By ALAN J. MARTIN and TILDA MIMS

“Thirteen-year-old boy dies in Missouri home fire.”

“Firefighter injured rescuing 10-year-old boy.”

“Oregon couple sentenced for fire death of 19-year-old son.”

These actual headlines all involved individuals with autism. In each case, autism contributed to the child’s death. The 13-year-old boy refused to escape with his family; his body was found in the bathroom behind a locked door. The 10-year-old was safely removed by his mother but died when he ran back into his burning home seeking the sanctuary of his bedroom. The Oregon couple often locked their son in the apartment when they went out together because he had no sense of danger and would often wander away.

Can tragedies like these occur in your community? Absolutely. The right knowledge and training can help prevent similar situations.

Autism is the fastest growing developmental disorder in the United States. It occurs in all communities, regardless of racial, ethnic, and social boundaries; family income levels; lifestyle choices; and educational levels. People with autism are as different from each other as we are. Some require a caregiver with them at all times; others live independently. In most cases, however, the person will have difficulties following verbal commands and understanding body language and social situations.

According to the Centers for Disease Control and Prevention, autism is growing at a rate of 10 to 17 percent per year, currently affecting one in 150 births. This means that as many as 1.5 million Americans today have some form of autism; 85 percent are younger than 18 years of age. The Autism Society of America estimates the prevalence of autism could reach four million Americans in the next decade.

Has your department responded to an incident that involved a person with autism? Autism researchers report these individuals have up to seven times more contact with emergency responders than typical citizens. Although their elevated risk is partly because of coexisting medical conditions such as allergies and seizures, the most tragic interactions may stem from our misinterpretation or misunderstanding of typical behaviors associated with autism.

Autism affects normal brain development in areas of social interaction, verbal and nonverbal communication skills, and cognitive function. Some individuals may show an unusual pain response that could include laughter, humming, and singing. Self-stimulatory behavior (stimming) refers to repetitive body movements or repetitive movement of objects. This can include hand flapping, snapping fingers, body rocking, or saying repetitive phrases. They may echo something you say or something they’ve heard.

Autism is an invisible disability. With no identifying physical characteristics that make the disability apparent, behaviors are often misinterpreted as mental retardation, drug abuse, psychosis, defiance, or criminal activity. In young children, observers may label them “spoiled brats” and categorize the struggling parents as too lenient.

Your goal in an emergency is to improve the situation, minimize damage, and prevent further injury. You accomplish much of this through continuous training, practice, and education. Dealing effectively with an autism emergency necessitates the same level of preparation as any other situation. By reading articles like this one and being more observant of your surroundings, you can better prepare to reach those goals and ensure a positive outcome.

It is more difficult to do your job when there is a language barrier. An individual with autism may have no verbal communication ability at all. For instance, if an autistic child’s parent is incapacitated or unavailable and cannot communicate with him, how can you expect to understand the situation?

For those in close proximity to lakes, rivers, and open water in your community, be aware that individuals with autism are often fascinated by water and, even if they are strong swimmers, fail to detect the dangers of cliffs, slipping on wet rocks, falling into rushing water, or entering cold water. The National Autism Association reports that drowning is the leading cause of death for children and adults with autism spectrum disorder. By knowing this, you can immediately assign firefighters to these areas when the child wanders from home. Offer to train parents in water safety, CPR, personal flotation devices, and other proactive risk reduction measures.

There are numerous documented cases where people with autism, safely rescued from a fire, died after running back into a burning building to seek shelter in the place where they felt safe. Training would prompt us to anticipate such behavior and assign a firefighter or EMS provider to stay with the individual once he is safely removed from a fire or other hazardous condition.

Children and adults with autism are often described as fearless, prone to wander, and attracted to high places. Parents and caregivers frequently install home modifications that pose unexpected hazards to firefighters. Locked interior and exterior doors, especially at night, are common. Windows, gates, and fences may be barred, nailed, locked, or otherwise secured. Normal window glass may be replaced with Lexan or another break-resistant product. Proactively flagging these addresses in the dispatch center will help protect firefighters and occupants.

With an autism diagnosis rate of one in 150 births, today’s firefighters will interact with these individuals as children, teenagers, young adults, and older adults throughout their careers. If firefighters continue to lead in community risk reduction, they must train in autism in medical and fire emergencies, marine operations, tactical rescue, swiftwater, search and rescue, and emergency preparedness.

Autism awareness training can be as simple as inviting family members into the firehouse to talk about their particular experiences and needs. Check with your local board of education or school nurse for recommendations. The Autism Society of America can refer you to local resources, too.

The Tuscaloosa (AL) Fire & Rescue Service began its autism awareness training in the summer of 2007 with programs taught by experienced teachers of children with autism. The Tuscaloosa City Board of Education allowed them administrative leave and covered the costs of substitute teachers. Through this experience, we frequently visit their self-contained classrooms and visit the after-school/summer program for these children.

The next training strategy step was to provide training specific to the fire service. Through the Internet, we met Firefighter Bill Cannata, developer of the program Autism Awareness for the First Responder-Fire/Rescue and statewide coordinator for the Autism Law Enforcement Education Coalition in Massachusetts.

Cannata brought his program to Tuscaloosa in August 2008. This is not a one-size-fits-all program but is designed from the perspective of a veteran firefighter and the father of an autistic son.

His original program is packed with practical, task-specific training to help firefighters recognize, communicate with, and appropriately assess and assist these individuals in all types of emergencies, from residential fires to high-angle rescues. The program includes excellent ideas for public education and public relations, fostering relationships with parent coalitions and support groups, and including parents in preincident planning.

If you are training to assist people with physical and mental disabilities and are not including sensory disabilities, you are not prepared for an autism emergency. Don’t wait for a headline; prepare now. Today’s firefighters need autism awareness training specific to the fire service to truly serve this unique, high-risk group as well as to ensure their personal safety.

Resources

Autism Risk & Safety Management, www.autismriskmanagement.com.

Autism Society of America, www.autism-society.org.

Centers for Disease Control and Prevention, www.cdc.gov/ncbddd/autism.

National Autism Association, www.nationalautismassociation.org/safetytoolkit.php.

ALAN J. MARTIN was named chief of the Tuscaloosa (AL) Fire & Rescue Service in July 2002. He began his 34-year career in the Birmingham (AL) Fire & Rescue Service as a firefighter, eventually being promoted to assistant chief of operations and emergency medical services, assistant chief of administration, and assistant chief of training and safety. He has a bachelor of science degree in public safety administration from Athens State College and an associate fire science degree from Jefferson State College. He is a certified paramedic and a graduate of the Executive Fire Officer Program at the National Fire Academy.

TILDA MIMS is a 20-year public education veteran and the fire and life safety educator for the Tuscaloosa (AL) Fire & Rescue Service. She has a bachelor’s degree in speech communication and a master’s degree in education from the University of Alabama. She is in the Executive Fire Officer Program at the National Fire Academy.