106: Special Subject Populations with Katie Schuelke

How can teams best support subjects from populations with unique needs?

Is your team prepared to respond to a call to support an autistic subject? Or a subject with dementia? What about someone with other communication or sensory needs?

Today, we talk to Katie Schuelke to get important perspective on working with these special subject populations. Katie is working with Base Medical to develop a course that can bridge this gap and set teams up for success.

Today's Guest

Katie Schuelke: King County Explorer SAR, EMT, and Speech Language Pathologist

Transcript

SPEAKER_01 0:01

Incident command to field team. Sending in mutual aid.

SPEAKER_05 0:06

Welcome to SAR Mutual Aid, the podcast where search and rescue teams share lessons, tackle challenges, and find real solutions.

SPEAKER_06 0:15

We bring together leaders from SAR teams across the country to discuss solutions to universal problems.

SPEAKER_05 0:20

I'm Teal Harvest, Base Medical CEO, a wilderness paramedic nurse, and a SAR volunteer in New Mexico.

SPEAKER_06 0:27

And I'm Lauren Skinechny, a wilderness EMT and SAR volunteer based in Portland, Oregon. Join us as we cross county lines to find new ways that you can empower and strengthen your team.

SPEAKER_01 0:38

Presented by Base Medical.

SPEAKER_06 0:40

Hi Teal. Hey Lauren. I am so excited to welcome everybody to the podcast today. We have now launched the podcast. It's been going for a little over a month and a half, and we have been so excited to see the response to some of the information in the interviews that we're sharing. So thank you so much to everybody that's listening. If you have any ideas for a future podcast or you want to participate or have questions, please reach out to us at hello at base-medical.com. We've already gotten some great emails. We might start sharing some of those on future episodes. So any thoughts at all, send them our way. Teal, tell me a little bit about what we have today.

SPEAKER_05 1:20

Yeah. Well, tell me, Lauren, have you on your search and rescue team, have you ever searched for someone who has dementia?

SPEAKER_06 1:30

We have, yes. We've been seeing more and more call-outs for folks that have walked away, especially in some of our more rural areas where it can get pretty dangerous pretty quickly. And it's it's a scary call.

SPEAKER_05 1:42

Yeah, exactly. And, you know, your team is not alone in that in experiencing an increase in searching for dementia subjects, maybe those with Parkinson's and Alzheimer's. Uh that we're seeing an increase nationwide with search searches for those subjects. Uh, but I also would like to know have you ever searched, been involved uh in a search for maybe a child with autism?

SPEAKER_06 2:06

Uh my team has not, but I can imagine the the challenges of that just based on how someone in that population might not match the standard expectations for how a child might behave. But yeah, I don't really, it's not something that we really talk about that much in the search and rescue community.

SPEAKER_05 2:23

Yeah. Well, and then we also have the deaf and hard of hearing community. And this community is the largest disability group to recreate and work in the outdoors.

SPEAKER_06 2:34

Oh wow. Yeah, I have actually um participated in a in a rescue with somebody who was deaf and had an upper arm injury. Um, and it really made communication so challenging. It made me realize the need for just increased communication tools.

SPEAKER_05 2:49

Yeah, exactly. And you don't want to restrict someone from signing if they're if they're deaf and hard of hearing, and some people may not realize that. But that's you know, what the point I'm getting at is we have subject populations that differ from the typical subject that we're searching for in the wilderness, right? They differ from the hunter that's lost or the trail runner. These are subject populations where we have to throw lost person behavior out the window to an extent because they just don't really fit that pattern. We can't do vocal attraction with the deaf and hard of hearing community. Dementia and um autistic children aren't going to display those typical thought processes and patterns that we would normally rely on and use to plan our searches. And so that's what today's conversation is about. It's about those special subject population groups. And that's what we're calling it for right now. Um, we are trying to find the best terminology. So I do want to put that disclaimer out there. Um, but for the time being, we're gonna stick more with like the EMS terminology of special population subjects.

SPEAKER_06 3:59

Yeah, it's it is such a good point. I mean, we we use things like last person behavior as a baseline to establish how somebody who fits this certain demographic might most likely behave. But within that, I mean, there are so many nuances and and gray areas, especially once you start to throw in folks who have autism, suffer from dementia, um, and other have other special communication and and behavioral needs.

SPEAKER_05 4:27

Yeah. And well, you know, when it came to just looking for resources and how we can better adapt to these special population groups, um, I found that there was not a lot out there. And in fact, I was asking our medical directors with New Mexico search and rescue to present on dementia subjects. And they were reluctant at first because they also felt, even though they were physicians, they felt like they weren't the experts in this. But we, as a search and rescue community, one of the unique things about our community is we do have so many people from such a diversity of backgrounds that bring so many, so much, so many other skills and knowledge to their teams that I knew someone was out there that could help us with this. And I did find that person. And she's actually leading the way in this and really helping her search and rescue team and others try to navigate the these uh special subject populations. And that's Katie Schuelki, and she's with King County Explorer Search and Rescue. And I am so delighted that we get to interview her today to learn more.

SPEAKER_01 5:27

That's great. I'm excited to hear it. In SAR, you're expected to deliver professional care, which is why every responder should at least have a Wilderness First Aid certification. Base Medical offers the only Wilderness First Aid and First Responder courses built for search and rescue. Get your SAR WFA or recertify your WFR with live instruction online from anywhere and for half the cost. Or become a base medical instructor to deliver training to your team in person. Learn more at base-medical.com.

SPEAKER_05 6:05

Hello everyone. Thank you for joining us today. We will be exploring how search and rescue teams can better support individuals from special populations, which we will define here in a moment. But from search planning to care delivered in the field and evacuation, we have so much to talk about today. And we have with us Katie, who brings forward her expertise in this area. So, Katie, I will let you introduce yourself.

SPEAKER_02 6:28

Thanks for having me here. I'm Katie Schulke with King County Explorer Search and Rescue based out of uh western Washington. And I have a plethora of experience and background professionally working with um kids and adults who are autistic and specifically concentrated in people who have difficulty communicating, so often defined as someone who's non-verbal or as limited verbal interaction. I've been with this population for the past 12 years through various roles. My current profession is I'm a speech therapist and I've had a specialty in this population. But prior, I have had experience with outdoor recreation, with inclusion. So helping people get into the nature get into hiking trails, Rocky Mountain National Park, all those different ones, experience with swim coaching, and different just therapeutic recreation. So I've been on the fortunate side to be able to both see from the search planning and from the search and rescue perspective of what these missions look like, but then also go into sessions where I've been greeted by parents saying something like, Oh, we almost had to call you this weekend because my son uh ran away from the home and we saw him right before he turned the corner, some or things like that. And I've been able to really help start to bridge that gap and realize that there is a gap that exists in those two communities.

SPEAKER_05 7:48

Yeah, completely. I mean, it seems like more and more we are seeing search missions that involve these special population groups, which again, I think before we go any further, let's go ahead and just get those disclaimers out of the way. Um, because when we're referring to special populations, this is the terminology we're currently using at the moment because we feel like it's the it's the best we've landed on so far that could change in the future. But we're really talking about individuals who, just as you described, have maybe some sort of communication or cognitive um challenge that then we have to consider in when it comes to searching and caring for these subjects. So can you just elaborate more on like what does special populations mean? Who are we referring to, and then kind of some of the disclaimers that will help guide the rest of our discussion today?

SPEAKER_02 8:39

Yeah, so specifically for today, we're gonna be heavily focusing on our population who is autistic and um often has city-think communication challenges. So the general public term would be nonverbal, which also means they might not have, they're not be completely nonverbal, but they might have very limited verbal communication or not be able to rely on it fully. So I'm gonna be referring to someone as autistic, nonverbal. Um, there's also a back and forth of that population. So we're gonna be using identity first language, which a lot of our autistic individuals prefer, but we don't want to get focused on those semantics right now. Um and also talking about so autism is a neurodevelopmental disability. We may want to make sure not to get stuck in the lump of if someone doesn't have a diagnosis, but it's someone who might fit that population. So sometimes we'll see kids who are younger who they've walked away, they don't have a formal diagnosis yet for various reasons, but we still want to be keeping these considerations in mind. We also, these different topics relate to someone who has a neurodevelopmental disability, so they're born with some type of disability or have had it since childhood, who may not have a formal auto diagnosis, but have other similar diagnoses too. So we want to make sure not to get stuck in a um monolithic type definition. And you also notice that a lot of these different strategies we'll be touching a little bit on um dementia, but we're really focusing on that autism and developmental disability today. But you'll also notice a lot of these different discussions we're having are actually applicable in these different terms and strategies towards all of our subjects. A lot of these different things are best practices for not taking a one size fits all approach using different communication strategies. And you'll hopefully start to notice trends that what we're talking about specifically with this population is applicable to almost all our subjects as well in different degrees.

SPEAKER_05 10:41

Wow. Um, I mean, I I guess I can I can see that where um there are aspects of how we adapt to this special population that can be included in just our general approach. And so that's that's really incredible. I do want to get back to something that you mentioned because I'm not too sure what it means. What is identity first language? Is that is that how you phrased it? What does that mean?

SPEAKER_02 11:06

Um, one of those kind of talking about the semantics, we want to make sure that semantics are not and syntax is not going to be a barrier for rescuers in the field. Um, just like everything, there are people on both sides. A lot of the autistic community is actually preferring to say their diagnosis first. So an autistic kid, an autistic adult versus a person with autism. Um, so for this podcast, there are people in both camps. I'm choosing to use that identity first language, but in the field, we really want you to be focusing on subject care and having those best practices holistically. We don't want you to be focused on semantics. And we've had that that I've seen that idea reflected repeatedly from my professional experience as well, um, is parents want to someone to ask them the uncomfortable questions versus just avoiding them or avoiding getting this knowledge. So we'll hopefully be touching on some of those things that people might be more nervous to ask too in this podcast and helping break down that barrier because that's where some of that divide between the communities of first responders and search and rescue come with those that autistic community, that neurodevelopmental disability community. And we want to help bridge that gap in a meaningful way and encourage people to start those conversations.

SPEAKER_05 12:23

Yeah, I I completely agree. I mean, that's definitely a barrier, the semantics and that fear. And if we can get past that, if we can provide a guide for search and rescue responders, then I think they'll be able to deliver better, much more um adequate care for these subjects. But one thing I do want to make sure we establish is why do you think this is so crucial for search and rescue teams today when it comes to understanding these special populations?

SPEAKER_02 12:53

What I would say is that with this population, there's not any more urgent things, say today, than there was a decade ago. But we're starting to realize that there is more of a gap that's growing as search and rescue is growing overall. Um, but then as social media things like this are coming out, um, as our society is becoming more integrated, we are noticing that there's a gap that is growing, feels like in divide there. Um, one of the reasons with our autistic population is about 50% of autistic kids have had what we call eloping instance. Eloping is a term you might hear commonly in this community. It doesn't mean running off to get married, it's a term that's meant um like running away from a safe situation, wandering away. It's just kind of a shorthand. Um, but that's a term you might hear with reports, things like that, that someone's eloping. Um, but research has shown about 50% of kids with a diagnosis have instances of eloping or tendencies to wander away. Anecdotally, with the population I worked with, I would say it's over 90% of parents, caregivers, both through my speech therapy practices and through the special recreation, who have shared concerns about whether there's frequent wandering episodes, um, frequent fear of what would happen if this happens, and that's people who arrive on scene aren't gonna know what to do, and a growing um misunderstanding of what's gonna happen. I've had parents report to me that they didn't know that 911 was a resource, and when their child or adult child walked away, ran away, they would try to recruit neighbors. And I've had people tell me that they had several hours that the person was missing. They didn't know they could escalate to law enforcement. Um, I've heard different myths, as in someone was worried and got the impression that the search dogs would bite their child. So in their mind, they thought it was better to um just recruit neighbors to help search than the risk of having a dog bite. That's such a sense. They were scared to ask that question and kind of have that back and forth dialogue. So that's why that the statistic is 50%, which is large in general, but anecdotally, the population who might have that divide might experience those wandering or loping instances much higher. And with our population dementia, it's six in ten adults who are diagnosed with dementia. Um, will have some type of episode of wandering, getting lost. So those are really high numbers. And as hopefully this gap narrows, we're likely going to see more in the field because hopefully we're gonna be getting more of those reports five minutes after someone runs away or gets lost versus hours after when we finally get notified, when 911 finally gets notified.

SPEAKER_05 15:47

Yeah, I mean, it seems like nationwide SAR teams are seeing more and more dementia um missions, missions that involved uh individuals with dementia. I I agree with you on like, you know, autism and those that are part of the deaf and hard of hearing community, like they've always been there and we've always been responding to them. But yes, the gap is now starting to grow. And so I think it is important that SAR teams address this head on. We actually address this head on in New Mexico with the dispatch legislation that we push forward. It heavily included the silver alert system here in New Mexico. And so if it is an elderly individual that is has wandered off missing, lost in a wilderness area, we're now part of that silver alert. So we actually are getting dispatched sooner rather than later. And we're as a result, seeing more and more of those calls. Um and the law hasn't even come into effect. But um, but yeah, Katie, can you with your experience, can you provide just some real world situations where a lack of awareness of how to adjust and best meet the needs of these special populations led to complications or maybe even poor mission outcomes?

SPEAKER_02 17:00

Yeah, so due to the sensitive nature of search and rescue missions, um I'm not gonna speak specifically on um real-life SAR missions. However, with that kind of breadth of clinical knowledge and outside knowledge I have, I'm gonna speak to some uh situations I've personally experienced that I uh could have done much better. And that's also to represent that I am a professional. I have that 12 years of experience, but I still have times where I look back frequently and say, I could have done this better, or I missed this cue. Um so we really want to start and just help people provide a concrete, like foundational base for them because that other divide is we've had I've had SAR responders come up to me and say that they were nervous to respond to an autism mission if they happen to be on the team on scene that they weren't quite sure what to do, things like that. So we want to make sure that divide is kind of narrowed and realize that everything's a little bit in flux. Even for us, this is a very new conversation that's happening in the search and rescue community. So we're also taking this day by day, month by month, and learning as we go. Um, so a couple of those just anecdotes from my personal experience where I have missed something or it hasn't gone well was um, and all these have happy endings. So my first job when I was a teenager was working for specialized recreation, which is a park district for people with special needs who are out in the community doing different things. And in one of our programs, we had a participant elope. Um, he got away and we didn't see which direction he took. So we were in a building and frantically triggered all the staff to start searching. And um kind of over the course of a little bit of time, we had we were pretty convinced he wasn't in the building. So supervisor was escalating up the chain, getting emergency services involved, and we had searched everything. We made sure the elevator had been checked, stairways, everything. And in this case, I had a bit of a just a gut feeling, is the best way I could describe it, to go check the elevator again. There's only one elevator in the building, a small little building. And this time I opened it and I walked all the way in. Um turns out our participant had wanted some respite. He wanted some peace and quiet. And that's one of the things we're gonna talk about a little bit later in this is really determining why, the best we can, why someone eloped, why someone wandered away, because that helps influence our search strategy. In this case, had we taken a step back, we may have been able to determine, thinking about who he was, thinking about just it was loud day that day, um, that he may have wanted some peace and quiet and try to find a place to hide versus like running out of the building or wanting to go explore. And he was sitting super content by himself. He'd gotten, I don't remember how long, probably at least 20 or 30 minutes of respite, just sitting underneath, pressed against the elevator panel. Um And the reason why we didn't see him when we had first checked it was because when the elevator was checked, it was just visually cleared. So the doors opened, looked in, said he's not here, versus he was just pressed on the back side underneath the buttons. So that was one of those areas where it's not a formal SAR mission, but that delayed being able to find him, he loved it. He got extra time of break. Um, and he was able to get some peace and quiet. But the natural thinking about those implications, if that was in a wooden environment, and we missed him by not completely visually clearing that area, but reporting that being cleared. Um, so those kind of extrapolations to a SAR mission. And then another one where I missed a signal from a client was a lot of our um kids and adults, and this is also applicable sometimes to dementia, different stages, use um unique communication or non-vert non-universal communication, which might mean they might use their body to communicate. Or we talked about they have um limited verbal speech or less robust, they're gonna get creative about it. So in this case, um, this participant had another medical condition that would flare up, it'd cause a significant amount of pain. And sometimes he had fairly subtle signs that he was in pain. So I had missed his subtle sign, and when you're in a pain, you can't really think about a more effective way to communicate. Everyone's had that experience where their brain just kind of freezes.

SPEAKER_05 21:37

Yeah.

SPEAKER_02 21:38

Um, so I had missed his subtle sign, and I was just kept talking and had not created an environment that was or helping him address it. And in that case, he took um a portable whiteboard and smacked me with it. And he was able to basically found an effective way to communicate and get my attention. He didn't pick the hard water bottle or something else that would have caused significant damage, but he knew that by doing that, I would pause and say, This was unusual. What is he communicating with this behavior? And in that pause and kind of having myself take a step back, he was able to effectively help me realize that something was wrong with him. He was in pain, he needed help.

SPEAKER_03 22:22

Yeah.

SPEAKER_02 22:22

Um, so that's another instance where I missed some signs, and he found a creative way to let me know that, hey, this happened.

SPEAKER_05 22:32

You know, to your point, as a nurse in the ER, we have dementia subjects, dementia patients that come in. And unfortunately, sometimes they're with us for a period of days based on our system and finding placement. And it's quite sad. And I when I'm treating these patients, I do have to go through the process of are they in pain? Do they have to use the bathroom? Uh, are they hungry? And a lot of times what I'm seeing our dementia subjects or patients start acting out or maybe becoming a bit more aggressive. I usually go just back to the needs. What do they need right now? And when I figure it out, the entire situation calms and they're much better. And so I think that we just have to remember those things. Um, but yeah, you know, I would it it does seem like obviously special populations, we there are some general approaches, but overall we can't do a one size fits all approach, which makes sense. I mean, you know, the the interacting with a dementia patient or an autistic individual is much, much different than if you were to interact interact with someone from the deaf and hard of hearing community. Um, but I do I would like to cover some of um the specifics, especially when it comes to autism, since you this is more of your expertise. But when it comes to our search and field operations, how do lost person behaviors differ for these populations? Um, is there some, you know, how do we adjust when it comes to the search phase of our missions?

SPEAKER_02 24:06

Yeah, so as we know with searches, it's not just the active field operations of each team going out. There's the strategy behind them, there's getting information, and we'll kind of talk about all those different areas. Um so as we talked about, as you were saying, there's not a one-size-fits-all approach. And we really want to emphasize that's not just in between subjects with different diagnoses. We all know that you're not going to have the same search strategy for someone with autism versus someone with dementia versus a hunter. A good example with our more tip more typical missions that we have are we're not gonna treat a mushroom hunter potentially the same search strategy as a large game hunter because they're gonna have different areas that they're going to, different patterns, things like that. So, but the same is done within the autism community or disability community as well. We don't want to just say that we have some of autism and we're gonna just universally apply all of these different techniques without taking into account other situations. We do acknowledge that um there are different different living situations people are in. Sometimes we don't have the um privilege of getting a lot of information about a subject. We might show up and they say, they just moved in here. Um, we see that a lot sometimes with our dementia patients or subjects of that they just moved in, we don't have a lot of information about who they were, what their job was, things like that. And sometimes we can see that with our autistic subjects as well. So, that being said, there are some base kind of foundational things that if you don't have any info, like lost person behavior, we're all fairly familiar with that, has some good starting spots to check in structures, dense foliage, things like that. Um, but what we don't want to do is just take a one size fits all, they have autism. We're only gonna go by this approach. Um, even with like that data, I think it's about 50% are found within a mile, but then 95% are found within just under 10 miles. So thinking about that range, about what other info do we have that we can try to figure out what profile this person's in. And that's especially important for autism. One of the common misconceptions that people have that I really want to help dispel is that just because someone is nonverbal doesn't mean that they are not capable of planning and having that online decision making. We'll find that sometimes people and caregivers will underestimate what their loved ones' ability is. Um, a great example of this is as a side, all of my examples that I'm using more specifically have been cleared with the actual individuals. They've all been de-identified, um, but we've been able to connect and they're all very excited to have their different information be able to help better responses for their community. Oh, wonderful. So, this one individual, a good example of how that planning is, is that we had a famous Snowqualmmy zebra incident about two years ago in this area where zebras got loose in Northend. And there's about a week-long period where a zebra was just chilling basically in our areas along one of the bike trails. People were seeing it. They couldn't, you can look it up. They couldn't get it contained for a while. So, for therapy that week, I had used that for a lot of my sessions to talk about that. And one of my individuals who he has a history of eloping, his family has had to call emergency service on him. He's given them some close calls, and he likes to get out and explore. He got really excited by hearing this and grabbed his communication device, which in this case is an iPad with photos essentially, that he can put sentences together. And he ran, got super excited, ran off camera, and got it back and said, Zebra moon. And his idea was that he wanted to go search for the zebra. He thought it would be a better, easier to see at night. And that was his idea. He was like, they haven't found it for four days. I'll bet no one searched tonight. Let's try this. In that case, the zebra was found a couple hours later, and think he was pretty bummed that he couldn't test that theory. But had he actually tried to get out of the house that night and not gone with parents, because our individuals there they want independence too. Um, they will sometimes take matters in their own hands. That would be critical information for us to know. We wouldn't necessarily be following as much of that typical profile for him of um really focus on buildings. Or we when they say check water first, like you still want to check like backyard pools, things like that, but we wouldn't be focused on that profile knowing that he had said that earlier in the day. We'd think, hey, on the news he's seen that's on this, I think it was on the Snow Qualmie bike trail, um, that he potentially would want to go search over there, or he was on a mission to try to find this zebra. So we might not look at like Safeway or Fred Meyer.

SPEAKER_05 29:21

Exactly. Well, and that's also, you know, again, with like the differences if you have a dementia patient, we had a we had a subject that um she she planned her escape. I mean, she told her family one thing and uh ended up out in the mountains because she was convinced that they were trying to kidnap her, and that's something that's quite common with dementia. And so that definitely provided a different element to the search because it's like, well, does she want to be found? Is she going to try to hide from us? Where is she going to try to hide? And um, again, entirely different approach that you have to consider. So that's it's all it's all very interesting. But um, but yeah, what are some, I guess, like modified search techniques or strategies that SAR responder, SAR teams could use when it comes to searching for these subjects? Is there specific information they should gather up front? What's the language they could use, just any any guidance there for search and rescue teams?

SPEAKER_02 30:23

We'll talk about a few of those different ones, and there's kind of some more questions and different things that you can get a hold of. And I know that we're working on developing some stuff with Face Medical too. Um, but a good place to start is just trying to figure out why they left. As we said, the Snow Qualmie zebra incident is different than um a different client who I see clients across Washington. So there's a different county that this client is a part of, and he is an independent teenager. He's nonverbal, he needs a lot of assistance, but he decides that he wants to go. In fact, he's used his um AAC device or that talker device to say, I'm a teenager, I can do it myself, and then go do something that he wanted to do by himself. So that he's a case where he will go and try to find different snacks that he will want to go and figure out. So for him, when he's also had escalations with law enforcement, he's been gone for a little bit longer and they've brought him home. Um, but he figuring out was he on a motivation to go get snacks? And he didn't want to ask for help because he's independent, he's a teenager, and he didn't want to ask mom, he wanted to go figure it out himself. So, really trying to figure out those different motivations. It can be things like wanting being on a mission, wanting to go find snacks. We've had a mission in county where someone was trying to go find their favorite snack, and they succeeded in it. We actually saw a CCTV of them that helped us kind of figure out where they went, but they had their convenience store um meal and a drink crossing the crosswalk. And so we kind of confirmed that they were successful in that, but that was the reason they left. So we're able to start saying, our best guess is they're looking for this, these are their favorite places they're gonna get this. Let's try to see what routes they would take from their house, typically with their family, to go to these different stores. Let's put resources here. Um, another example is we had a mission where somebody was likely trying to initiate a game of tag with a caregiver on one of our local trails, and he was much faster, and the caregiver lost sight of him, and that's how the mission began. In that case, um, the likelihood that he was going to check out something that's like an item of interest or trying to go to McDonald's was a little bit lower than that ongoing guess that the caregiver was, he always likes to initiate these games. So he's gonna act in a different way and he's gonna make different decisions when he realizes that he's lost, he went too far, he now lost contact. Um, and he is gonna make different in the field decisions. We have other examples of it, might be that they want to go to a favorite park. So determining those different parks. Um, it might be that they are trying to escape something that was like a loud or uncomfortable stimuli. Um, and that's more of that immediate fight or flight. I just need to remove myself from this situation. Um, in that case, you might have someone who's more like wedged themselves underneath something because that deep pressure. So I've had clients who have gone under dressers and actually caused like an hour-ish search and they finally found them under a dresser that they didn't think they could get under because they're trying to get that pressure. Wow, which means they could also get under a log or so that's kind of live decision making of our subjects is important because someone on a mission to go find um something that they're interested in is going to be a different rationale than someone who is trying to escape something that's uncomfortable or painful for them. With sometimes we know that loud noises, um, overwhelming visuals can be amplified in autistic brains and it can cause them to try to get into that fight or flight. But really trying to determine those different things and find those individual interests can help guide that search planning phase and where you're putting some of those resources.

SPEAKER_05 34:32

You mentioned so many good points on trying to figure out the why, which we may not know, but um, the other consideration, it seems, is just the sensory side of things. So with our autistic individuals, maybe it makes sense to rethink vocal attraction and how many lights and loud noises we have going on. Of course, that's a factor when it comes to interacting with the individual, but it could be the opposite for someone of the deaf and hard of hearing community. Obviously, yelling their name, they're not going to have a response to that. That's going to be useless in your search technique. And so that's where you may want to rely more on the uh visual uh signaling the individual through visual um cues like the siren, the lights, and um maybe those other those other types of strategies. When it um when it comes to actually interacting with these individuals, what are some of the things you can give search and rescue responders to make them feel much more comfortable and providing the best care that they possibly can for the subject?

SPEAKER_02 35:40

Yeah, and backing up a little bit, because they all kind of tie in. So then that micro level with that sensory input, um, even for both planning and then subject interaction, sensory is a really big component. So for specifically for autism, something that I've come up with both professionally and used in search and rescue is behavior. So how someone's acting, because a lot of times there can be some stereotypes or even negative stereotypes or mystery behind autistic behaviors. They're just a combination of communication and sensory. So, what are they communicating with their behavior? Um, if the sensory profile, if they're getting overwhelmed, overstimulated, just like if you or I get too much coming up at us, we're gonna start acting differently. Or if we get shined in the face with a headlamp, we're probably gonna be a little more irritable. Um, and maybe say, Hey, please stop that. I've had subjects ask me to stop that before. Um, but kind of figure out how the sensory environment is also gonna influence how they behave. So both on the search to try and get in their minds a little bit and asking more questions, like how how would they react if they do they like gardening? Do they like getting dirt on them? Do they like um kind of like bushwhacking is a hard term, but do they like when they if I see something interesting, will they go into a bush? I've had a client, there is a single bush in a parking lot next to a fence, and instead of going walking around, or not even bush, a tree, instead of walking around the tree, he saw something marginally interesting on the other side and just went straight through the pine tree. Oh wow. So that's incredibly important information for us to figure out because that means we're gonna be focused potentially more on off-trail searching because that's not a turn for him. He is not as impacted by that touch. He likes those actually bigger touches of scratches versus someone who is really aversive to it. We've had a subject profile where the caregiver's best guess was if they if he had decided to go off-trail a little bit because he saw something or he thought he saw the exit, they think he would go in a couple feet, and then it was gonna be such a versive experience that he actually wouldn't want to exit. He would just freeze and sit down.

SPEAKER_04 37:59

Oh, wow.

SPEAKER_02 38:00

So that also changed how we were having teams clear areas, knowing that he might be sitting down and that we probably weren't pushing again. This is all for that hasty search at that start when we have limited resources, limited time. But we weren't gonna use as many of our resources pushing 100, 200 yards into the woods in the dense brush. We were gonna try to focus more on clearing trails and a little bit off. So knowing that information and getting that information from family and kind of a dynamic interview comes in handy for that like micro search planning as well as that subject interaction.

SPEAKER_05 38:34

Yeah, I mean, it's interesting what you say on the elevator example of how it was visually cleared, but you had to actually walk in and clear it. Um, that that does remind me of the the mission that I told you about with my my family. So it was like when I was living back in Germany, my my uncle and my cousin, who was autistic, went on a hike, and my uncle ended up falling to his death. And my mountain rescue team had to search. Both of them were, of course, overdue. But one of my friends on the mountain rescue team found my cousin huddled behind a waterfall, which probably was the last place they would have considered looking for him. And um, that's where that's where he ended up being. I think they almost just looked past the waterfall because again, who who would think to actually look behind the waterfall, and that's where he ended up being. So just fascinating points there. Um, and yeah, and when it comes to, okay, you've you've found the the subject. My my cousin in this case on this mission was found, of course, behind the waterfall, but completely naked. And the situation was such that the mountain rescue team, my friend, had to somehow convince my cousin to repel down the waterfall. They were gonna repel together. That was the only way out of it. And so very intense situation. And overall, I think he handled it well. They got my aunt on the phone. Um, she was able to talk to my cousin and they were able to figure out and it went smoothly. But yeah, what are some what are some tips for responders out there when it comes to interacting with these individuals in the field?

SPEAKER_02 40:10

Mm-hmm. So remembering that formula that behaviors are a mix of communication. So what they are trying to tell you, communicating with their body, and then that sensory experience. So you're talking about with your cousin, um, some of those different profiles we see, and why this population is also a higher risk profile is because sometimes clothing can be even day-to-day a sensory and comfortable experience. Think about scratchy tags, those different seams that clothing can have. Um, one of my clients who has interacted with first response several times from getting lost or walking away often goes out without potentially any clothes on, or at least socks and shoes. So thinking about we don't get super cold in Western Washington, but we're still sometimes mid-20s and raining. So that raises up that urgency, and that also explains when somebody is when anyone's stressed out, those different things that can be triggers get amplified. And especially if somebody has um extra like sensitivities to sensory different things. You they're already stressed out, there's more people around them, they've been lost for a while. These um strategies are not just for our missions that are known an autistic subject who's lost, walked away, or someone's dementia. Our subjects go out and recreate. I've had um subjects who almost had a call search and rescue on their mother who rolled her ankle, and he was just hiking with her. So it'd still be as our teams are responding on a packout. Coming on the scene and realizing that someone is also autistic is using some of those different strategies because had it escalated, mom would have been in pain in the litter and less able to help with those barriers. So having subject and teams on like a knowledge base for this is important. Unless there is an imminent life threat or scene safety issue, which often we don't see those super imminent type things with this population, being able to take a step back and analyze the situation because it's a lot easier, again, with anybody, but especially when there's a communication barrier, it's a lot easier to keep someone we call regulated. Um that kind of calm or relaxed state versus trying to get someone who's then agitated back to that calm or relaxed state because we don't have those different creature comforts of like being inside. It's still potentially cold, wet, rainy, you're getting more and more tired. The subject's gonna get more and more tired as things are going on. So you really want to work on trying to maintain that regulation, that calm state as much as we can. So being able to approach the subject and just take your time. So when you go off, see how they're responding to you. Um, did they acknowledge that you were there? Or do they appear that they don't see you, which can be a big thing of if they're not hearing you, if they didn't see you, startling someone is not going to be a beneficial thing towards building up that rapport.

SPEAKER_03 43:17

Yeah.

SPEAKER_02 43:18

Um, are they walking around? Are they pacing? Um trying to get out of that typical um protocol, but the typical routine we have for subjects and just be able to slow down and realize what we can adapt. Um, because again, if it's not a life or life or immediate same safety issue, um, we can be flexible. We can be a lot more flexible than we think, where that means we're walking with the subject, we have just one person approaching them, maybe two, but we don't want to add extra overwhelm. Um, keeping headlamps low, having whoever's doing your radio comms not right next to the subject.

SPEAKER_05 44:00

Yeah, that's important.

SPEAKER_02 44:02

Those different things are even best practice for our typical subjects. So kind of going back to that, a lot of these different modifications are going to be helpful for all our subjects, but especially important when you have a subject who might have sensory or communication or cognitive differences.

SPEAKER_05 44:20

Yeah, no, I I think those are all really, really great points. Uh, and something you mentioned earlier, too, of just how do they communicate and to be prepared for communication if you do find them. So whether that's um bringing maybe bringing the iPad that they use to communicate into the field or uh making sure you have a family member to call if there's a need, like the what happened with my cousin, um you know, with the some of the dementia subjects, especially those that think that we are there with ill intentions. Um, I found that a great de-escalation technique is just to validate their feelings. They might have an altered perception of reality. And if you were to deny that and deny what's going on for them and how they're feeling, that's going to make the situation much worse. So I think validation goes a long way. And then, you know, with the deaf and hard of hearing community making sure that you may not have an interpreter or that capability in the field with search and rescue, but that's where a little bit of pre-thought, like uh making sure you have a whiteboard and a Sharpie or a notebook and a pen and making sure they have access to that as well. So that way you can communicate back and forth. I mean, those are all things to think about when you're on scene with an individual. Likewise, uh, with the deaf and hard of hearing community, and I think with some of these other special population groups, when it comes to evacuation as well and getting them possibly in a litter basket and strapping them down to think about how that might impact the subject. And with the deaf and hard of hearing community, you definitely wouldn't want to restrict their hands from being used, whether it's for writing or for sign language. Are there any other aspects you can think of with um the autistic community when it comes to like actual evacuation, packaging them, getting them out of the field?

SPEAKER_02 46:08

Well, again, if we if we're in a situation where we need to evacuate somebody, um first of all, thinking about again, that's slowing down. Um, visuals for any of our subjects, how many times have you tried to describe what a litter is? Because for anyone, that's a very novel concept, and a lot of people get nervous with that. So taking that time, um, potentially having a teammate get into the litter, if you can wait, if it's there's a little bit of cold stress, but you can wait for caregivers to get on scene to show them, even have a caregiver get in quickly package them. It takes an extra 10 to 15 minutes, but being able to not have somebody think about if someone has a broken ankle and some of our kids and adults will have when you call fight or flight, it's a flight response. Think about if someone starts getting uncomfortable and either jumping on that injured ankle or running. That situation just got worse for their injury, their healing, because we tried to rush it or go too quickly. Um, when you're talking about like writing, try different methods of communication. Um, it's typically, I would say it's unlikely that um their communication device will be able to get sent into the field just from the logistics of how many teams are there. Um, parents might have it on them in that case of an individual who's just hiking with their family doing leisure and um someone gets injured. But one of the things that we'll do in County is a lot of us just have a communication board that the likelihood of being able to use it with a subject because all of our different um subjects have different methods of communication, different symbols. There's I don't know, probably 50 different libraries, types, things like that. But building up that rapport and making that effort can go a long way. Rap is really, really important, as well as being unconventional about things, potentially being flexible. Um, and examples if someone's hands are really, really cold and wet, um, seeing if they want to put socks on or helping them socks on their hands, um, helping them if they're cold and wet, taking that time, if they're cold stressed, a few extra minutes isn't gonna make it worse. However, if they get more stressed out and they have that sensory like sensitivity to their clothes and they disrope, suddenly that situation got much worse because it's gonna be difficult to get on layers. They're not only in mildly wet clothes, they now have no clothes on. So be able to take that time, slow down and watching the situation, watching their behaviors, taking note of who arrived on scene. If um, sometimes we'll get drones overhead and whether trying to get visual on the scene, things like that. If you hear a drone come in, note that because then even if a couple minutes later there's an extra, there's um growing like dysregulation or someone's getting more stressed out, you can start to notice note those different factors that change to try to get ahead of it. Because we want to be proactive, not reactive for those different situations.

SPEAKER_05 49:09

Yeah, I think that's really important. And you mentioned rapport. One of the things that I've seen done really well on some of my missions and with my my cousin, including, even though again I wasn't there, but how it was retold to me is the when rapport is established, it's important that you keep that same responder with the subject and you're not switching responders, like typically happens on a lot of our search and rescue missions, like the when the litter basket has to be carried and there's a lot of changeover. You may want to set rethink that um with these with these individuals. Um likewise, again, just like realizing how capable they actually may be to back it up just a little bit with my cousin. They found him behind the waterfall. I believe he was like actually up on more of a cliff. Like he climbed up there. He was physically the age 21 and would join my uncle on lots of different hikes multiple times a month and was incredibly fit and very capable of really going the distance. Um, and likewise, we've had some subjects that again, we we have found um climbing and in places that we never would have thought of and that have presented a safety issue, but building that rapport with them, calming them down, and keeping them with one person really went a long way, as well as reducing the radio traffic and the headlamps and all of that. So I think those are all really great points. Um is there you know, anything, anything else you think that um SAR responders can do to prepare for these situations and anything, any other like mindset shift you wish that SAR teams would adopt when it comes to these special subject populations?

SPEAKER_02 50:56

Yeah, those different takeaways. Um, first of all, is starting to learn about the community because um as we talked about earlier, there is a mistrust and a misunderstanding back and forth between the two communities, whether that be a lack of knowledge of that our autistic community thinks that they're on their own. Um, I've had that echoed when we've done outreach to the Alzheimer's and dementia community too, that they didn't know that 911 was a resource. Um, or they thought it was the myth of you have to wait 24 hours to report someone missing. So, really including that when we're doing outreach now, we're not just talking about our typical trail rescues. We are making an effort to go and build uh bridge the gap in these two communities. Um helping people just learn more about each other. One of the organizations that we've um helped out when they come to the area is called Courageous Kids Climbing. They're basically an outdoor recreation option for kids and adults with disabilities to go and do adaptive climbing. Um, so starting to build up that relationship back and forth because there are those questions that SAR responders aren't have trouble sometimes understanding why when we have kids and adults who are repeated subjects. I've had clients who have had wandering or elopement instances every single week for years. And it's not that the families, sometimes they're a misconception in the SAR community that the families aren't trying or aren't aware, but there's thinking about just takes 30 seconds. I've had clients who we think planned for a while. I know someone who had a special interest of like large appliances, and we think that an office complex was throwing out um a bunch of those things. And he planned, and we think he left around 2 a.m. and likely walked about a total of six miles because he took back 13 of them to his house and they were about two miles away. So he must have made several trips. Um, they were like cleaning implements, they were long and narrow, but he thought he strategized when parents were going to be asleep and went out to get them. He may have seen them on his restaurant at home, we're not sure. But making sure that you're understanding what the barriers the communities are facing, because that's how you make effective um reach outs and effectively bridge the gaps. Same with things like trackers. There are great tracking programs, but until you understand the difficulties that they can implement, you need to talk to the different communities to figure out is it a sensory barrier? Is it there's a common one that they're several hundred bucks? I'm not gonna say the name. But I've had a client chuck two or three over the fence, get eaten by the neighbor's dogs, and his family went, we can't keep affording this. Um, so really understanding those barriers that exist, and that's those conversations can happen through finding different organizations. Almost every city has outdoor inclusion or some type of inclusion for people with disabilities. Um, you have Alzheimer's Association for people with dementia. Um, other takeaways are avoiding a one-size-fits-all approach. Sometimes that is necessary because we don't have that information. Or we for whatever situ for reason we have to take kind of that standardized type thing, but using that information you have from families. That could be a dynamic interview. Um, you might be going back to ask more questions, but actively trying to figure out what that individual is doing. And after the mission, you likely won't know all their decision-making points, but see if one of the possibilities of how they ended up where they were potentially lined up with one of your theories. We don't know if that, we don't know if that's correct. However, you can see if you were potentially way off. Or in the case of that CCTV video, hey, he was on a mission to get his favorite snacks. We have proof of that. Um, don't underestimate our individuals just because someone has a communication challenge. Um, we're talking about climbing different things. Um I have clients who their climbing skills, honestly, if they got into bouldering, they would probably be at a V3 to V5 level. Um, they're climbing door frames in their house and jumping off of them. Their grip strength is amazing. So being able to really talk to families and figure out what their skills are. Um, I found anecdotally, if you're getting conflicting reports, because sometimes you'll talk to families and then siblings, and you'll get a drastically different picture. Um, both in SAR and professionally I've had this happen. Often assuming that the individual matches up with that higher skill report. Um, siblings are often the person's partner in crime. And just like you or I with siblings, we were doing things that parents didn't know we were doing, doesn't change if you have a disability. And then knowing that all behaviors are communicating something. So making sure that you're analyzing why someone's behaving some a certain way and trying to figure out what they're communicating with that. Just because it's not a like universal or common way to communicate, it's a unique way that they're saying it, being observant for those little things because they're trying to tell you, they're trying to work as a team together with you and say, these are my needs, how can we work together to meet these needs? And just because I have I'm a professional in this field, however, these different tips, even if you have never interacted with someone with a disability before, these are different things that you can do and you can have successful interactions. Sometimes I've seen that people who have more professional experience and more individuals that they know, it's easier for them to get stuck in a box because they're saying, I know five individuals and they all communicate this way. So there's trouble, they have trouble making themselves cognitively flexible to address the needs of someone else. So don't be nervous to go on these missions, don't be nervous to go respond, and don't be nervous just to get involved in the local community. Um, that gap exists. And from the families I know, um, they want people to come over and ask questions. They want people to become involved and have that meaningful involvement. They don't want that gap to exist.

SPEAKER_05 57:26

Yeah, yeah, exactly. Uh, well, this has been so insightful. Uh, it's such a challenge that we do have to address in search and rescue, which I'm so thankful that that is what you are doing. And of course, you know, we are working on developing a course on the base medical platform to help teams with these special subjects. But in the meantime, while we develop that, any resources that exist out there for search and rescue teams to help them um provide better for this community?

SPEAKER_02 58:00

Unfortunately, there's not a ton of specific resources I've seen that speak to search and rescue. We have different environments than like an urban EMS response that's happening, potentially because someone already has a serious injury or there's an escalation happening, but still learning from those different um tips. Like National Autism Association has some different toolkits for first responders. Um, there's often local resources that you can really start to just talk to families. Again, like having those conversations, trying to find those events in your area. Like if you're on the West Coast, um, you have the courageous kids climbing that you can see if you can get involved with them, and actively having conversations with those families to say what are the barriers, how can we help? Um, we've also had people come up to us at non-specific um preventative search and rescue events that we figure would be more focused on your typical injuries, searches, things like that, and ask about our outreach for dementia, um, ask about our outreach for autism. So, really taking advantage of all those different things because you'll be surprised at how many people have connections to that community and will be able to spread that knowledge. Um, and really that one emphasis that we're trying to make sure everyone knows is that call 911. Um, it's not an embarrassing thing, it's not we don't think that there's there was an issue, which is why that person left for 30 seconds. We want you to call 911, we want to have a good outcome versus we find out about it already behind the ball hours later. Um, so really helping with that emphasis.

SPEAKER_05 59:43

Well, Katie, thank you so much for your knowledge and expertise today. I think it's helped, it will help a lot of search and rescue teams. And yeah, I know you and I will definitely talk soon.

SPEAKER_02 59:54

Awesome. Thank you so much for your time.

SPEAKER_00 59:57

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SPEAKER_06 1:00:35

That was a really great lesson. Some of Katie's stories were so interesting and just such great examples of how your mindset might have to shift a little bit to best serve the subject that you're looking for or working with.

SPEAKER_05 1:00:51

Yeah, I know. And again, this kind of hit home for me just because my family has personally been impacted in this area as far as like having someone with special needs, my cousin out on a mission, the mission that my uncle died. And I'm just so thankful that my team was so empathetic to him and knew how to interact with him and um bring my cousin home. But you know, I do think it's important to point out that it's okay to be nervous about interacting with these subjects. Um, you're not going to know everything. You're not going to maybe know the proper terminology. And that's okay. I think as long as you remain empathetic and open-minded and willing to learn and listen from the family, then it'll be okay.

SPEAKER_06 1:01:42

Absolutely. I think the yeah, the fear of doing something wrong or saying something wrong or being perceived, you know, to be a certain way can really hold people back from even trying to have these conversations. And so I think the more we can kind of um it's not that expectation that you're not going to be perfect, but the best thing you can do is to learn can really make a big difference. Um and I really also liked what Katie pointed out that really it's just how we should be treating everybody. Um, but it just maybe takes a little bit more intention or um creative thinking when it's somebody who communicates differently or or maybe behaves a little bit differently than you might be expecting.

SPEAKER_05 1:02:23

Absolutely. I also like that we now know that we can have an approach. Um, like SAR teams can use tools and data and just more knowledge about these populations to guide their team and deliver better care. Of course, it's hard to find those resources, and that's why we're developing these the uh SAR subject special population course on the base medical platform with Katie and with others. Um, I know Sam Bragg, who is our deaf wilderness medicine instructor. She's actually writing the deaf and hard of hearing section of this course, but it will be free to all search and rescue responders, and it will be there to help guide teams in providing better care and searching for these subjects.

SPEAKER_06 1:03:18

Yeah, it's amazing. I'm really uh proud to be part of an organization that's that's leading the way in that way. I think not only does it just help teams have more tools, but when folks know that they can be well taken care of in the outdoors, it also lowers that threshold to get out there and do things and try new things. Um, you know, if somebody who previously, you know, didn't want to participate in outdoor sports or had a family that was hesitant about allowing them to participate in outdoor sports, to know that there are people prepared to help them if anything goes wrong, who have the right tools. I mean, that that lowers that barrier of entry. And so I think that that's a really important piece of this too.

SPEAKER_05 1:03:59

Well, and then also you're able the search and rescue team can then provide something to the outdoor community that the other agencies possibly cannot. And so the fire department, the sheriff's office, they may not be as well trained in these special populations, especially when it comes to searching for them, interacting with them. Um, I was on a mission where we had to win over our dementia patient because we had to convince her to get in a litter basket and we had to do a high angle lower. And it went really well for us as soon as we got to the parking lot, though, with the lights and sirens and the way the fire department rushed her and she she completely panicked and it just didn't go well. Um, but those are things that you know we can bring that value to the outdoor community and then increase the value of our team.

SPEAKER_06 1:04:54

Absolutely. Well, thanks for sharing that that talk with Katie. And I'm really excited to see where the course goes. Um, and of course, we'll keep folks updated on that. Um, if you don't already subscribe to our newsletter, you can do that on the website and also make sure that you're following us on social media so that you can stay up to date on updates like that.

SPEAKER_04 1:05:12

Thank you so much, Lauren.

SPEAKER_06 1:05:14

All right, thanks. SAR Mutual Aid is produced by Lawrence Ganechny and Teal Harbin and presented by Base Medical. For more information, visit Base Dash Medical.com.

SPEAKER_01 1:09:38

All right, thanks.