With incidences of Autism Spectrum Disorders (ASDs) on the rise, emergency medical technician in MD, serving as first responders, are increasingly likely to encounter individuals with autism in the community. Because persons with autism are not immediately identifiable, it is important to check for medic identification bracelets, necklaces, anklets or dog tags attached to clothing or shoes. Vehicle stickers may also alert first responders that an occupant has autism. Approaching an individual with slow movements and calm tone of voice may help to avoid escalating the individual's distress. If a caretaker or a family member is available to assist, allow them to identify the individual's ability to function, facilitate information exchange, provide comfort and assist with calming strategies for the individual. When possible, allow the caretaker to remain with the individual.
Because individuals with autism often have language deficits, they may be completely non-verbal, and even in cases where an individual with an ASD has spoken language abilities, they may lose the capacity to communicate when in distress. This does not necessarily mean that the individual does not comprehend what they are hearing. It is important to convey instructions in small amounts, giving short breaks after each statement to allow time for them to process incoming information. Where possible, give a visual, step by step demonstration of physical exams. Give information to help prepare the patient for changes in location, introduce new persons assisting in their care, and give advance notice of physical touch.
If an individual cannot communicate verbally, some may be able to communicate through sign language, visual picture menus or written language with pen and paper. Be aware that individuals with autism may repeat or echo what they hear. When asking yes/no and either/or questions, be aware that an individual may simply echo the choice they heard, rather than give a deliberate answer. It may also be difficult for the patient to describe physical symptoms or communicate whether they are in pain; this is further complicated by sensory processing difficulties experienced by many individuals with ASDs. Tactile defensiveness may result in highly overactive responses to pain or touch (some individuals have great difficulty tolerating bandages or safety belts on stretchers).
In the event that restraint is necessary for safety of the individual or first responders, be particularly aware of the risk of positional asphyxiation (due to low muscle tone in the upper trunk) and do not allow individuals to be placed face down. Change positions as frequently as possible and provide continued reassurance to the patient.
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