The unpredictability of a crisis can magnify the person’s anxiety, sensory responses and inability to communicate their needs. As a result, first responders, who try to assess, treat or transport an individual to a hospital may find this task challenging.
By being prepared, first responders can help these individuals manage the overwhelming stress of an emergency.
Here are 10 tips police officers, paramedics and EMTs need to know to achieve the best outcome.
#1 Speech quality does not determine intellect.
Many chronic health challenges affect one’s muscle tone and quality of speech. Difficulties, such as slow, stuttered, odd or flat speech can affect how one talks and responds to questions or commands. Many times, others assume that if an individual has poor speech, they also have low intelligence.
This assumption is not correct. In fact, many individuals with speech, physical or sensory challenges have average to above-average intelligence. However, when experiencing a crisis situation, their speech challenges may be exacerbated due to anxiety.
First Responder Tip: Work to calm the individual and decrease anxiety. Modify the pace of your questions. Paramedics or EMTs who ask individuals about symptoms should ask one question at a time. Listen and give the person time to answer. Wait for a response to your first question before you ask the next.
#2 Some individuals are ‘non-verbal.’
Some individuals cannot utter a word, while others may be able to say their name and address, but beyond that, they too are non-verbal. They cannot answer questions verbally, because they are unable, not unwilling. They may react with frustration by running away or with aggression. When this occurs, the situation often deteriorates.
Non-verbal individuals are taught to communicate through I-Pads, phones or other technological devices and are often eager to talk to you. You may not succeed with the first method you try and that’s ok. Don’t second guess yourself, try again.
First Responder Tip: Make available non-verbal alternative ways to communicate, such as through typing, writing, signing, drawing, picture cards or other forms of technology. If the individual has a phone, they may be able to text you or use other resources available in their phone to communicate. It is a good idea for paramedics and EMTs to learn a few basic signs such as pain, hurt, eat, ambulance, drink, etc. If possible, include picture cards in the ambulance so that EMT’s and paramedics can communicate with non-verbal individuals.
#3 Touch, sound, light or sudden movements can trigger a panic.
Some individuals are sensitive to lights, sounds, smells and movement of the environment and respond with panic. Even when EMTs and paramedics are called to a home where the individual is familiar and comfortable, the individual may panic. To decrease a possible panic response, move slowly and observe. Some individuals will react with a fight, flight or freeze response when overwhelming stimulation feels painful.
First Responder Tip: Approaching the individual suddenly, touching them without warning or approaching them with loud verbal commands may destabilize or jar them. This may cause them to flee or become aggressive. Once the scene is secured, approach the individual calmly and if possible, keep a distance. Try to eliminate sounds and lights, such as radio chatter and lights from your vehicle. If you need to touch the individual, explain what you will do first, so they understand and can anticipate your next move.
#4 Unaware of the danger, they may run back into a burning home.
There is a lot of activity during a house fire. In addition to smoke and fire, the sounds of fire truck engines, gushing water and people crying can be confusing. Bright flashing lights can be upsetting.
Individuals with sensory conditions may hide under a bed or in a closet, making it difficult for firefighters to find and save them. Once rescued from the home, they may find the chaos of the fire scene unbearable. As a result, paramedics and EMT’s must be aware that even if the individual is hurt, they may still run back into their burning home because it is comfortable and familiar to them. In a panic, they seek to avoid stimulation and get back to their comfort zone. Other reasons they may run back in their home (even if it is burning) is to resume an activity they were doing, to save a pet or to help firefighters.
Teaching fire safety and becoming familiar with the sounds of the alarms and sirens will help prepare the individual for a fire emergency. Family practice drills will help everyone in the home be prepared about what to do in a fire.
First Responder Tip: Secure the child or adult once they are removed from the burning building. Try to place them in a calm, non-stimulating place away from the sights and sounds of fire rescue. Provide headphones and/or sunglasses to decrease stimulation. If possible, pair them with a responsible and trusting adult who understands their needs and can calm them and help them understand the situation.
#5 Individuals who are HYPER-sensitive may run.
First responders encounter many individuals who have a sensory challenge that makes it very difficult for them to regulate their sensory systems. They are hypersensitive and easily overwhelmed. These individuals are often comfortable and better able to focus while wearing headphones and sunglasses to decrease light and noise.
Hypersensitive individuals are triggered by too much information coming at them at once, causing them to overreact. For them, sounds are louder, lights are brighter and touch is more intense, and sometimes painful. Hypersensitive responses can be misinterpreted as a mental health crisis when it’s not. Instead, this over-reaction indicates the need for less stimulation so that they can function.
First Responder Tip: Decrease stimulation by moving them away from onlookers, barking dogs, sirens, flashing lights, and radio chatter. Their lack of eye-contact, use of headphones or sunglasses is not a sign of disrespect. Allow them to wear these items during your encounter to decrease environmental stimulation and help them focus on your commands and questions. EMTs and paramedics treating an individual after an accident or illness can ask the individual (or parents) about what interests them. If the situation allows, try to get to know the person. Talk with them about their interests (a movie, athlete, space, cars, video game), so they begin to feel connected, calm and engaged with the professionals trying to help them. By focusing on their topics of interest, they may be distracted from overwhelming stimulation and gain a sense of control.
#6 Individuals who are HYPO-sensitive can say they are ‘fine’, when they are severely hurt.
Some individuals with a sensory challenge can be hyposensitive. As a result, they under-react as their sensory system shuts down due to too much information coming at them all at once. Their reaction is often misunderstood as indifference, avoidance, or uncaring.
First responders should be mindful that during a crisis, fire, or accident, a hyposensitive individual may not tell you they are sick, hurt, burned, cut or in pain. They are vulnerable because they are unable to respond to fear, pain or danger. They may not moan, cry or appear in pain, even though they are bleeding or have an obvious burn or broken limb.
First Responder Tip: When called to a home or site of an accident, EMTs and paramedics should investigate beyond what the individual tells them. They may be bleeding, sick, hurt, or significantly burned, but when asked, say they feel “fine”. Observe carefully. Look at their stomach, back, feet and head area, even if they are not complaining.
#7 Stimming is not a sign of disrespect or intoxication.
Stimming is a repetitive behavior that individuals engage in to calm themselves. Stimming behaviors can include, but are not limited to, repetitive flapping of the hands, swinging a piece of string, tapping, rocking, or any other rhythmic movement that the individual finds calming. Individuals who stim often carry a self-soothing device (string, stick, toy car, rubber band) that could be mistaken for a weapon in a tense situation.
Sometimes stimming is interpreted as an effort to distract and manipulate the situation. Other times it is misinterpreted as being intoxicated or impaired by a mood-altering substance. Both interpretations are incorrect.
First Responder Tip: Become familiar with “stimming” behaviors and know that stimming usually keeps the person calm while interacting with you. Unless stimming behaviors become aggressive and harmful, stimming should not be stopped.
#8 Look for ‘wanderers’ near places with rhythmic movement or sound (these environments often mimic stimming).
Many frantic 911 calls occur because an individual is wandering or missing. Places that attract individuals on the Autistic Spectrum or with other sensory disorders, provide rhythmic stimulation. The rhythmic sight and sound of pools, streams, lakes, ponds, trains, or traffic are attractive to individuals on the Autistic Spectrum, because it is very similar to the rhythmic movement of ‘stimming’. They do not always recognize the dangers of water, traffic or trains.
Unfortunately, children with Autism are 160 times more likely to die from drowning compared with the general pediatric population. They are often unaware of the danger that exists in these situations. Special needs therapists work with parents to develop emergency plans in the event a child is missing.
First Responder Tip: When police are called because an individual is wandering or missing. Ask for a copy of the emergency plan (if available). This often includes identifying information.
Look first at nearby bodies of water, traffic, trains or even a swing in a neighbor’s yard. Wanderers often go back to places with rhythmic sights and sounds to feel calm. They may also return to familiar places (a McDonalds or neighbor’s home) or to the last place they visited.
#9 Not knowing what to expect can cause a total loss of control and panic.
Many individuals with chronic conditions have already experienced many hospital stays, blood draws and multiple surgeries. Being poked with a needle or squeezed with a blood pressure cuff is not new. They need a sense of control. Knowing what is going to happen next can help them feel control. Telling them what to expect before it happens can decrease panic and anxiety and prevent them from resisting or trying to run away.
You can eliminate a panic response by remaining calm. Many times, a parent or caregiver can inform you of best ways to calm the individual.
First Responder Tip: When possible, EMTs and paramedics should explain step by step exactly what is going to happen next, before you do it. Explanations such as, “You are going to feel a small poke of this butterfly needle” or “You are going to feel a squeeze on your arm to check your blood pressure and you will be ok,” can give the person a sense of control.
Often, the individual will ask you to put the cuff over their sleeve or take pressure on their lower arm so their skin feels less of a squeeze. Their requests are often based on their sensory triggers and past experiences.
#10 Parents and caregivers know the individual best.
Parents and caregivers are often available and willing to share important information with police, paramedics and EMTs during a crisis or emergency situation. This gets difficult when an adult with special needs, who does not have a legal guardian, refuses treatment. In some cases, the patient's right to refuse treatment trumps the parent or caregivers’ opinion about treatment needs. In any event, parents and caregivers are an excellent resource for police officers, paramedics and EMTs, because they know what calms and what triggers the individual, especially during an emergency.
First Responder Tip: Ask parents, caregivers and those who know the individual about how best to communicate. EMT’s and paramedics can inquire with parents and caregivers about an updated emergency medical sheet that lists medications, doctors, treatment facilities, triggers, calming techniques and best ways to communicate. In some cases, the fire department has already been alerted. This is because, prior to an emergency, some families alert the fire department about an individual in the household who has a care plan regarding a chronic condition. This helps first responders know what to expect if they should encounter this individual.
Nothing can take the place of a first responder who is knowledgeable about this special population. Police officers, paramedics and EMTs often save the lives of children and adults with chronic health challenges. Understanding the 10 First Responder Tips allows everyone to be prepared and achieve the best outcome during an emergency.
About the author:
Nancy Musarra Ph.D. is a licensed clinical psychologist who provides forensic services regarding psychological and competency evaluations. In her private practice, she consults with parents regarding developmental, neurological and mental health challenges at home, school and in the courts. She authored The New Normal; 7 Things to Know as You Care for and Love a Child with Special Needs. She also facilitates First Responder Training Workshops for law enforcement, fire and EMS: Dealing with Autism and Neuro-Developmental Challenges in Public Safety and How Do Professionals Who Deal with Stress and Trauma Everyday Maintain Resilience? Contact her at nancy@drnancymusarra.com.
Read the article here.