Tia Dickson, RN, BSN

Primary Children's Hospital

• Nationally, 1 in 69 births are an autistic child and that number is on the rise
• In Utah in 2021, 1 in 46 children were born with autism
• Boys are 4 times more likely to be born with autism than girls
• Most children with Autism Spectrum Disorder (ASD) are diagnosed by the age of 4 years

Chances are high that a first responder will come into contact with an autistic person. Most often EMS encounters these children in wandering circumstances.

There is a saying in the autism community; "If you've met 1 person with autism, you've met only 1 person with autism." No two are alike. There is no single physical characteristic and no universal trait that distinguishes someone with autism. Identifying a person with autism can be a challenge. Special training and understanding is important for positive interactions with these youth.

The core symptoms of autism are

1. Deficits in communication
2. Deficits in social understanding
3. Narrow, restrictive, or repetitive interests and behaviors

https://autismsociety.org/

Understanding Autism; autism, and neuro-diversities for medical professionals

Jeff Wilson NREMT-PM

Excerpts from January 9th PETOS

Jeff is a paramedic who works for Gold Cross and his 6-year old son is autistic. Jeff and his wife, Heather, are dedicated to helping medical professionals understand autism.

As of 2019, neuro-diversity, asperger's, and autism are one in the same. Autism Spectrum Disorder (ASD): is a developmental disability caused by differences in the brain. As a spectrum, the symptoms of ASD may range from mild to severe. But for all people with ASD, life can be challenging.

Severity is often broken into 3 sections

• High functioning: can function in everyday life
• Moderate functioning: needs some help with activities of daily living
• Severe: need 24/7 care

Think of extremes: new experiences or overstimulation can trigger aggressive behaviors. These children often exhibit ritualistic behaviors, focus in on specific topics of interest, and they are unwavering in their routines. About half of the children with ASD like to wander and will "bolt" when something attracts their attention and most are fascinated by water.

EMS are called to respond to an ASD youth for the same reasons they are for the general pediatric patient but their presentation can be more extreme.

• Epilepsy
• GI issue related to their eating habits or rituals
• Overdoses
• Falls
• Drowning
• Dehydration (forgetting to drink or too busy)
• Behavioral issues

Children with ASD are often teased or bullied. They are different and targeted for that reason. This is often related to fear and a lack of understanding. Protect them rather than add to the problem when you respond to these patients. They want to be accepted.

Be aware that family may be injured. These children have behaviors which can cause harm. Headbutting, punching, scratching, and other aggressive behaviors occur. When you respond to a call, look for injuries among caregivers. Also look for emotional injury. Parents may be at their breaking point. Look for signs that a caregiver needs help.

Jeff also included these:

• Use a monotone voice and mirror their energy level
• Instead of open ended questions, use direct, simple yes or no questions
• Let them "play" with your equipment
• Turn an exam into a game. Example: play The Floor in Lava when you ask them to get on a stretcher.

• Family and caregivers know best. Allow them to stay with the patient, even during transport when possible.
• Ask the family about the child's triggers and tips on approach.
• Determine their language capabilities. How do they communicate? Use interpreters if needed.
• Stay composed and calm. Remove yourself if you feel overwhelmed. (Safety officers or captains should facilitate this).
• Only use medical sedation in extreme situations as a very last resort. Get approval from caregivers before you choose this route.

Consider making an autism response kit for your ambulance. Items could include:

1. Sound canceling headphones
2. Non-verbal cue cards
3. Sign-language cards
4. Sensory toys (poppers)

• Don't let them play with gloves or other possible choking items
• Don't use a demanding, threatening, or loud tone
• Don't assume
• Don't lose your patience
• Don't try to stop repetitive behaviors
• Don't try to stop tantrums unless there is a risk of self-harm
• Don't rush. These calls will take time. They are not load and go.

Jeff provides on-site training for EMS agencies, schools, and communities. Contact him if you would like more training.

jeffwilson122615@gmail.com

https://utahparentcenter.org

Adult Autism Center in Murray Utah

Utah Autism Council

The University of Utah is offering a Autism 101 ECHO Module beginning 2/22/23. These courses will focus on the needs of children with ASD. Register here

Autism Society of America

National Autism Association Big Red Safety Box

Autism Speaks: Wandering Resources

Do you have a question for our EMSC medical director, Sarah Becker, MD, PCH, ER attending physician about this newsletter topic or anything related to pediatrics? Email tdickson@utah.gov.

On topic

• EIIC: Pediatric Education and Advocacy Kit: Agitation

On Covid-19 and kids

• CDC and the Council of State and Territorial Epidemiologists: New definition of MIS-C and a related webinar, Updates on Multisystem Inflammatory Syndrome in Children (MIS-C): Epidemiology, Case Definition, and COVID-19 Vaccination
• AAP: COVID Vaccine Checklist for Kids
• CDC: Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Approved or Authorized in the United States - updated with new recommendation for bivalent vaccine for children
• CDC and HHS: Vaccine finder website
• COVID-19 hospital admissions rising among children, especially those under 5 - AAP News, Dec. 8

Utah EMSC is participating in the upcoming zero fatalities conference which has an exclusive EMS track. We have scholarships for attendance. Save the dates April 24-27, 2023 and contact our program manager jaredwright@utah.gov if you'd like to go on our dime.

The 2023 EMS survey has launched! Utah EMS agencies and Utah PECCs, we have a legacy of getting a 100% response rate on these surveys and that's our goal for 2023. We need your help. Take the survey now and avoid the pleading phone calls from us in March. Click the pic below to get started

2022 National EMS for Children survey results

• EMSC Data Center: EMS for Children Survey National Report

PECCs, check out the new EIIC PEAK resource on agitation and join for quarterly PECC meeting this month (See below).

• EIIC: Pediatric Education and Advocacy Kit (PEAK): Agitation

Pediatric education for the prehospital provider

Register online at www.peppsite.com. Look up classes in Utah and find the 1 that works for you. Once you find the class, go to jblearning.com, and look up pepp als in the search tool. Purchase the number ($21.95). Return to peppsite.org to register for the class and follow the prompts.

If you have any questions, please email Erik Andersen at erikandersen@utah.gov or text/call 435-597-7098. Continue to watch the website for additional classes.

The Emergency Medical Services for Children (EMSC) Program aims to ensure emergency medical care for the ill and injured child or adolescent is well integrated into an emergency medical service system. We work to ensure the system is backed by optimal resources and that the entire spectrum of emergency services (prevention, acute care, and rehabilitation) is provided to children and adolescents, regardless of where they live, attend school, or travel.

Email: tdickson@utah.gov
Website: https://bemsp.utah.gov/
Phone: 801-707-3763
Facebook: facebook.com/Chirp-UtahDepartmentofHealth