a PSA from your friendly 'local' paramedic

[starling&diesel]

Hi everyone ... I'm a paramedic, and just did a call that made me think of coming on here and reminding everyone of a couple of things, no matter where you live or what special needs your child has.
We just did a call for a 10 yr old autistic child who was "out of control." When we got there (the parking lot of a kids fun centre) we saw two police officers and two other adult men restraining the child, who was screaming and trying to free himself. We restrained him with soft restraints on our cot, and then transported him and his two respite workers to the nearest hospital. One of the respite workers wanted to take him home, the other one wanted him to be admitted. They had no PRN ativan for him, they had no transfer of guardianship to act on his behalf, no personal identification for him, no list of his meds, no protocols for restraining, and obviously no training in non-violent crisis intervention.

So, please, if your special needs child is out in the community and might require an ambulance (and who wouldn't, at some point or another) please be sure to have the following go with the child:
- personal ID for the child, including medical insurance information
- a list of medical conditions and allergies
- a list of medications, dosages and times
- emergency contact numbers
- PRN meds such as ativan that the caregiver is authorized to give
- papers that clearly show that the caregiver can make choices on your child's behalf in your absence
-copies of any relevent protocols from your child's care plan
- an original of any DNR orders
- a clear care plan should hospital transfer be necessary

Gotta go, another call coming in. More later if I think of it. But having the above at least will make the process go much more smoothly for your child.
Gotta run!

[Scullery]

I think you and your community's first responders need autism/SN training, and how to adapt to situations with patients with autism and de-escalate or cause no further escalation of a situation. 4 people holding him down, 2 arguing respite workers, and the use of soft restraints? That was a recipe for disaster from the start. As first responders fire and EMS there has to be some responsibility for adequate management of a patient with special needs under less ideal circumstances such you're describing, it's even in a perfect world and there will be gaps in handing off information. Google Dennis Debbaudt, he offers workshops all over the country and if there is enough interest it can be sponsored for free by local autism groups. Autism Society has a Safe and Sound project with information for first responders as well as parents, so does Autism Speaks with their Autism Safety Project.

The problem is outreach, which I understand you're trying here, but to be truly effective it needs on a larger scale and coordinated. SN parents have A LOT on their plate and sometimes we don't do everything perfectly, like have full medical records at the ready in case of any and all emergencies. There are options, as I mentioned with Autism Speaks and Autism Society programs, and there is a Medic Alert program for around 30-40 dollars a year you can have all that info held by them and they can transfer it to the hospital. But either people don't know where to find them, can easily afford them, how to carry them accessibly, who to give them to, and in turn community first responders may not know what to do with the information or interpret it, etc. If you've met one child with autism, you've met one child with autism. A simple diagnosis isn't enough and would you really have enough time to read a thorough medical history to get a good sense of what you're dealing with?

I think your message is important, but if you truly want to help more learn more autism/SN first responder training, generate interest in the training, look into "premise alert," see what you can do to make it all go smoother for SN families.

Signed, former paramedic returning to the field and SN mother

[Linda on the move]

I think it's solid advice for ANY child, sn or not. (it would be a lot shorter for a kid with no issues!)

Every sn child is different, a copy of any special protocols for a specific child make sense. You know what they say, "if you've met one child with autism, you've met one child with autism."

[babygirlie]

I wonder how my child would feel with a Do Not Resusitate note permanently in their pocket.

Nor would I feel comfortable with a "worker" having full control over whether my child lives or dies. That's for the parent to decide and dependent on the situation.

I understand where you are coming from but it sounds like everyone involved needed a little more education in their position.

[babygirlie]

Originally Posted by Linda on the move

You know what they say, "if you've met one child with autism, you've met one child with autism."

Love this quote!

[KJoslyn78]

Originally Posted by babygirlie

I wonder how my child would feel with a Do Not Resusitate note permanently in their pocket.

Nor would I feel comfortable with a "worker" having full control over whether my child lives or dies. That's for the parent to decide and dependent on the situation.

I understand where you are coming from but it sounds like everyone involved needed a little more education in their position.

I did not read the list as something you HAVE to have, but IF there was a DNR order in place, then certainly, that is something that should be on file and easily obtainable in the event of an emergency.

Not all children/adults take medications or have allergies... but certainly whatever pertinent information about the child/patient should be known, or have documented readily available in the event of an emergency.

For example: If your child was a diabetic, you would make sure that your child knew, or that those with him/her knew the child's condition (an how to reach someone in an emergency, if juice or glucose tablets should be given for low blood sugar, etc) and maybe even a med-bracelet in case your child was unconscious and could not relay information about themselves. Having Autism, or any other disorder, is no different in my opinion.

I've worked with developmentally disabled (both in day treatment, as well as house care), and it was required that we carry a sheet with the most pertinent information (not as long as the list the OP gave, but nearly) at all times we were out of the house, for each residents that was with us, IN CASE something happened. In my opinion, the respite workers were in the wrong, and completely irresponsibly for not doing so.

[starling&diesel]

Originally Posted by Scullery

4 people holding him down, 2 arguing respite workers, and the use of soft restraints? That was a recipe for disaster from the start. As first responders fire and EMS there has to be some responsibility for adequate management of a patient with special needs under less ideal circumstances such you're describing, it's even in a perfect world and there will be gaps in handing off information. Google Dennis Debbaudt, he offers workshops all over the country and if there is enough interest it can be sponsored for free by local autism groups. Autism Society has a Safe and Sound project with information for first responders as well as parents, so does Autism Speaks with their Autism Safety Project.

Thanks for the information. I'm in Canada, but will look into it. The call was audited by a supervisor later in the day, and one of my suggestions to him was exactly this.
I would love to hear if you have any suggestions about alternatives to using soft restraints to safely transport this particular child in the back of a moving ambulance while he was wanting to bite? He bit three children at the play centre, with two of the bites requiring stitches. He also bit two of the adults involved, also drawing blood.
When I worked with autistic kids, we were trained in 1:1 or 2:1 physical restraints, through Non-violent Crisis Intervention, but wouldn't have been able to do that while in a moving vehicle. It stumped me.

Originally Posted by babygirlie

I wonder how my child would feel with a Do Not Resusitate note permanently in their pocket.

Oh goodness, this was only meant for anyone who HAS one. Not to imply that it's standard ... sorry if that was confusing. I worked with a minor who was palliative, so when we went out in the community, this was a must-have, so Emergency Workers could abide by his parents wishes.

Originally Posted by KJoslyn78

I've worked with developmentally disabled (both in day treatment, as well as house care), and it was required that we carry a sheet with the most pertinent information (not as long as the list the OP gave, but nearly) at all times we were out of the house, for each residents that was with us, IN CASE something happened. In my opinion, the respite workers were in the wrong, and completely irresponsibly for not doing so.

I agree that the onus on this one lays mostly on the respite workers. Having been a respite worker, I was appalled at their lack of preparedness. Just as you leave the house with your own essentials, we also had to have our client's ID and important information to. As well, it was the policy of the society I worked for to have protocols in advance of potential situations like this.

I just want to reiterate that I did bring this call to my own supervisor's attention, with hopes that this kind of call would be run differently in the future. Thanks again for everyone's input and feedback!

[beachcomber]

I just want to reiterate that I did bring this call to my own supervisor's attention, with hopes that this kind of call would be run differently in the future. Thanks again for everyone's input and feedback!

Thank you. Seriously. I am very grateful that there are first responders working in my community who constantly strive to improve their knowledge and strategies for handling crisis situations. I commend you for being proactive and using this as a learning moment for yourself and your colleagues.

[Scullery]

Dennis Debbaudt does go to Canada for training. A good start would be talking to your local autism societies and seeing if there is way to get a grant for him to come.

There are resources on the web, but really, he is the go- to guy for de-escalation and proper restraint techniques. He was in law enforcement for years and he has published books on videos about it.

[SpottedFoxx]

I'd love to hear some recommendations about identification. My son, while verbal, is tough to understand (articulation disorder). He is learning his address right now and is doing a great job. We can understand him but I don't highly a first responder would understand what he is saying.

I worry about him when he is on the bus on the way to school and the bus to aftercare. I'd love to have some identification on his person (book bags can get separated from a child). I've thought about a medicalert tag but I doubt he'd wear it daily.

[nicky85]

When my son is old enough to be out and about (probably around 3-4-ish?), we're going to get him a medical alert tag with his name, our names and contact info, his condition, note of possible latex allergy, and that he has a CVP shunt in place for hydrocephalus. I know you can get clothing tags, but from what I understand, EMS mostly look for necklaces and bracelets, and I'd rather have it be seen. I guess I also feel like it will only be a big deal if we make it a big deal that he wears medical alert jewelry. If any of his friends ask him about his necklace/bracelet, he can just tell them it's an ID tag in case of an emergency.

[laurata]

Originally Posted by SpottedFoxx

I'd love to hear some recommendations about identification. My son, while verbal, is tough to understand (articulation disorder). He is learning his address right now and is doing a great job. We can understand him but I don't highly a first responder would understand what he is saying.

I worry about him when he is on the bus on the way to school and the bus to aftercare. I'd love to have some identification on his person (book bags can get separated from a child). I've thought about a medicalert tag but I doubt he'd wear it daily.

We got one for my ds, for the same reason. He takes it off. I think I'm going to look into getting several of them, and make them part of our getting dressed routine, just like socks and underwear. I like the idea of sewn in tags for his clothes too, although I can imagine those bothering him.

[SpottedFoxx]

I just saw on www.medicalert.com they have a special program (cheaper) for kids and they have an alert tag that slips onto their shoe. I may order that for my son.

[Smokering]

We got one for my ds, for the same reason. He takes it off. I think I'm going to look into getting several of them, and make them part of our getting dressed routine, just like socks and underwear. I like the idea of sewn in tags for his clothes too, although I can imagine those bothering him.

[Forum crashing!] Could you put the info on a laminated card that went in his pockets (if he wears cargo pants or shirts with breast pockets), or some other non-scratchy place?

[KCMichigan]

Kudos to the OP.

Have been a Spec.Ed teacher, I am surprised at times at how 'non-school' activities are approached since at school we have to have medical info on hand at all times.

For those asking about Medialert.


For little ones or sensory kids that wont wear a bracelet---they make shoe charms/tags that will hold info as well. They *rarely* bother kids since they are on the shoe, AND the paramedics are aware to look for shoe/ankle/bracelet/necklaces. An ankle bracelet is also often used since it can go 'over' a sock, but is hard to get off of an ankle...for sensory kiddos they have fabric or woven ones with a metal plaque on it (for kids that do not tolerate a metal bracelet).

[nicky85]

Originally Posted by KCMichigan

Kudos to the OP.

Have been a Spec.Ed teacher, I am surprised at times at how 'non-school' activities are approached since at school we have to have medical info on hand at all times.

For those asking about Medialert.


For little ones or sensory kids that wont wear a bracelet---they make shoe charms/tags that will hold info as well. They *rarely* bother kids since they are on the shoe, AND the paramedics are aware to look for shoe/ankle/bracelet/necklaces. An ankle bracelet is also often used since it can go 'over' a sock, but is hard to get off of an ankle...for sensory kiddos they have fabric or woven ones with a metal plaque on it (for kids that do not tolerate a metal bracelet).

That is a handy bit of info! Thanks!

[anj_rn]

Originally Posted by babygirlie

I wonder how my child would feel with a Do Not Resusitate note permanently in their pocket.

Nor would I feel comfortable with a "worker" having full control over whether my child lives or dies. That's for the parent to decide and dependent on the situation.

I understand where you are coming from but it sounds like everyone involved needed a little more education in their position.

OK, if a child HAS a DNR it is because the PARENTS have determined that there are certain life saving measures that they do not want taken. If the medical provider (nurse, paramedic, fireman, doctor, etc) does not have a copy of it they are required to attempt to resuscitate the child.

I have a typewritten card that has her info (name DOB, address), as well as doctor's names & phone numbers, hospital preference (with MR#), Meds, allergies, and emergency contacts with phone numbers, and a summary of her baseline status. She has one in her bag, one on her car seat, one with each family member, nurse, etc who travels with her. In the carseat, by the bedside, and in her bag is also a copy of her modified DNR, schedule (with med times). My son has one as well (that is not as extensive since no special needs. I also have cards with pics for the whole family in my purse.

It sounds like overkill, but when I worked in the pedi ER we had a case of 2 siblings that were brought in by abulance after a car accident. The man driving the car was in critical condition, and we had 2 kids wo we had no idea who they were, who were acting delayed. We did not know if this was their baseline or if the was due to the injury and they father was in surgery and the mother had died at the scene. I just want to make sure any emergency personel have the most info possible.

[Oubliette8]

There was a thread over in family safety awhile ago about putting stickers with pertinent medical and contact info on kids carseats. This way if they are in a crash and the parents are unable to communicate, the information for who to call and any medications or medical conditions your kids have is right there and easy to locate for the EMTs.

Obviously a medical alert bracelet is going to be more effective in all situations since you only use carseats in the car, but it would have helped with the pp's scenario.