning structure

Individuals who have gone missing have been recovered after numerous days without food and shelter. These individuals CAN survive we just have to find them!

National Autism Association National Center For Missing And Exploited Children AWAARE

When you call, try to be calm. It will be hard, but stop for a second and take several deep breaths. Tell the Telecommunicator the LOCATION (the corner of Fifth and Elm; the Tower Building, 10th floor; 123 Street, the blue house). Give the PHONE NUMBER you are calling from. This is especially important if calling from a cell phone. They don't know EXACTLY where you are!

If you're not sure you need 911, CALL. The Telecommunicator will talk you through to determine if your situation is a true emergency. They have heard it all! If you or your child accidentally dials 911, don't hang up! Stay on the line and explain what happened. They must check out the call and will call the number back, if possible

What we need to know 1. Where are you? – preferably and address 2. When did this occur? – if it is a missing person; when was the last time they were seen? Is this the first time or a habit?

What we need to know 3. Description – What are they wearing and any other descriptive information you can share? 4.What are the circumstances – Did he or she just wonder off, were they angry when they left, what were they doing when they left?

What Families Can do Go to a local fire, ems, or police station as a family field trip and let them get acclimated and comfortable with the equipment and personnel. Recognizing and learning that the person behind the uniform or safety equipment is a friend and may help when the family member is approached by a responder during an emergency situation

Some with autism walk away, run away, or literally escape from a closed, locked building. The reasons vary and may be impossible to predict. If you have any concerns it’s a good idea to be prepared. Luckily there are steps families can take to be ready, just in case.

Installing deadbolt locks and out of reach bolts on doors and windows Experts recommend once this is done installing simple bells on doors and windows – this is an effective, low cost way to let families know that someone is leaving the house

Put together a basic identification sheet that can be photocopied and attached to your loved one’s clothing, backpack, and other belongings

Practice: What should your loved one do if he can't find you? What should you do if your child with autism disappears? Like anything else, coping with a runaway will be more effective if it's practiced over and over again. Role play with your loved one, making sure he knows where to find and how to present his identification card. Know where to find photos of your loved one, what number to call, and how to alert neighbors

Autism Rates have increased from 20 years ago of 1 – 10,000 to roughly: 2011; 1 – 110, 2012; 1 – 88, 2014; 1 – 68, and 2015; Ref: Health.usnews.com CDC 11/13/2015

Jared W. Pelham, ENP Hamilton County Emergency Communications District 3404 Amnicola Hwy Chattanooga, TN