Tag Archives: public safety

weather and autism

Does Weather Affect Autistic Behaviors?

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weather and autism Anyone in the Atlanta area can attest to how dreary and frustrating it’s been to wake up to recent days of endless rain. I feel like it’s been raining for months straight! Memes are starting to pop up on Facebook naming us Atlantis or Seattle, Georgia. Oh and the MUD! I have two huskies that go and sit in mud puddles in the back yard – you wouldn’t believe what my carpet and furniture looks like, despite daily cleanings.

But dreariness and carpet mud cakes are not the only side effects of bad weather. I’m hearing from parents and teachers that children have been especially wild, fidgety, irritable and aggressive during this endless bout of downpours. In fact, low pressure systems have long been linked to increased behavior problems in children. In my own household, I’m seeing its effects as well. My son is much more “in your face,” making increased noises, and treating almost every object in our living room as if it’s a soccer ball and he’s Pelé, going for the winning goal. My daughter has been extremely achy, moody and depressed. But then again, she’s 17. Isn’t this normal for a teenage girl?

What is barometric pressure?

Barometric pressure is the weight of the overlying air pressing down on the earth. It is also known as air pressure.   Low barometric pressure means the overlying air is rising, whereas high pressure means the overlying air is sinking. High barometric pressure supports sunny, clear, and favorable weather conditions. Low barometric pressure promotes rainy and cloudy weather conditions.

The Canadian Psychiatric Association published a study concluding that, “low barometric pressure is associated with an increase in impulsive behaviours.”

It seems to be magnified in children who already struggle with impulsivity or behavior issues. On a forum called Healthboards.com, a teacher that works at a Jr. High school noted that it has a big impact on the behavior of her students (especially the 7th graders). Students who have a tendency to be impulsive or hyperactive are particularly impacted. Another parent stated that their 7 year old (PDD-NOS) has always been sensitive to this, noticing a correlation between his moods, behaviors, aches and pains and the pressure in the air. You can read their specific comments here.

Tips for Weather-Related Autism Behaviors

Expect increased calls or issues during bad weather and low pressure systems. If you are responding to a call involving someone with autism, increased aggression, anxiety, impulsive behaviors and sensory issues may occur.

It is especially important to try and reduce sensory triggers and keep the environment as calm as possible. Even a small effort to district with a tactile object (such as a piece of gum or a slinky) may help de-escalate someone in a meltdown.

Be prepared to wait it out. Once you know there’s a reason for the behavior, it’s generally easier to get through it. The storm will pass, in more ways than one. Let’s hope Atlanta’s rain will do the same!

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Autism Tips for Emergency Responders: Pain Perception

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Identifying sensory issues have always played a large role in autism. In fact, it’s what finally led my son to a correct diagnosis. I spend nearly one-third of my autism training class talking about sensory processing and how people with autism perceive the world, because I believe that once emergency responders understand what’s physically going on with someone – with their brain and nervous system – they may recognize them as autistic on a scene and possibly adapt their response to de-escalate or prevent a meltdown.

In addition to sensory issues, it is known that someone with autism may not have the same response to pain as a neurotypical person. That may mean that an autistic individual could have a severe injury and be completely oblivious to it, or have a completely inappropriate response.

Few investigators have looked into how people with autism experience pain. New information suggests, according to unpublished research presented at the 2015 Society for Neuroscience annual meeting in Chicago, that autistic people show abnormal brain responses when a painfully hot object is placed against their skin. These new findings come from one of the first brain imaging studies of pain processing in autism.

SpectrumNews.org reported that in the study, 17 adults with autism and 16 unaffected adults were placed in a functional magnetic resonance imaging (fMRI) scanner with a small piece of metal strapped to one calf. The metal heated up over three seconds to 120 degrees Fahrenheit — hot enough to hurt, but not to cause injury. The metal stayed hot for 12 seconds, then cooled to room temperature. The researchers measured participants’ brain activity through a dozen of these cycles of pain and relief.

The brain’s response to pain has three phases: early, intermediate and late. The study showed that people with autism had very similar levels of brain activity as the neurotypical control group during the early phase, or the first seven seconds of heat. The initial pain processing showed nearly identical brain activity in the somatosensory cortex, a brain region that governs touch.

However, it was during the last five seconds of the heat and cool down that showed dramatic differences. After the painful stimulus ceased the brain activity in the control group was still responding. It was noting that the body was in pain and logging it for future memories. In the autistic group, all brain activity around the pain center was completely gone once the pain ceased.

This suggests that, while the initial processing of pain may be the same in both groups, the later steps that relate to the cognitive and emotional evaluation of the pain are definitely not.

I always tell the story about how my son – who has been executing self-taught computer coding to create his own video games since age nine – will touch a hot stove, burn his hand, and go back and do it again. I always believed this was due to his inability to think through or process cause and effect connections and their consequences (and that’s still part of it). However this study may help me understand more about my son, and help clinicians get a better handle on pain perception in autistic individuals they treat.

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Autism in the Emergency Room

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image courtesy of horizonhealth.eu

image courtesy of horizonhealth.eu

Autism families learn fast and early how to effectively anticipate and manage a crisis. When that crisis involves a trip to the emergency room, it can escalate quickly due to the sights, sounds, smells, and accelerated pace of the environment, which can quickly overwhelm an individual with autism.

Recognizing that someone has autism is only one part of a successful emergency room experience. Here are some other tips for the ED staff to help ensure a safe and manageable experience for everyone.

Emergency Room Tip #1: Decrease Wait Time if Possible

Recognize that simply entering a noisy, crowded waiting room may trigger acute anxiety and sensory overwhelm for a person with autism. This can result in escalated and challenging behaviors. If at all possible, accompany the patient and primary caregiver to a quiet room for initial assessment and registration. If the triage nurse determines the patient will need to wait to see a physician, provide a quiet place to do so.

Dim overhead lighting if necessary and possible and monitor the patient continuously for signs of overstimulation.

Emergency Room Tip #2: Caregivers Are a Wealth of Information

Most autism parents or caregivers are well versed in their child’s medical information and are extremely helpful in gaining cooperation. Use this information! Make sure to ask early about the patient’s primary form of communication; if they are non-verbal, make sure they have a method of communication familiar to them, such as a paper and pencil, pictures, gestures, or a communication device.

Find out from the caregiver what has worked in the past when at medical visits, what their particular sensory issues are, and what their heat, cold and pain tolerances are.

Emergency Room Tip #3: Explain and Demonstrate First

Order and expectation is everything to someone with autism. Try to explain procedures before performing them to help alleviate anxiety. Use simple words and drawings if necessary.

Demonstrating what you are about to do on yourself, a colleague or the caregiver is also helpful. These modifications call for extra effort and understanding, but go a long way toward a positive experience for everyone involved.

Finally, recognize that people with autism may be on many different medications due to comorbid conditions. They can be prone to allergic reactions or dangerous drug interactions. Only administer medications when absolutely necessary.

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5 Ways Autism Skills Can Help Emergency Responders On Scene

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image courtesy of http://resources1.news.com.au/

image courtesy of http://resources1.news.com.au/

The nature of my training classes unfortunately tend to focus on the struggles and deficits side of the autism spectrum, as this is the primary way for responders to quickly identify someone as autistic on the scene of a crime, fire, disaster or medical call and potentially adapt their response. In an emergency situation, being able to recognize the appropriate signs and adjust communication can be the difference between a potentially negative and positive outcome.

I tend to go a bit deeper in my weekly articles, offering more detailed techniques for de-escalating dangerous behaviors, discussing comorbid medical conditions for better patient assessment, proper protocol for handling service dogs, or explaining why people with autism are often drawn to water. What happens if we flip that proverbial coin for a minute and ask, how can someone with autism be helpful on scene?

People with autism display a wide range of intellectual abilities. Some show exceptional talents despite some functional challenges. Along with the struggles, autism can bring individual strengths along with special abilities, such as strong memory skills, math skills, three-dimensional thinking, musical ability, artistic ability, honesty, and the ability to intensely focus on an interest.

While only 10 percent of people with autism have savant syndrome (a condition in which a person with a disability such as an autism spectrum disorder demonstrates profound and prodigious capacities or abilities far in excess of what would be considered normal), many do have special abilities. These may include:

  • Calendar calculation – identifying the days of the week on which any date fell or will fall in a wide span of years
  • Memorizing large chunks of facts about specific subjects
  • Dismantling and reassembling complex machines
  • Working with computers

While verbal instructions are more challenging, people with autism do have advanced visual-spatial abilities, such as solving puzzles or matching items that display some sort of pattern.

How could these things help during an emergency call?

Autism Skill #1: Rote Memory Ability

An excellent rote memory – memorizing large amounts of material or storing huge lists of items in their minds and repeating them accurately can be a huge help when piecing together what may have happened on scene. This could be recalling details of an auto accident or trying to determine how a crime was committed.

Autism Skill #2: Details and Patterns

To piggyback on rote memory, the ability to notice small, individual details is a huge asset on any scene. While autistic individuals may not be able to see the big picture or piece together the information to determine meaning, they can not only recite details no one else may have noticed but often see a distinctive pattern in those details.

Autism Skill #3: Calculations

Some people with autism also have quick mathematical calculation skills – they’ re able to mentally add, subtract, multiply and divide large numbers at astonishing speeds. This could be helpful, again, in any line of questioning where numbers or specific times are important to the situation.

Autism Skill #4: Artistic Talent

Being masterful with expressing yourself through drawings can aid in finding out what happened on scene, especially if the person with autism is nonverbal. Even if they are able to communicate in a typical way, drawings can both relay missed details of the scene and the person’s perspective – how they experienced the situation.

Autism Skill #5: Musical Talent

How could someone’s musical talent possibly be of assistance during an emergency?

Many people with autism spectrum disorder have outstanding abilities in tone recognition; they can be highly methodical listeners and are able to access musical details more readily than others. The ability to mimic an exact sound they heard in perfect pitch – such as the order of numbers punched in a keypad – is definitely a skill that could come in handy on scene.

I know it can be challenging to communicate and interact with people with autism on scene, especially if they are experiencing sensory overwhelm from the noise and chaos of the emergency situation. But remember, autistic people are typically good-natured and honest, and almost always have a genuine desire to help. Why not welcome their skills and abilities? You may just end up with critical details that no one else was able to see!

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Autism Tips for Emergency Responders: Service Dogs on Scene

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image courtesy of paals.org

If you have recently attended one of my Autism Training classes for emergency responders, you’ll recall a short video of a woman’s service dog that alerts to self-harm while she is having a meltdown. You can view that video here.

While I included that in my training to illustrate an adult with Asperger’s having a meltdown, someone in class brought up an excellent point: how do you, as a responder, recognize a service dog and what do you do with them on scene?

Project Chance explains that autism assistance dogs are somewhat unique. Unlike a guide dog that helps with physical tasks, autism assistance dogs mainly provide emotional support. They can also help with sensory processing issues by giving their handler a focal point, or a way to ground their sensory input when the environment is overwhelming.

Many autistic children especially have no concept of personal safety and are prone to wandering. A child may be tethered to the dog’s harness or the dog may be trained to alert to potential bolt risks.

Dogs can also be tasked-trained to use touch intervention, as well as pressure intervention and mobility assistance when repetitive or self-injurious behaviors occur.

How is a Service Dog Defined?

According to the Americans with Disabilities Act (ADA), service animals are defined as dogs that are individually trained to do work or perform tasks for people with disabilities. Service animals are working animals, not pets. The work or task a dog has been trained to provide must be directly related to the person’s disability.

Service animals must be allowed to accompany people with disabilities in all areas of a facility where the public is normally allowed to go.

The Ohio Department of Public Safety has a great downloadable trifold with tips for encountering service dogs. Here are some highlights from the brochure.

First and foremost, find out your agency’s policies on service animals! This includes how they define a service animal, information about applicable laws and how to comply with them, what to do if the handler is not in a condition to control the animal, proper movement and transport of the service animal, and veterinary facilities with whom there are established agreements for providing emergent care/boarding for service animals.

Next, you must determine if it is a family pet or a true service animal. The law permits you to ask these two questions only:

  1. Do you need the animal because of a disability?

  2. What tasks related to your disability has the animal been trained to do?

By Federal law, service animals are permitted to go wherever the public is allowed, including your ambulance. If it is not possible to keep a handler and their animal together (e.g., the handlers’ medical condition warrants transport by air or prevents the handler from controlling the animal) make sure a responsible party or someone with the handler’s permission can transport the animal safely and reunite them with their handler as soon as possible.

If the dog is being transported with the patient, load the dog last and unload it first, as this minimizes risk of injuring the animal and gives you needed space for maneuvering equipment.

If you must handle the dog, use the leash, not its harness. Use the side door of the ambulance for loading and unloading the animal; avoid open diamond plate gratings as they may injure the dog’s paws. If you need to lift the dog, put one arm behind the back legs, the other in front of the chest and gently lift. Offer to get food and any other supplies the dog may need before transporting.

Overall, try to accommodate the dog as you would a child alone with the patient. Take the dog with you and if the handler is unable to care for the dog at the hospital, attempt to notify a caretaker known to the handler for the dog, if possible.

You can download the entire helpful brochure here.

Have you encountered service dogs on scene? How did it go? Share your comments below!

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Trix Are for Kids, Autism is Not (Only)

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image courtesy of freedigitalphotos.net

When I first began my Autism Training for Emergency Responders journey, my presentation focused heavily on children with autism, as that was my personal experience. This, of course, is well needed, but with 50,000 autistic teens transitioning into adults each year (with very few resources to aid that transition), my teaching has expanded immensely. Especially knowing that people with autism are seven times more likely to interact with emergency responders.

I have two teenagers – 13 and 17 – on the autism spectrum. My daily contemplations and challenges have gone from, “Please stop climbing on that thing, we’re going to get thrown out!” to, “Am I providing enough support to teach you the life skills you need as a young adult?”

Additionally, my 13 year-old is seven inches taller than me, has a mustache, and wears men’s large clothing (when he wears clothing at all). Despite his level of comprehension and response in an emergency situation, his size alone would warrant him being treated like an adult on scene, which has the potential to go downhill very quickly.

In 2000, 1 in 166 children were diagnosed with a form of autism. That figure has been climbing ever since, as we are now looking at 1 in 68 (1 in 42 boys). Here in metro Atlanta, that’s one child on every school bus. 1 in 42 boys will grow up to be 1 in 42 men.

You do not “grow out of” autism. Sure, with the right support and tools you can learn coping skills and methods to help improve your day-to-day living. But autism doesn’t magically go away when you turn 21!

The Centers for Disease Control says that the number of adults living with autism is expected to climb by about 700 percent by 2030. From 1990, when adult stats were first taken, the number of adults being diagnosed with autism has nearly tripled.

This does not even include the number of parents who, after receiving an autism diagnosis for their child, came to the realization that they, too, have autism but were never diagnosed.

Recognizing Adults with Autism On Scene

Emergencies are stressful for everyone! An adult with autism may react in ways that appear odd or threatening to a responder. It can be more challenging to identify on scene, and responders can be caught off guard if someone goes from “having it all together” to a complete autism meltdown in a short amount of time.

Remember, we always treat the patient or victim, not the diagnosis. However, here are a few common traits or behaviors that might help you recognize that your patient or victim has autism.

Body language/facial expression challenges. Neurotypical people often easily express themselves, including verbal and non-verbal methods. Adults with autism have significant challenges when it comes to interpretation and displaying types of non-verbal communication. They have trouble maintaining eye contact, interpreting facial expressions, and using motions and gestures. Remember to use direct words that have only one meaning when communicating so there is less chance for misinterpretation.

Sensory Processing challenges. Individuals with autism have either extreme or inefficient sensitivity when it comes to stimuli. While some autistic adults have learned to cope with sensory issues in their daily routines, an emergency situation will involve a ton of new smells, sounds, input, and sights, and they may be unable to process these sensory details adequately. Remember to reduce sensory triggers if at all possible (e.g., turn off lights and sirens, remove unnecessary personnel).

Empathy challenges. Adults with autism struggle with showing shared sensitivity of feelings with others and have difficulty processing others’ perspectives. On scene, this could present as if someone is “cold” or doesn’t care about the outcome of a family member, or sometimes even themselves.

It is typically taught that people with autism are incapable of employing “theory of mind,” or, in other words, unable to imagine anyone else’s thoughts and feelings. Empathy is more complicated than that. There is cognitive empathy, the ability to read other people’s feelings, but there is also affective empathy, the ability to share other people’s feelings. Just because someone with autism may not have the social/cognitive skill to read someone else’s feelings doesn’t mean they can’t feel someone else’s pain. Do not assume that a person’s inability to interpret nonverbal cues means that they don’t care and lack empathy.

Verbal challenges. Up to 40% of adults with autism never learn to speak. If they are verbal, they may have trouble maintaining a conversation, expressing their needs, or processing thoughts appropriately. Remember to look for or provide alternative communication methods if possible (pen and paper, sign language, smart devices).

Uncommon preoccupations. Many people with autism are extremely knowledgeable about certain topics, such as aviation, engineering, word origins, video games, or old movies. They may demonstrate hyper-focus on a particular area of interest, while showing complete disinterest or inability to follow along with other topics. If you are having trouble completing your patient survey or interview, try to engage the person in the topic they are preoccupied with to start the conversation rolling. Once you have gained rapport, you can gradually “fold in” the questions you need answered.

Routine challenges. Routines and rituals are very important to people with autism. They help to maintain order and predictability in their daily lives. This can be a challenge on scene, as most emergencies are not part of a schedule! You may need to swiftly remove someone from a dangerous situation or separate them from their caregiver depending on the emergency. If the scene is safe, allow them to maintain as much of their routine as possible. When you cannot, take a minute first to explain to the person what is about to happen before you act.

SOA You Get What You Get

Autism Tips for Emergency Responders: You Get What You Get!

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A guest post by Wanda Refaely, ICE4Autism.

SOA You Get What You GetIt’s like my son used to say about the color of the popsicle he got at snack time in preschool: You get what you get! Emergency calls sometimes come in with lots of information, but most of the time they don’t. As a first responder, it’s your job to attend to whatever is thrown at you, with however much, or little, information you’re provided. This is, undoubtedly, one of the greatest challenges in the field.

Picture this: You arrive on the scene of a motor vehicle accident and the driver is unconscious. In the passenger seat is a young adult male rocking back and forth and repeating “cheeseburger, cheeseburger, cheeseburger”. You gently lean your head in and ask, “Are you OK?” The young man continues uninterrupted on his rant. “What’s your name?” you try again. “Cheeseburger” is all you get in response. You reach in and put your hand on the young man’s shoulder to calm him and he responds with a blood curdling scream.

Is the young man hurt? Has he suffered a concussion or brain injury? Can he even hear you? Maybe he doesn’t understand English? Could he be intoxicated, on drugs or is he mentally ill? Or… Maybe he has autism?

The techniques you implement and how you proceed will differ based on the response to each of these questions. In fact, how you assess the young man’s needs and condition may require an adaptation of your usual or customary protocols. But how do you know?

The best way to distinguish autism, as opposed to other possibilities, is through your powers of observation. The ability to recognizing the “signs” associated with autism is essential to responding appropriately. Though different in every person, autism is often characterized by communication differences, social challenges and unique – and often misinterpreted — behaviors.

A person with autism may exhibit repetitious behaviors – such as rocking, arm flapping or bouncing up and down; “echolalia”, the repetition of phrases or words and/or parroting back what someone has said to them; varied communication abilities which may require the use of a communication device; hyper or hypo-sensory responses including sensitivity to light, sound and touch; and an extreme pain threshold which may be unusually high or extraordinarily low. It is important to note, that autism is a spectrum disorder which means that it may be extraordinarily difficult to discern at all in some people while extremely severe in others.

All of this will all present added challenges for you, the first responder.

Getting back to our scenario, looking for the young man’s (and the driver’s) mobile devices and checking for an ICE (in case of emergency) app may be the single most productive action you take in attempting to figure out the young man’s needs. As the public’s reliance on mobile devices for everything from banking to restaurant reviews has blossomed, so has their use for safety purposes. The implementation of Bob Brotchie’s ICE concept – entering In Case of Emergency information in your cellphone — which went viral nearly a decade ago, has been broadly embraced around the world and is now highly prevalent. And, more specifically, the ICE4Autism mobile app, developed specially to address the unique needs of individuals on the autism spectrum is now used by those with autism, their families and caregivers. ICE4Autism can answer many of the pertinent questions that the driver may have been able to answer for you were she conscious: Who is the young man? Does he, in fact, have autism? How old is he? What is his blood type? Does he have any additional medical conditions? Allergies? How do you contact his emergency contacts? Are there any special instructions related to his care that would be helpful?

Proceeding with the young man’s care based on the valuable information gleaned from the ICE4Autism app is, obviously, preferred to proceeding “blindly”; but, you don’t get to choose – you get what you get.

You may need to move forward based on your observational assumption that the young man in our scenario IS on the autism spectrum. If so, turning OFF lights and sirens, for example, can dramatically reduce stress levels. Looking for and giving the young man what might be a “preferred item” may reduce his anxiety and thereby also improve his ability to respond and cooperate. Speaking in short, direct language and allowing extra time for him to respond will likely yield better results. And limiting physical contact to only the most essential preceded by an explanation of what you are about to do and what to expect are all good ideas.

Responding to a call involving a person with autism isn’t going to be a rare and unusual occurrence. The fact is that autism is the single fastest growing developmental disability in the United States today AND people on the spectrum are seven times more likely to interact with first responders. Being ready and knowing how to respond properly and safely to the unique needs and sensitivities of people with autism is now an essential part of the first responder job description because when the call comes in, you get what you get!

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About Wanda Refaely

Wanda Refaely is passionate about and deeply committed to reducing the barriers to needs-conscious emergency and general care and treatment for individuals with an autism spectrum disorder. She is the founder of ICE4Autism, the ONLY autism-specific in case of emergency mobile app, and is an active contributor to the autism safety and emergency preparedness arena. Wanda’s involvement in the autism community began with her participation in the advocacy and lobbying efforts leading to the passage California’s autism insurance reform law (SB946). She continues to work as an independent consultant specializing in assisting autism treatment providers with their insurance contracting, credentialing and clinical audit needs. Wanda also volunteers as a board and executive committee member at Include Autism, a San Diego autism inclusion and education non-profit. She is a proud mom whose son has been, and continues to be, her inspiration, motivation and her greatest source of joy.

More information:

On the web: www.ICE4Autism.com

On the App Store: https://itunes.apple.com/app/ice4autism/id969601780?mt=8

Via email: wanda@ICE4Autism.com

On Twitter: @ICE4Autism

On Facebook: ICE4Autism Mobile App

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Weekly Autism Tips for Emergency Responders: Co-existing Conditions

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image courtesy of freedigitalphotos.net

image courtesy of freedigitalphotos.net

Children with an autism diagnosis often have more concurrent medical and psychological or mental health conditions than their non-autistic counterparts. Because of this, they are also more likely to use EMS and healthcare services.

Learning to recognize the signs and behaviors of autism in a patient can be challenging enough; adding medical complications to the mix can further complicate the call. Approximately one third of patients with an Autism Spectrum Disorder (ASD) have seizures.

According to a guest post on AutismSpeaks.org by epidemiologist Laura Schieve, Ph.D., at the Centers for Disease Control and Prevention, her study concluded that children with autism, ADHD or other developmental delays were:

  • 8 times more likely than children without developmental disabilities to have ever had an asthma diagnosis,

    6 times more likely to have had eczema or a skin allergy during the past year,

    8 times more likely to have had a food allergy during the past year,

    2 times more likely to have had frequent severe headaches or migraines during the past year, and

    5 times more likely to have had frequent diarrhea or colitis during the past year.

    Children with autism were twice as likely as children with ADHD or other delays to have had frequent diarrhea or colitis during the past year and were seven times more likely to have experienced these gastrointestinal problems than were children without any developmental disability.

Other co-existing conditions commonly found with autism are tic disorders, like Tourette Syndrome, Attention-deficit-hyperactivity-disorder (ADHD), Obsessive/compulsive disorder (OCD), sleep disorders and mood disorders.

Obesity is another common issue, mostly due to poor trunk development, picky eating habits and decreased physical activity.

Medications, Pain Management and Field Impression

When in the field, be aware that standard dosages of medication for pain control may be ineffective for patients with autism. Be careful when relying on “outcome-based” pain management, as higher dosing may result in unintentional overdose.

Your patient with autism may also exhibit uncommon side effects or adverse reactions to routine drugs, and they may be on uncommon medications that may have interaction with drugs given in the pre-hospital setting.

Remember that it is not your job to diagnose an autism spectrum disorder or try to differentiate it from other conditions. The goal of learning to identify autism is solely to form a working impression that will help you use more appropriate assessment and treatment strategies. As always, you should treat the patient, not the diagnosis.

You should also always consider that there is a medical reason for the behavior, as stroke, brain injury, seizures and hypoglycemia may present with similar signs and behaviors. DO NOT IGNORE LIFE-THREATS just because your patient has autism or you suspect they do.

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Weekly Autism Tips for Emergency Responders: Excited Delirium or Sensory Meltdown?

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image courtesy of exciteddelirium.org

image courtesy of exciteddelirium.org

During my last Autism training class for law enforcement, someone brought up an excellent question immediately following the Sensory Meltdown section of my program. They commented that many of the signs and behaviors of sensory overwhelm that lead to a meltdown sound exactly like those of Excited Delirium (ExDS) and wanted to know how to tell the difference.

I absolutely LOVE getting tough questions during my training programs! It’s because of everyone’s valuable input that this training remains fluid and continually improves after each experience.

I have been researching ExDS extensively and, while sharing some signs of sensory processing issues, the outcome is very different. Michael Curtis, MD, who created a field guide to help EMS and Law Enforcement recognize ExDS, refers to the condition as a “freight train to death.”

Excited Delirium typically accompanies the use of stimulants, most commonly but not limited to cocaine and methamphetamines, as these drugs block the re-uptake of dopamine, resulting in elevation of dopamine levels in the brain. This is amplified if the person already has a pre-existing psychiatric condition that is treated with dopamine re-uptake inhibitors.

According to the JEMS website, elevated levels of dopamine cause agitation, paranoia and violent behavior. Heart rate, respiration and temperature control are also affected by dopamine levels, with elevation resulting in tachycardia, tachypnea and hyperthermia. For this reason, hyperthermia is a hallmark of excited delirium.

Look for persons partially clothed or naked, exhibiting violent, almost primal behaviors. They may appear to have “super human” strength, but in actuality merely it’s the loss of pain receptors that creates the illusion.

Excited Delirium is a MEDICAL condition, with a grim outcome once a person enters arrest. The best way to manage it is to prevent cardiac arrest. Prehospital therapy should focus on treating the increased metabolic activity and hyperthermia first.

The mnemonic “NOT A CRIME,” developed by Michael Curtis, MD, clearly sets out the signs and symptoms of ExDS:

  • N – Patient is naked and sweating from hyperthermia
  • O – Patient exhibits violence against objects, especially glass
  • T – Patient is tough and unstoppable, with superhuman strength and insensitivity to pain
  • A – Onset is acute
  • C – Patient is confused regarding time, place, purpose and perception
  • R – Patient is resistant and won’t follow commands to desist
  • I – Patient’s speech is incoherent, often with loud shouting and bizarre content
  • M – Patient exhibits mental health conditions or makes you feel uncomfortable
  • E – EMS should request early backup and rapid transport to the ED

Sensory Processing Meltdown

A sensory meltdown is when a person’s nervous system has been so bombarded by sensory input that it enters survival mode, perceiving that it is under attack. These may occur in autistic adults just as much as children.

An adult experiencing a meltdown describes the experience on SPDSupport.org:

“All sensory systems start firing! Everything pierces you like a knife! Every sound, every speck of light, every texture against your skin, and everything you can smell. It surrounds you and cuts right into you. Trapped within your skin, like a caged animal under attack, you are basically helpless. You thrash, you heave, you scream, you do whatever you can, because you are perceiving something killing you. You need to escape! Everything is hurting you, things that no one else can even believe would be affecting you. The smallest noise makes you want to claw your ears off, the slightest movement of you head might make you sick, and even the dimmest lights in the room make your eyes feel like they are bleeding.

Nothing matters anymore. You only have a few options: fight, flight, or freeze.”

Not unlike ExDS, some of these signs may present as agitation, violent behavior, resisting, tachycardia and tachypnea. If your nervous system believes you are in imminent danger, it will employ survival techniques.

There is typically no hyperthermia involved with a sensory meltdown. Additionally, once you reduce sensory triggers or remove a person from the environment, the meltdown begins to lessen. The person may begin to self-calm and use relaxation techniques in order to return to their baseline behavior.

It is always best to try and prevent meltdowns by learning to recognize the signs and behaviors leading up to them. If that cannot be achieved you want to immediately remove harmful stimuli and reduce sensory triggers. Once their nervous system begins to stabilize, you can then add positive stimuli. Tools such as deep breathing, gum chewing, handling a fidget item, redirection and distraction can all help the nervous system relax and block the stressors. It is only then that you can gain compliance or begin communicating.

SPD meltdowns are incredibly intense and often traumatic for the individual experiencing them. However, unlike ExDS, the person is aware of the way they acted during, even though they were not in control of their behaviors. There is no blackout or acute altered mental status. It is essentially a response to a nervous system overwhelm and will eventually subside. The goal is to keep the person safe and do whatever you can to reduce sensory triggers.

Recognizing a sensory meltdown is extremely helpful, but as always, DO NOT IGNORE LIFE-THREATS such as stroke, brain injury, seizures or hypoglycemia just because your patient has autism or you suspect they do.

Have you responded to a call involving excited delirium or a sensory meltdown? What were your indicators? How was it handled? Share your thoughts below or send me a confidential email with your comments! Input from the field is ALWAYS valued.

ShakeOut

Great ShakeOut Earthquake Drill – Who Will Be Joining My Family?

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ShakeOutEveryone, everywhere, should know how to protect themselves, their family and their business in an earthquake. As a CERT member and vocal disaster preparedness advocate, I’m thrilled to be participating with my family in the world’s largest earthquake drill.

Earthquakes have certainly been a huge topic both in the news and in Hollywood. The April 2015 Nepal earthquake killed more than 9,000 people and injured more than 23,000. San Andreas, a 2015 disaster film, portrays how a seemingly ideal day turns disastrous when California’s notorious San Andreas fault triggers a devastating, magnitude 9 earthquake, the largest in recorded history. While the Nepal earthquake is an unfortunate reality, thankfully the movie San Andreas was mainly fiction. To help learn more about earthquake facts the several organizations have offered many resources, including for those who have family members with Autism or other needs. (I recommend that my readers go here first for information.)

I’m in Atlanta, Georgia. You may be thinking, “Atlanta? Earthquakes? I can see being prepared for a tornado, but come on. Georgia doesn’t have earthquakes.” It’s that kind of “it won’t happen to me” thinking that gets us all in trouble when it comes to emergency preparedness. Guess what – in the past year alone, Georgia has experienced seven earthquakes. In my research I also found a great deal of Georgia earthquakes that caused significant damage dating back to 1811.

The USGS provides much information about earthquakes on their website. Click

image courtesy of earthquake.usgs.gov

image courtesy of earthquake.usgs.gov

here to learn more.

Even if earthquakes are rare where you live, they may happen where you or your family travel. While earthquake hazard varies from region to region, most of the Southeast really is prone to earthquakes. You could be anywhere when an earthquake strikes: at home, at work, at school or even on vacation.

What you do now will determine your quality of life after our next big earthquake. Are you prepared to survive and recover quickly?

What is Great ShakeOut?

shakoutGreat ShakeOut Earthquake Drills are an annual opportunity for people in homes, schools, and organizations to practice what to do during earthquakes, and to improve preparedness.

By participating, you and your family can practice how to be safer during big earthquakes: “Drop, Cover and Hold On.” The ShakeOut has also been organized to encourage you, your community, your school, or your organization to review and update emergency preparedness plans and supplies, and to secure your space in order to prevent damage and injuries. Below I have listed the Seven Steps to Earthquake Preparedness. You may wish to copy these bright images and laminate them as part of your family preparedness plan to have on hand as an aid for communication. Laminating them will help them to last longer.

Also, remember that when a disaster hits one should be ready to either shelter in place or evacuate. For children and adults with Autism that means extra care in planning is required. It is a good idea to communicate with your local First Responders about the needs of your family and share with them some tips on how to help a child or adult with Autism during these stressful situations.

Read about Apps to help with disaster response when your family has a member with Autism

Why Register for ShakeOut?

Not only will you find many safety tips, like having a disaster kit that applies to tornadoes and hurricane safety as well, but families with individuals with special considerations or are non English speaking will find a plethora of resources.

  • Be counted in the largest-ever earthquake drill in the Southeast!
  • Be listed with other participants in your area (Optional)
  • Be an example that motivates others to participate & prepare
  • Be updated with ShakeOut news and preparedness tips
  • Have peace of mind that you, your family, your co-workers and millions of others will be better prepared to survive and recover quickly from our next big earthquake!

Don’t just register, get involved! Join the ShakeOut community and participate in the weekly Tweetchat on Wednesdays from 2-3 pm EST. This Wednesday, July 22nd, I will be tweeting live during the Tweetchat! Join me, @SpiritOfAutism, and be sure to use hashtags #ShakeOut and #DropCoverHoldOn. Don’t forget to upload pictures of you and your family registering for Great ShakeOut!

join us

Seven Steps to Earthquake Safety

PREPARE:

  1. Secure your space (a list of how to do that here)
  2. Plan to be Safe (and review and practice your plan with your family members)
  3. Organize your disaster supplies – don’t forget to add any special objects that help your child to transition or feel more comfortable. Especially if you are relocated to a shelter or another’s home.
  4. Minimize financial hardship. Remember that your basic home or renter insurance most likely will not cover earthquakes.

SURVIVE and RECOVER

  1. Here is where you Drop- Cover and Hold On! Remember to practice this during the ShakeOut drill and several other times during the year.
  2. Improve Safety. After an earthquake happens be sure to check on people nearby for any injuries. Evacuate if need be.

And after the Earthquake happens Step 7 is to Recover and Restore with daily life by repairing anything broken and assuming daily routine when possible.

Images for use and download to help with communication and to create social stories:

 

water heater cell
disaster kit documents
drop cover hold on recover
rebuild