Autism Spectrum Disorders and EMS

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
 Prevalence is on the rise
 CDC estimates 1 in 110 children diagnosed with
 More common in men than women 4:1
Click on the link below to view the video.
Tips to Identify Individuals with
 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
 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 online
 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 painexamine 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 2009-2010
EMS Implications for Treating the Autistic Patient, Dunn 2010
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