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s p o t l i g h t o n S A F E T Y 40 NOVEMBER 2017 | EMSWORLD.com Following the initial training program, it became apparent that varying participant background education levels were a significant barrier. Some first responders had only high school educations, while others had master's degrees. Some individuals came to the class with a strong understanding of autism, while others were not as familiar with the diagnosis. The first responder autism training program was then modified to ensure a basic understand- ing at all levels of education for both fire and rescue personnel. The instructor-driven program included the following components: • General characteristics of the autism spectrum, including no real fear of dan- ger; inappropriate laughing or giggling; not responding to his or her name; over- or undersensitivity to pain; may dislike physi - cal touch; may avoid eye contact; echoing words and phrases; insisting on keeping routine/keeping things the same; chal- lenges expressing needs; using gestures as opposed to words; difficulty interacting with others; preferring to be alone. • How characteristics of ASD can increase the danger of an emergency situation: An individual who has no fear of danger may not realize safety limits, an individual who does not make eye contact may be perceived as avoiding something, and an individual who echoes words and phrases may be perceived as mimicking. Issues with social interactions and communica- tion challenges that are part of autism can create a barrier for providing care during an emergency. • Knowledge that autism is a spectrum disorder, meaning no two individuals will present the same characteristics. Every individual will demonstrate specific characteristics that may have more of an impact on function than others. Being a spectrum means some individuals will be highly independent while others depend totally on caregivers. • Providing an understanding that the home environment of an individual with ASD— what parents go through to keep kids safe—isn't always the safest option. Par- ents do the best they can to keep children safe; however, at times a first responder may see locks on exit doors that children cannot open in the home of a child who wanders—this would be a major safety concern and requires parent education to improve safety. First responders may be the key to helping parents connect with social and support services that can help improve safety within their environment. • Steps to provide care while meeting needs of an individual with ASD. First respond- ers may need to demonstrate what they're going to do on another individual to help someone with autism understand what's going to happen. Use of words such as take should be limited, as individuals with autism are quite literal and may believe something will be taken from them. Allow- ing caregivers to remain with the individual as long as possible may also help prevent increased behaviors and improve commu- nication. • Understanding risks for elopement and being drawn to water. Many individuals with autism will run when faced with a challenge or uncomfortable situation. Many children with autism have little fear of water but often lack the ability to swim, putting them at risk for drowning. • Understanding how to best de-escalate a situation and keep a crisis from becoming confrontational while still providing care. Sometimes individuals on the spectrum will go into a behavioral mode that does not allow for de-escalation; these indi- viduals may need to be provided space to experience their behaviors and ensure the safety of others. Although it may take time for the individual to calm, fatigue will set in, and the individual will then be able to be approached safely. Allowing individuals on the spectrum time to process the informa- tion/instructions provided will help pre- vent increased behaviors, as will allow- ing them to perform behaviors they find calming—for example, rocking, humming or hand motions. Permitting an individual to look away and not make eye contact will also help reduce stress and anxiety with the situation, along with allowing caregiv- ers or an important object/toy to remain with the individual. • How to help families connect with first responders before an emergency occurs. Encourage families to send an updated information page to the dispatch center with a recent picture, any allergies, likes and dislikes, and if they know they have a child prone to elopement. Also encourage the use of GPS tracking devices for indi- viduals who are an elopement risk. • Opportunities for community outreach. Encourage families to attend National Night Out and other community events where individuals with autism might be provided the opportunity to meet first responders and see equipment outside an emergency situation. The original phase of this 2009 study focused on learned content with a pretest (including true/false, multiple-choice and problem-based learning questions) to dem- onstrate general knowledge about autism. Following completion of the presentation, participants were then provided the same questions in a post-test to assess any changes in the number of correct responses. In addi- tion, participants were asked to rate their Table 2: Phase I Study Results Measured Component Score Number of incorrect questions pretest 3.28 Number of incorrect questions post-test 1.82 Level of comfort pretest 4.41 Level of comfort post-test 6.67 Table 3: Phase II Study Results Measured Component Score Pretest number correct 22.91 Post-test number correct 24.02 Pretest empathy, self-reported rating 3.78 Post-test empathy, self-reported rating 6.96 Pretest self-perceived ability to identify characteristics of autism 5.09 Post-test self-perceived ability to identify characteristics of autism 6.91 Pretest confidence, self-rated ability to perform job duties 5.98 Post-test confidence, self-rated ability to perform job duties 7.31