Making The ER Less Stressful For Those On The Spectrum

BY DEBRA ERDLEY, The Pittsburgh Tribune

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.

Learn more about the Autism Spectrum and how you can better serve children with Autism by becoming a Certified Autism Specialist. Click here for more details.

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