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Educating ER Personnel About Treating Autistic Patients

Dr. Arvind Venkat says that hospital emergency rooms are basically an autistic person’s worst nightmare.

“I think if you were to purposefully design an environment that was going to be difficult for an autistic patient, you could not do worse than what we do day to day in emergency medicine,” he said.

Venkat is the Vice Chair for Research and Faculty Academic Affairs in the Department of Emergency Medicine of the West Penn Allegheny Health System, a part of the Allegheny Health Network. He is part of a team of doctors and researchers who put together a new training manual and DVD to educate emergency medical personnel on how to approach patients with autism.

A 2011 survey conducted by the Bureau of Autism Services at the Pennsylvania Department of Public Welfare found that most family members and caregivers of autistic patients were dissatisfied by the emergency room care they experienced.

Emergency rooms tend to be loud, chaotic and over-stimulating. They create the exact type of sensory experience that is likely to agitate an autistic patient, and a patient in an agitated state is much harder to treat. In the worst case situations, patients may become so agitated that they are chemically or physically restrained and the police are called.

“You are likely going to have, both from a patient perspective, and a healthcare provider perspective, a lot of difficulties in terms of being able to obtain a history, obtain a physical examination, do normal lab and imaging studies and treatment options, because they’re going to be potentially very agitated by our usual process,” Venkat said.

The training manual and DVD, titled “A Guide for Emergency Department Personnel: Assessing and Treating Individuals with Autism,” provides clear, easy-to-follow instructions about how to interact with autistic patients.

The materials suggest that doctors and nurses triage with patients in quiet, low-light rooms without a lot of clutter or distractions.

Dr. Joann Migyanka, associate professor at Indiana University of Pennsylvania in the Special Education Department, said it’s also vital to take things slowly with autistic patients, moving methodically from one step to the next.

“Gaining their trust and establishing a relationship with them," Migyanka said. "Letting them see what you’re going to do. Prepare them first, maybe with visuals: ‘Here’s a stethoscope, I’m going to examine you, would you like to touch it? It’s cold. I’m just going to place it on your chest,’ before you actually do it.”

Very specific yes or no questions also help autistic patients communicate with nurses and doctors. Migyanka provides an example of an appropriate series of questions: “Does your tummy hurt? Yes. Did your tummy hurt before breakfast? Yes. Did your tummy hurt after breakfast? Yes.”

Both Migyanka and Venkat said information on how to interact with autistic patients is often absent from educational programs and day-to-day practice.

“If you go into a room and you ask anybody, do you know anybody or have you encountered anybody with autism, about 95 percent of the room will raise their hand," Migyanka said. "If you ask them how comfortable they are delivering services to them, that comfort level goes way way down.”

The materials have actually been available since June, but Migyanka said getting them into the hands of emergency medical personnel has been a challenge.

“We’re trying desperately to get this out, to say, 'Hey, here are these materials, and they’re available to you,” Migyanka said.

Migyanka, Venkat and the rest of the team, which includes Dr. Jeffrey Fratangeli and Dr. Susan Glor-Scheib, also of IUP, are now working on creating online training modules and figuring out how care providers can receive continuing education credits for completing the training.

The training manual and video is available at the Bureau of Autism website. Organizations can order hard copies of the materials for a small fee, which covers production and shipping costs.