You are called to the scene of a single car MVC. Upon arrival the driver is unresponsive. Witnesses report a passenger exited the vehicle and was seen walking down the interstate. You spot the passenger: a twenty something, Caucasian male. He appears to be standing in traffic, waving his hands and rocking back and forth mumbling to himself. When you ask him if he needs help he ignores you, but you notice blood running freely from a large laceration on his scalp. When you attempt to assist him he screams and tries to run from the scene. This patient could be suffering from a head injury, he could be intoxicated or he might suffer from…

Autism Spectrum Disorders and EMS The Essentials

Autism - what is it & why do you care?  Autism spectrum disorders are a range of neurodevelopmental disabilities  This means the person is born with it  It is a lifelong condition  Characterized by impairment in communication and social skills, and repetitive, ritualistic behaviors  Prevalence is on the rise  CDC estimates 1 in 110 children diagnosed with ASD  More common in men than women 4:1

Identification Click on the link below to view the video.

Tips to Identify Individuals with ASD  Poor/No eye contact - may be uncomfortable  Repetitive actions - rocking or hand flapping, for example  Fixations/special interests - may be fixated on a particular topic or area of interest (could be with your equipment)  Communication problems  Echolalia - repeat what you say  Monotone voice, inappropriate volume  Non-verbal - may use sign language or pictures to communicate  Inappropriate/unusual attire (shorts in snowstorm, etc.)  Obvious tags (bracelets, cards, database, etc.)  Inappropriate laughing or giggling  Escalation/Meltdown - aggression or anxiety for no apparent reason  REMEMBER - ASD is a spectrum - everyone’s unique!!

Probable Encounters  May wander away from caregivers  As many as 23% of people with ASD  Check water sources first (pools, lakes, fountains, etc.)  May look into or even enter other people’s houses  Display unusual behavior that may be misinterpreted as drug/alcohol use  Victims of abuse or other crimes  Roughly 1/3 of all individuals with ASD victim of crime  4-10 times more likely to be the victim of a crime  Sexual abuse much more likely than general populace  Inappropriate exposure or sexual conduct

Probable Encounters Click on the link below to view the video.

Preparation for Encounters  Keep in mind patient is person first (person with autism versus autistic person)  Education - there are many excellent resources on- line  Allocate resources to accommodate patient’s needs  Co-morbidities are common  Epilepsy, Obesity, Depression, Mental Retardation, etc.  BE PATIENT!! These calls will likely take more time than a usual call  Allow at least 10 seconds for verbal reply  Suggest a toe-to-head exam to gain trust before inspecting head and neck area (can be very sensitive to touch)

Tips for ASD Encounters  Caregivers are your best friend!!  Use them as you would an interpreter for a non-English speaking person  Create atmosphere of calm  Remove lights/sirens/K-9/crowds/etc.  Maintain good space and calm posture  May only be able to perceive one sensory stimuli at a time  May not recognize First Responders as there to help  Use simple, direct commands  Use open-ended questions and don’t interrupt person  Avoid slang phrases (“what’s up?”)  Explain what TO do (rather than what not to do)  Some individuals with ASD communicate non-verbally  Don’t disrupt patient’s behavior unless dangerous

Tips for ASD Encounters Click on the link below to view the video.

Tips for ASD Encounters Click on the link below to view the video.

Tips for ASD Encounters Click on the link below to view the video.

ASD Encounters Gone Wrong  Persons with ASD may become aggressive or their actions may present a danger to themselves  If patient’s behavior becomes dangerous engage their caregiver and try to follow recommendations  De-escalation is responder’s primary goal  Person may regain control if given time and space  Remain positive and try to refrain from physical contact  Don’t separate patient and caregiver (during exam, transport, etc.)  If “hands on” approach deemed necessary:  Use minimal restraints needed  Positional asphyxia is a very real risk  Persons with ASD may have a distorted sense of pain- examine for injury after restraint

Rescue tips for ASD  People with ASD of any age may hide in closets, under beds, etc. when a fire alarm is going off  May resist rescue - use caution and keep yourself safe  Caregivers may have extra locks, bars on windows, etc.  Both a clue to possible ASD as well as barrier to entry  If possible, remove distractions/danger from scene rather than attempting to remove patient with ASD  May attempt to reenter a burning building or run away from EMS  May not understand danger to themselves or others  Allocate someone to care for person with ASD  Gently wrap person in a blanket to comfort and contain  May be fascinated with water, heights or other dangerous areas (busy roadways, etc.)

What to Remember:  Be alert to the possibility of ASD or other disability  Stay Calm & Positive  Seek out caregivers and follow their advice  Don’t interrupt behaviors unnecessarily  Be Patient  Minimize stress - things to avoid:  Change of routines  Physical contact - especially head and neck  Extreme sensory stimuli Resources: NJ Disability Training for First Responders, State of New Jersey 2008 Demystifying Autism Spectrum Disorders, Bruey 2004 Autism Information for First Responders, ASA 2009 Introduction to Autism Disorders, Kelble EMS Implications for Treating the Autistic Patient, Dunn 2010