Autism 101 for Paramedics/EMS (Emergency Medical Service)

Autism Facts To Know Individuals with autism cannot be identified by appearance. They look the same as anyone else. They’re identified by their behavior. Autism is a spectrum disorder. It presents differently in each individual. What works for one individual with autism may not work for another. 50% of individuals with autism are
nonverbal throughout their…

Autism Facts To Know
  • Autistic people can’t be identified by appearance. They look the same as anyone else, and anyone of any age can be autistic. They’re identified by their behavior. Autism is a spectrum disorder. It presents differently in each individual. What works for/applies to one autistic individual may not work for/apply to another.
  • 50% of individuals with autism are
nonverbal throughout their life span, meaning they cannot communicate via speech;
another 20% may present as nonverbal when highly stressed.
  • 30 – 40% of autistic individuals will develop epilepsy or some other seizure disorder during adolescence.
  • Autistic individuals have a difficult time reading facial expressions. The Wong-Baker Faces Pain Rating Scale will NOT be an accurate measurement for pain.
  • You may encounter autism by one of its many other names such as, ASD – Autism Spectrum Disorder, Asperger’s Syndrome, PDD – Pervasive Developmental Delay, PDD NOS – Pervasive Developmental Delay Not Otherwise Specified and of course autism.
  • Some autistic individuals 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. They may show an unusual pain response that could include laughter, humming, singing and removing of clothing.
  • Autistic individuals may engage in self-stimulatory behavior such as hand flapping, finger flicking, eye blinking, string twirling, rocking, pacing, making repetitive noises, or saying repetitive phrases that have no bearing on the topic of conversation. This behavior is calming to the individual, even if it doesn’t appear calming. They may repeat something you said or something they heard over and over and over again. This is called echolalia and can be calming to the individual. If these behaviors are NOT presenting as a danger to themselves or others it is in your best interest not to interfere with it. Allow it to continue as long as they are safe and safe to be around. Trying to stop it will increase their anxiety and may cause the individual to act out aggressively.
  • Autistic individuals often have tactile sensory issues. Band-Aids or other adhesive products could increase anxiety and aggression.
  • When restraint is necessary, be aware that many autistic individuals have a poorly developed upper trunk area. Positional asphyxiation could occur if steps are not taken to prevent it: frequent change of position, not keeping them face down. Individuals with autism may continue to resist restraint.
  • For these and other concerns, ask the autistic individual’s caretaker if possible what affects the individual’s behavior. You should also ask the individual themself what would make them more comfortable and take their input into account if they can properly answer, as the individual may not think to give information if not asked to.
  • Whatever measures you take, be sure to explain what is happening/what you are going to do to the autistic individual if time allows. If not, the individual could interpret your actions as attempts to harm them and resist your attempts to help.
Exam Tips
  • Move slowly, performing exams distal to proximal. Explain what you plan to do in advance and as you do it. Explain where you are going and what they may see and who might be there. This may avert unnecessary anxiety and/or outbursts or aggressions from the patient.
  • Speak simply; give plenty of time for an autistic individual to respond to questions. A 3 – 4 second delay is not uncommon. Repeat your question and wait again. Use a calm voice. Be aware that some autistic persons’ use of “yes” and “no” to answer questions may be random and misleading. Try inverting your questions to validate the patient’s response.
  • Expect the unexpected. Autistic individuals may ingest something or get into something without their caretakers realizing it. Look for less obvious causality and inspect carefully for other injuries.
  • If possible, ask a caretaker what the functional level of the autistic individual is, then treat accordingly. Stickers, stuffed animals and such which are used to calm young children may be helpful even in older patients.
  • If a caretaker is present, allowing the caretaker to ask the questions involved in an exam may increase the likelihood of getting information from the person. Advise the caretaker closely on how to rephrase questions to be more understandable without being leading.
  • Listen both to the concerns of the caretaker and the patient—either could have missed something the other noticed. If a caretaker brushes a concern of the patient off as something minor, still take the due diligence of checking it out as even if it turns out to be nothing; addressing it will make the individual feel reassured and taken seriously. However, if a caretaker brings up a symptom the patient doesn’t, it is likely that the patient simply forgot to mention it.
  • Allow a caretaker to ride with the patient if possible. This will reduce anxiety and make your job less difficult.
  • Don’t presume that a nonverbal child or adult who seems not to be listening can’t understand.
  • Individuals who present as nonverbal may be able to write or type responses. Provide paper and pen or laptop for the best chance of getting the information that is needed.
  • Attempt to perform exams in a quiet spot if at all possible, depending on the severity of injury and safety of the scene. Demonstrating what the exam will consist of on another person first may help the person with autism have a visual knowledge of what your intentions are.
  • Emphasize the comfort and reassurance repeatedly.
Other Helpful Information and Ideas
  • When possible avoid use of sirens and flashing lights. Sound and light sensitivity is common in autism.
  • Alert Emergency Room (ER) personnel to upgrade triage for autistic patients even if injuries are relatively minor. Having the person wait for medical attention may cause avoidable disruptions in the ER. Expect the sensory stimulation of the ER room such as equipment, lighting, noises, aromas, and commotion to cause a negative escalation of behavior. Upgrading triage will save valuable ER time and resources.
  • If possible, communicate with receiving hospitals before arrival. Request a quiet isolated area or room for the autistic patient. If not possible, a fiddle toy such as those found in pediatricians’ offices could provide the patient a means of calming themself down and distracting themself from the distressing situation.
  • Some autistic persons will be terrified by restraint systems used in ambulance transfers. Ideally, explain and get consent from the patient or guardian before attempting to strap onto a KED or stretcher.
  • An autistic individual may not respond to directives, and that can be because they don’t understand what’s being demanded of them, or even just because they’re scared — the fact that they’re scared is the only thing they will be aware of — they may not be able to process language or understand a directive when fearful.
  • Autistic individuals may fixate on or stare at an object in the room (or on your body – a badge, earrings, buttons). If the individual is distracted, address the distracting object by answering any questions the individual may have on it before asking your question again. However, the individual may be looking at something else to avoid eye contact—invert questions to check if the individual is listening to your questions.
  • Whenever possible, avoid touching these individuals. Some, but not all, autistic individuals will become more agitated and possibly aggressive when touched. Tell them what you are going to do.
  • Identification can often be found on individuals with autism in the form of a Medic Alert Bracelet or a necklace; some families may thread the ID into a shoelace, a belt, or as a zipper pull; or a business card with personal information may be in a pocket or wallet.
  • Overstimulation, a state of overwhelmedness that occurs in autistic individuals, often comes with physical symptoms such as increased heart rate, sweating, shortness of breath, headaches, and nausea, among others. These symptoms may make diagnosing any health issues more difficult. A caregiver may be able to advise you on what symptoms the individual usually experiences when overstimulated to make diagnosis easier.
Citations:

Information in this section is based on source material drawn from:

“Autism 101 for EMS.” papremisealert.com. http://papremisealert.com/us/autism-101-for-ems/.