The Importance of Teaching Autism Awareness to EMTs and Paramedics
The prevalence of autism spectrum disorder (ASD) is on the rise, according to new reporting from the New York Times.
With proper access to the right screening tools and resources, children are receiving autism diagnoses earlier than ever before—resulting in early interventions that can have a huge impact on functional abilities later in life.
Thankfully, there is also far less of a stigma around autism today than there once was. With more people being properly diagnosed, more people have direct experience with ASD through family or loved ones. This, in turn, has resulted in an increased understanding of the disorder and how to treat it.
Still, a lack of formal autism training pervades the EMS profession. Without proper training, EMTs and paramedics cannot provide the proper and specialized care that autistic children and adults require—and, as a result, patient care suffers tremendously.
Read on to learn more about ASD as well as the importance of giving EMTs and paramedics the tools and knowledge they need to manage the care of this population.
Facts About ASD
Specifically, autism spectrum disorder refers to a developmental disability that is caused by differences in the brain that are present at birth. This disorder is characterized by:
- Difficulty communicating and socializing with others.
- Repetitive behaviors (such as arm flapping) and limited interests.
Autism diagnoses fall on a spectrum because no two people are affected by the disorder in the same way. Some people with ASD may need much more support and outside care, whereas others may be able to function well with minimal intervention.
According to the Centers for Disease Control and Prevention (CDC), about 1 in 36 children have ASD, although the diagnosis is about four times more common in boys than in girls. ASD also affects nearly 5.5 million adults, which is about 2.2 percent of the population of the United States.
The Importance of Proper Autism Training for EMS Professionals
With only about 4% of the total United States population falling somewhere on the ASD spectrum, it may seem like the average EMT or paramedic would not encounter an individual with autism very often. In reality, however, autistic individuals are far more likely to encounter emergency responders—especially when you consider that ASD often comes with co-occurring medical and mental health conditions (including potentially dangerous behaviors, such as wandering).
In fact, according to research published in Emergency Medicine, 13 percent of autistic children have used at least one emergency service within just a two-month period.
Though emergency responders are actually quite likely to encounter people with ASD on a regular basis, most EMS professionals receive little to no formal training on how to properly interact with these individuals. And, oftentimes, the inherent and chaotic nature of EMS response (lights flashing, sirens wailing, etc.) can be extremely stressful for those with ASD.
In one study published in Pediatric Emergency Care, a simulated school bus crash was performed and emergency medical responders were assessed for their ability to recognize and properly care for an adolescent portraying ASD symptoms. Of 75 interactions, only 27 percent of responders provided proper reassurance to the patient with ASD—and only 13 percent were able to identify the presence of ASD symptoms.
The good news? In recent years, there have been more initiatives to train emergency responders on recognizing signs of autism and responding appropriately.
Teaching EMS Professionals to Identify Behaviors of People with Autism
If you're looking to add autism-specific training to your program, one of the most important things to cover is how to identify common behaviors and indications of autism in both children and adults. Some of the most common signs to watch for include:
- Attempting to avoid sensory input (flashing lights, sirens, etc.)
- Being nonverbal or having difficulty communicating
- Not responding to questions or commands
- Avoiding eye contact
- Moving away or running when approached
- Repeating only what is said to them, or responding with only "yes" or "no"
- Failing to recognize or acknowledge pain/injuries due to hyposensitivity
- Using devices that block sensory input such as headphones.
Rhonda J. Hunt, MEd, NRP, author of Advanced Emergency Care and Transportation of the Sick and Injured, Fourth Edition, says to be sure to instruct personnel to speak directly to the patient and use family or caregivers for confirmation.
“This allows the person with autism to feel valued as a person instead of feeling ignored or overlooked,” she says.
Emergency responders should also be aware that individuals with ASD can end up in dangerous situations following a traumatic event, such as a car accident. For example, an individual may leave the scene of a car accident and gravitate towards a nearby body of water or train tracks. In the event of a fire, people with ASD have also been known to hide in closets or under beds in an attempt to escape the noise from smoke detectors.
Emergency responders, including EMTs and paramedics, should also be trained to follow some basic best practices when working with individuals who have autism (or are suspected to have autism). When working with ASD adults, it is important for first responders to communicate as clearly and directly as possible, avoiding the use of slang or colloquialisms that may confuse patients.
Whenever possible, responders should offer choices to give the patient a sense of control. For example, when taking a patient's blood pressure, asking them which arm they prefer can go a long way in establishing trust and helping them feel more comfortable.
There is something to watch out for here, Hunt says.
“I am very big on giving choices, but never give the option to say ‘no,’” she says. “I like to combine things such as saying, ‘I need to listen to your chest, and I need to feel your tummy. Which one would you like for me to do first?’”
Instructors should teach EMT and paramedics to familiarize the patient with the equipment. When not dealing with an emergency, take the time to allow the patient to touch the equipment and explain what it is for. For example, let the patient listen to your breath sounds first.
Likewise, instruct EMTs and paramedics to remember to preserve the patient’s modesty, explaining that you need to visualize a specific area or apply a particular device, such as ECG electrodes to the skin, prior to lifting a patient’s shirt.
“Don't assume they know what you are doing as another person might,” Hunt says.
One good way to help ease concerns of a person with autism is to engage the patient’s participation through use of games. For example, Hunt says a pulse oximetry probe can look like something that may bite or pinch. Show the patient the light and make a game out of putting their finger inside to touch the light.
Note that when repetitive behaviors are present, EMS professionals should not attempt to stop them unless there is a clear risk to the patient's wellbeing or the safety of others in the area.
Special care must also be taken when caring for ASD children. Whenever possible, emergency responders should:
- Ask a family member or caregiver for advice on calming the patient.
- Consider turning off bright lights and sirens.
- Clearly explain what they're going to do.
- Start with less invasive procedures first before working up to more invasive ones.
- Use "soft words," like describing a stretcher as a "bed with wheels."
- Assure parents/caregivers that their child is in good care.
Working with patients with ASD can present some unique challenges to emergency responders, but with these challenges comes a wonderful opportunity to provide quality care to somebody in a time of need. With proper ASD training, EMTs and paramedics can confidently care for patients on the autism spectrum—providing the quality and compassionate care that these patients deserve.
Download a sample chapter of Advanced Emergency Care and Transportation of the Sick and Injured, Fourth Edition.
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