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August 10, 2005

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Publication Date: Wednesday, August 10, 2005

Health & Fitness: Positive signs -- Sign language and symbols help Woodside firefighters communicate with autistic children Health & Fitness: Positive signs -- Sign language and symbols help Woodside firefighters communicate with autistic children (August 10, 2005)

By Andrea Gemmet

Almanac Staff Writer

The bus was on its side and its driver was injured and unconscious when the firefighter-paramedics from Woodside Fire Protection District arrived at the scene. Inside the bus was a burly 16-year-old boy with autism.

"Our firefighters could not convince him to come out of the bus," says Chief Mike Fuge. "When they tried, he got violent."

The firefighters ended up having to call another bus driver the boy was familiar with to come to the accident scene.

Just two weeks later, a Woodside crew had to take a boy with Down's syndrome to the hospital, Chief Fuge says. The boy was not able to communicate verbally, and his mother wasn't able to go with him.

Those two incidents, which happened in 2001, were enough to convince Woodside firefighters that it was time to explore methods of coping with such medical emergencies.

They didn't have to go too far to find expert advice on better ways to communicate with kids with autism, Down's syndrome or other disabilities. Glenda Fuge, the chief's wife, is an occupational therapist with 25 years of experience working with children who have developmental disabilities, and she specializes in autistic children.

She worked with Woodside firefighters to pinpoint where they ran into trouble. Often, when dealing with children, first-responders tell them to "be like a statue" or "freeze" when they want them to hold still. Those kinds of directions don't work with autistic people, who take things very literally, Ms. Fuge says.

"Metaphors are just lost on these guys," she explains.

And there are plenty of other potential problems. Flashing lights and sirens can be terrifying to people who are sensitive to light and loud noises. Firefighters in their bulky gear may look like aliens or monsters, especially to children.

People who respond violently to being touched, or who reply to directions by yelling them back, may be misinterpreted. And even disabled people with good verbal skills may temporarily lose the ability to use them in stressful or frightening situations.

So Ms. Fuge came up with a succinct list of 10 commonly used ideas and directions, such as "friend," "lie down" and "medicine," and taught firefighters how to express them with sign language and by pointing to symbols in a flip book she created.

Simple sign language and the symbols, designed by educational resources company Mayer-Johnson, are commonly used in special education classrooms, she says.

Ms. Fuge also taught firefighters how to recognize disabilities that can impair verbal communication, including physical disabilities like cerebral palsy and psycho-social disorders such as schizophrenia.
Ready for takeoff

The program was off to a promising start when the terrorist attacks of September 11 threatened to derail it, as interest and grant money became focused on weapons of mass destruction, bioterrorism and the like. But now, thanks to an $11,000 grant from FEMA, the Federal Emergency Management Agency, Woodside's "When Words Are Not Enough" program is poised to take off.

The program includes a poster of symbols, a manual describing various types of disabilities, and a booklet of the 10 symbols and signs for first-responders to carry with them in the field.

The centerpiece is a training video produced with the FEMA grant money. It includes interviews, a sign-language demonstration and a dramatization of firefighter-paramedics responding to a car accident in which one of the three injured children is a little boy with Down's syndrome.

Everything, including the video, can be downloaded for free from the fire district's Web site,

Firefighter-paramedics from the Woodside, Redwood City and South County fire departments have all been trained in the program, and it won the support of San Mateo County Fire Chiefs Association, which provided funding for 500 of the posters, says Chief Fuge.

San Mateo County's Adult Services on Aging paid for the development and production of the booklets, and the county Commission on Disabilities sponsored the project.

This week, a delegation from the Woodside fire district is set to travel to the International Association of Fire Chiefs annual convention in Denver to present the "When Words Are Not Enough" program. It was one of 11 new programs chosen for exhibition in the convention's "Innovation Alley."

"It's almost taught us to deal with any kid," says Capt. Dan Ghiorso, a Woodside fire paramedic. In automobile accidents, paramedics often have to interact with upset children without help from their parents.

"A lot of times, the adults are hurt, but the kids in the car seats are fine," he explains.

Emergency workers are also finding that these calls are not as uncommon as they thought. Although the number of children with autism spectrum disorders has been rapidly rising in the past few years, Capt. Ghiorso says he thinks that often, emergency workers just didn't recognize the signs.

Five years ago, a child who didn't respond to questions or answered nonsensically would end up strapped to a backboard under the assumption that he or she had a head injury, he says.
Other side of the coin

Training firefighters and paramedics is only one side of the program, says Fire Marshal Denise Enea. The program's posters are designed to be hung in special education classrooms, and the fire district is stepping up its outreach efforts.

Capt. Ghiorso recently hosted the fire station's first group of special education students. Fire station tours usually include a demonstration of a fire engine's lights and siren, something he made sure to avoid. Following Ms. Fuge's advice, he kept his explanations short and sweet, he says.

"It was probably the best class we've ever had," he notes.

In the two months since then, Woodside firefighters have done several more programs with special ed classes, says Ms. Enea, and they'd like to bring more groups of children to the fire station.

"It's nice to finally incorporate these kids," she says.

Cecilia Hinkston, the program manager for Parca's Reach after-school child-care program, says her staff holds monthly fire and earthquake drills, and tries to familiarize the children, who range in age from 5 to 12, with first-responders such as police officers and firefighters. Parca is a Bay Area nonprofit that serves people with developmental disabilities and their families.

Programs teaching the developmentally disabled to cope with emergencies are needed, but they're in short supply, according to Ms. Hinkston. "It's a good thing they're starting," she says of the "When Words are Not Enough" program.

Autism facts and resources

According to the Center for Disease Control, between one in 166 to one in 500 children are affected by autism spectrum disorders (ASD).

Symptoms can range from mild to extremely severe, and about 70 percent of affected people are also mentally retarded. About 40 percent do not talk at all, while others may be highly intelligent and verbal, according to CDC statistics. Autism affects boys more often than it does girls.

Common ASD symptoms include:

** Limited social skills, such as a lack of interest in other people or an inability to understand other people's feelings.

** Communication difficulties, which may include echoing back what is said (echolalia), and trouble listening to what other people are saying.

** Repetitive or ritualistic behaviors; changes in familiar routines may be extremely upsetting to autistic people.

The Autism Society of America has information and resources online at A support network for families is at

Parca, a Bay Area nonprofit that serves people with developmental disabilities and their families, can be reached at 312-0730 or on the Web at

Materials for the Woodside Fire Protection District's "When Words Are Not Enough" program are available online at, or by calling the main fire station at 851-1594.

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