The ABCs of Autism is a pneumonic device to prepare emergency personnel and medical professionals of the fundamentals of caring for a patient with an ASD. They stand for:
> Awareness > Basic > Calm and > Safe
The ABCs apply in a variety of situations you may encounter, including escalation and meltdown crisis to assessing and treating a medical emergency or injury. While the following is a fundamental outline of the ABCs, most advanced concepts of interacting with patients with autism can be categorized in one of the four groups.
Awareness:
It is very important for EMS providers to be aware that persons with an ASD will not behave or react in the same manner that most people will. Usually, it is not out of defiance; they have perceptual, social interaction and communication barriers that affect how they behave under certain circumstances. The person with autism will not have the ability to adapt to the situation that they find themselves in, whether it is a medical emergency, an injury or an autistic meltdown. This means that the EMS providers will need to change their approach and strategies to meet the needs of the person with autism.
Basic:
One of the most important aspects of interacting with persons with autism is to keep things basic. There are a few ways that this concept applies:
· - Basic Instructions: Keep your instructions simple, precise and clear. Avoid using slang, sarcasm, joking or inferences. For example, say “sit down here” (pointing at chair), not “why don’t you have a seat?” · - Basic Questions: Many people with autism will do better answering short, closed-ended questions, than responding to open-ended questions. · - Basic “Stuff”: Our radios, pagers, cell phones, even things like flashlights and stethoscope covers may cause overstimulation of the person with autism’s senses. As much as you can, keep “stuff” turned off and out of sight. Since some people with autism have hypersensitive hearing and difficulty separating loud foreground from faint background noise, “off” is preferred over just turning your electronics down or putting them on vibrate. · - Basic People: While a “show of force” may be an effective deterrent to most people, this concept will likely be lost on the patient with autism. If anything, extra people add to confusion, increase frustration and heighten anxiety, all of which could cause negative behaviors to escalate. A better approach is to allow one person to make direct contact with the autistic patient, preferably accompanied by a parent, family member or caregiver. · - Basic treatment: It is usually best to defer treatment that isn’t immediately necessary or that is for “precautionary purposes only.” Ask yourself, “what does this patient absolutely need to get to the hospital safely.”
Calm
When dealing with the patient who has autism, particularly if they are escalating or having a meltdown, it is imperative that you remain calm. Posturing aggressively, commanding loudly, becoming aggravated with the patient and even telling them to “calm down” will either be ineffective or counterproductive. Your tone of voice should be clear and controlled. Offer empathy and compassion; reassure them that you are there to help them and to provide support. If the person with autism does not respond to questions or statements, understand they may not be process what is being demanded of them or they cannot speak. Don’t force your agenda. It’s their timeline, unless they have a clearly life-threatening condition.
Safe
Having a sense of safety and security is important to patients with autism. Often the environment that you find them in offers a sense of comfort and familiarity, even if it does not seem apparent to you. On the other hand, your ambulance is a strange and unfamiliar place; although we know what to expect, to the person with autism, the ambulance represents unpredictability. Therefore, it is usually best to begin patient interaction where the patient is found. Remove things from around the person that may be aggravating to them (for example, turn off fluorescent lights), including unnecessary personnel and bystanders. Allow the person to tell you when they are ready to move to the ambulance. They may want to look around the ambulance, look in cabinets and drawers and even handle equipment before they are comfortable settling down. Whenever possible, you should accommodate these needs.
Being safe means having a sense of what to expect. This is particularly true of persons with autism. Before each action, tell the patient what is going to happen next, how long it will last and what to expect. This begins with the first assessment and continues after the patient reaches the emergency department. Again, allow the patient to tell you when they are ready to transition to the next step.
Even if the person with autism is escalated or having a meltdown, restraining the individual is frightening and terrifying. It should be avoided wherever possible and saved only as a last resort, and only when the person is an immanent danger of causing harm to themselves or others. If restraint is necessary, a four person standing restraint is preferred. Avoid crossing the person’s arms in front or behind them, as respiratory compromise may result from underdeveloped trunk muscles. Never restrain a patient in a prone position or hog-tie them.
Copyright 2009, Dean R. Kelble, Jr.
Please provide feedback on this article. Either fill out the contact form or email me directly at dean@autismems.net. Please refer to "ABCs of Autism".Thank You!
