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Making The ER Less Stressful For Those On The Spectrum


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An emergency room physician from Allegheny General Hospital in Pittsburgh and three university professors are trying to change the way emergency rooms treat patients with autism, as hospitals begin to feel the effects of an exploding population of patients with the perplexing disorder.

The noise, bright lights and occasional chaos that characterize emergency rooms allow doctors and nurses to save lives, but Dr. Arvind Venkat wants his colleagues to realize that such an environment can pose special dangers for patients with autism.

Venkat, an emergency room doctor at AGH, joined Indiana University of Pennsylvania professors Joann Migyanka, Jeffrey Fratangeli and Susan Glor-Scheib this year to develop a training manual and DVD to help ER clinicians deal more effectively with patients on the spectrum. The brain disorder affects communication skills, sensory perception and social interaction.

Change can’t happen soon enough for Lisa Licata.

Licata, a Pittsburgh mother of three, said emergency room visits are a trial for her son Dylan, 8.

The boy, who can’t speak, is overwhelmed by loud noises, crowds and strangers. So, Licata makes it clear that Dylan must see a single doctor or nurse, rather than the parade of practitioners who typically treat patients in emergency rooms.

“I said long ago, everyone in a hospital should know about autism. An ER is a scary place to any kid, and with these kids, it’s just magnified,” she said.

Joann Migyanka taught children with autism for 10 years before she joined the faculty at IUP. She now teaches at the university and consults on autism.

She said professionals in all fields need additional training to deal with individuals with limited communication and social skills.

“That first wave, who were children when we started to see the rise of autism, are becoming adults. They are in the community. They’re accessing health care just like any other adult or adolescent,” Migyanka said, adding that people with autism can become combative if restrained or approached briskly.

“First-responders and ER personnel have their protocols, and they are all about getting it done. But you have to approach a person with autism much more slowly, with words they can understand,” she said.

Venkat said such patients “can be a ‘black box’: we can’t communicate with them, and they can’t communicate with us. So we look at what we can do to fix the problem.”

The Bureau of Autism Services of the Pennsylvania Department of Public Welfare assembled the team and paid for the training program. A 2011 survey found families including individuals with autism have reported problems with medical care.

The training manual and DVD alert practitioners to clues that they may be dealing with autism. They encourage providers to evaluate patients with autism by accessing patient history from care providers, preparing a quiet exam room, minimizing the number of personnel, using the patient’s first name, asking simple “yes” or “no” questions and letting patients see or touch materials that will be placed on their bodies.

Kay Ella Bleecher, president of the Pennsylvania State Emergency Nurses Association, said the group previewed the program at its annual convention in June. She found it a welcome addition for ER workers.

An emergency room nurse practitioner, Bleecher said the association’s members report seeing more patients with autism every year.

“They definitely present some special challenges. We’re going to do more education on it next year,” Bleecher said.

© 2013 The Pittsburgh Tribune-Review (Greensburg, Pa.)
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Comments (6 Responses)

  1. Iris Gray says:

    A few months ago I had to spend time in the ER due to a bad fall in which I fractured my elbow. (You must understand that where I live, we have universal health care and there is no payment required in the ER.) When the nurse brought me some papers to sign, he suddenly said, “So how much are you going to pay me?” I had no idea what he was talking about and asked for clarification. “My tip. How much are you going to pay me for my tip?” I still didn’t know what the heck he was trying to say, so I finally said, “Look, I am autistic. I don’t get jokes. I don’t get sarcasm. I don’t understand figurative language. If you have any questions or need to tell me something, or if I have to pay for something, please just get right to the point in plain English.” Well, he dropped the bit about the “tip” but when the doctor arrived and asked me about pre-existing medical conditions, the nurse said sarcastically, “She SAYS she has autism.” I guess since I can talk and I was not visibly stimming or flapping (hard to do so when your arm is wrapped up in a mountain of tape and gauze) he didn’t believe me.

  2. fairlady68 says:

    As an adult, when I mention I have autism and/or sensory processing issues, most medical personnel have been understanding, especially lately as more people are aware of the condition.

  3. Bianca Veritas says:

    To Iris: How come you could pick up the sarcasm?

  4. Donna Maheady says:

    Can you provide information about how to obtain the training manual and DVD?

  5. Jon White-Spunner says:

    This report is such welcome news. Bravo to all involved. These protocols should also be taught across the board in hospitals and doctor’s offices. Time and again my wife and I take our 14 year old autistic daughter to office visits or to a day surgery for a procedure. We try very hard to prepare the staff in what to expect, but in the vast majority of cases we are told not to worry, “we deal with children like yours all the time”. More often than not, after tables and chairs have been upended or equipment pushed over, they start to listen and realize that, just perhaps, the parents, who have been working with the child for years, know better than they what will work with their unique child.

  6. Heather Hudson says:

    It’s about time. I live in Canada and my lil boy has severe Autism and we have had too many ER visits to count and all but one have been horrible care,mean dr.s and nurses,rushed or no care and I have taken steps and time to educate,phone ahead and give my situation with my son etc..etc.. it falls on deaf ears. I sincerely hope they as well as police and fire services will get the much needed training a.s.a.p.My son deserves much better and he deserves proper care and treatment when we must go to the emerg department.

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