Fire safety for persons with autism

By DANG U. KOE, ASP Chair Emeritus

MANILA, Philippines -- Last April 12 this year, six-year-old child with autism Jose Sixto Hernandez, died from a fire that razed his family’s home in Pakil, Laguna.

Fire Safety Tips

The fire started from the second floor of their home, trapping Hernandez, fondly called Amboy, who was alone on the third floor, while his family was on the ground floor.

Autism Society America noted in their website: “It is an unfortunate fact that individuals with autism are at high risk in a situation involving a fire. Children with autism (CWA) have died in fires when they retreated to a favorite hiding place; others died when they retreated from an approaching firefighter, apparently frightened by the firefighter’s appearance (with mask, etc). Some children with autism had escaped fires, only to die after re-entering their dwelling to retrieve a prized object, not mindful of the danger they are placing themselves in by doing so. It is essential that we as parents/care-givers pre-plan for how to ensure our loved one's safety in the event of a fire.”

While we still lack documented local experiences for preparing children with autism during fire emergencies, there are many websites where we can get fire safety tips from.

Readers can link to http://www.asmonline.org/programs_law_fire.asp for ASA’s Guide to Fire Safety for Individuals with Autism Spectrum Disorders, which includes the following suggestions:

Be sure that a smoke detector is placed in or near the CWA's room, as well as on all levels of the home. Test those smoke detectors frequently to make sure they are in working order.

Teach your child the basic fire safety tips (stop, drop and roll; touching a door before opening it, etc). This includes picking a gathering spot outside the home.

It is imperative that one family member be specifically assigned the responsibility to get that person with ASD out of the home and to a place of safety.

It is critically important that this person also stays with their loved one to ensure that they do not re enter the home to retrieve a favorite object. Remember that the individual with ASD may become overwhelmed (with the lights, sirens, frantic activity and excessive stimuli) and attempt to flee the situation.

Be proactive by providing your local fire department with as much information as possible about your loved one. This includes advising them of the location of the loved one's room and other places they may flee in an emergency situation.

Visit the firehouse often, so that your loved one can see a fire-fighter with all of their protective and fire-fighting gear, including the oxygen masks, axes and hoses, so that they can grow accustomed to them. Also, acquaint them with medical equipment, such as stethoscopes, blood pressure cuffs, oxygen masks and stretchers, so that they might be prepared in the event of a medical emergency.

If your loved one is non-verbal, prepare a laminated card containing basic information about your child (including any allergies to medication) in case of a medical emergency.

1. Meet the firefighter

Imagine that you are suddenly surrounded by noise so loud that you cannot hear, colors have suddenly changed and it is hotter than you have ever felt. You might automatically understand that these signs mean fire but your child with autism may not.

Into this intense sensory overload, a giant hulking creature that talks funny and has no face suddenly appears. It is possible your child may have a meltdown, attack the "monster" or even hide and further endanger himself. For these reasons, it's important to prepare your child, so that in the event of a fire, he will understand what a fire-fighter is and why he is there. Having an event in which children can meet fire department personnel, see them in their suits and be instructed on how to react in the event of a fire may save their lives.

2. Use picture exchange communication

A non-verbal child with autism may be the most at risk because people tend to assume that she cannot learn. Fortunately, you can use PECS or picture exchange communication system to explain fire situations visually and show your child how to respond.

Using images that your child relates to rooms in the house, show her escape routes. You can draw how to react when smelling smoke, how to feel a door to tell if fire is on the other side, how to cover her face with a wet cloth and crawl under the smoke if possible.

These ideas can be clearly communicated with images, just make sure that your child understands the concepts as you are trying to communicate them. Do not use images she is unfamiliar with to introduce new concepts; use things she is comfortable with and then walk her through the actions the images present.

3. I know my fire safety plan

This is an interactive book created by The National Fire Protection Association (NFPA), in conjunction with a psychologist and a writer of social stories, to teach children with autism and other developmental disabilities what to do in case of fire. The book can be personalized with the child's name and information about the outdoor meeting place. It is suggested that parents use this book while showing children their home escape plan. The book can be found at the NFPA website (http://www.nfpa.org/gallery/Fire%20Safety%20Book/flip_book_r7.html).

Angels Talk tried this book online and agrees with Fire Safety Net (http://www.firesafetystoreblog.com/?tag=autism) that “ NFPA does a great job hitting points that are especially important to children who deal with autism, such as leaving behind personal objects, coping with bright lights and loud sounds, staying at the meeting place, listening to the fire-fighters, and asking parents for help to cope with the situation. The authors use repetition to stress these important factors of a good fire escape plan.”

4. Sensory issues

Children with sound sensitivities may need extra help preparing for fire situations. Often, fire drills and alarms are so shocking and distracting that the child stops understanding what is going on around him. A sound or behavioral therapist can work with the child and slowly introduce the sound (possibly at a lower, less jarring volume) until the child becomes accustomed and then teach him how to react upon hearing that noise.

Laboy also gave a list of other materials for fire safety activities including video images for fire detection.

Autism 101 for fire and rescue

From Pennsylvania Premise Alert, we found Autism 101 for Fire and Rescue (http://www.papremisealert.com/id72.html)

50 percent of individuals with autism are nonverbal throughout their lifespan; another 20 percent may present as nonverbal when highly stressed.

30-40 percent of individuals with autism will develop epilepsy or some other seizure disorder during adolescence.

Individuals with autism cannot be identified by appearance.

They look the same as anyone else. They are identified by their behavior.

When restraint is necessary, be aware that many individuals with autism have a poorly developed upper trunk area. Positional asphyxiation could occur if steps are not taken to prevent it: frequent change of position, not keeping them face down.

Individuals with autism may continue to resist restraint.

Some individuals with autism do not have a normal range of sensations and may not feel the cold, heat, or pain in a typical manner. In fact they may fail to acknowledge pain in spite of significant pathology being present. They may show an unusual pain response that could include laughter, humming, singing and removing of clothing.

Speak in short clear phrases: “Get in.” “Sit Down.” “Wait here.” An individual with autism may take longer to respond to directives. That can be because they do not understand what is being demanded of them, or because they are scared, they may not be able to process the language and understand a directive when fearful.

Individuals with autism may engage in self-stimulatory behaviors such as hand flapping, finger flicking, eye blinking, string twirling, rocking, pacing, making repetitive noises or saying repetitive phrases that have no bearing on the topic of conversation. This behavior is calming to the individual, even if it does not appear calming. They may repeat something you said or something they heard over and over and over again. This is called echolalia and can be calming to the individual.

If these behaviors are NOT presenting as a danger to themselves or others, it is in your best interest not to interfere with it. Allow THE BEHAVIORS to continue as long as the individual is safe and is safe to be around. Trying to stop the behaviors will increase anxiety and may cause the individual to act out aggressively.

Difficulties with rescue

Force entry will be most likely. Families often need to lock doors including interior doors for safety reasons. Some families bar, nail or lock windows to keep individuals with autism from trying to elope or wander.

Plexiglass or Lexan windows may be in place. This makes access a problem for rescue. Also fences with locked gates. So think of bolt cutters.

Adults with autism are just as likely to hide, like children, in a fire situation.

Closets, under bed and behind furniture checks need to be done during search and rescue.

When moving an individual with autism quickly, wrap them in a blanket with their arms inside. This will give them a secure feeling and may help to calm them during a rescue. This will also prevent thrashing while trying to escape an emergency situation.

Extreme caution should be used with any rescue from heights. An aerial tower or platform would be the easiest way to remove an individual with autism. This person may aggress towards the rescuer during this operation. Always make sure you are secured before you attempt to rescue the individual.

These individuals are a bolt risk after rescue. Fire-fighter must stay with the individual with autism.

Uploaded with Permission

Acknowledgment to Manila Bulletin: Fire Safety for Persons with Autism