Special Care for Special Needs Children

The most important job of a firefighter is fire prevention. I’m sure that some may question this statement, but think about it. If we were really good at fire prevention, then the number of firefighters needed for fire suppression would be reduced as the number and severity of fires would be reduced. The final outcome? Fewer people would die in fires.

When we do take the time to talk about fire prevention, a phrase that often is mentioned in the same breath is life safety.

I would be willing to bet that there are firefighters reading this who are asking what does this have to do with me doing my job of fighting fire?

Here is my story.

Every October, my fellow members and I, for lack of a better term, would “celebrate” Fire Prevention Week. Our crew would make plans to visit the various elementary schools in our response area to talk to the children about fire prevention. After telling the kids not to play with matches and teaching them to stop, drop and roll, we would then move out to the engine.

In most of the cases, the engine would be parked on the playground. We would open the officer’s and engineer’s cab doors. One of us would be stationed at each of these doors, passing the kids up into the cab and ushering the kids to the other side of the cab where they would be lowered to the ground by one of my fellow team members and sent back to class!

For some reason, seldom did the kids from the special education classes come out for tours.

I think we messed up!

EDITH

One of the subjects that is often talked about during school programs is Exit Drills In The Home, also known as EDITH.

When talking about EDITH, we discuss things like feeling the door to see if it is hot, placing clothes and towels around the base of the door to keep smoke from entering the room, having two ways out of every room and the list of items goes on.

Yet, in my travels, it appears that we are leaving one group of people out of the EDITH discussion. This is people with special needs and their families.

When discussing people with special needs, this includes a significant variety of challenges that these people face on a daily basis. Intellectual challenges include things like autism and Down syndrome. Physical challenges include hearing impairment/deaf, visual challenges/blind, cerebral palsy and muscular dystrophy. Let’s not forget that in many cases, this includes people who use crutches and wheelchairs for mobility.

Obviously, the number of challenges that people with special needs face are so numerous as to prohibit the discussion of each and every challenge within the confines of this article. What I will attempt to do, is to discuss some things that we need to discuss with these families in relation to EDITH as it relates to the challenges of the individual.

Let’s walk through a fire incident in a two-story residential structure. A fire has started in the kitchen of the home in the early morning hours. A child with special needs is asleep in their second-floor bedroom.

Doors

As firefighters, we encourage people to keep the doors to their bedrooms closed when they are sleeping. We know that this will help to slow the spread of the fire into the bedroom, giving occupants a better chance of surviving.

Parents of a child with special needs may challenge you on the need to keep bedroom doors closed. They will cite the reason as they want to be able to hear if the child wakes up in the middle of the night or be able to hear if the child should have any issues, especially medical issues, during the night. In some of these cases, we might suggest that the family purchase monitors that are used to monitor a sleeping infant.

On the opposite side of this subject, the child with intellectual challenges may have issues with their bedroom door being kept shut. This may make them feel trapped.

Many people with special needs do not like change. If they have been sleeping with the door open, getting them to start sleeping with the door closed could create issues.

Smoke detectors

Some children with special needs may not know what a smoke detector sounds like. This could be because that some children with intellectual challenges do not like loud noises. Activating a smoke detector one time for a child with intellectual challenges will not likely help them to overcome their fear, but may actually have the opposite effect of intensifying their fear.

Helping a child with intellectual challenges to overcome their fear of smoke detectors may not be easy. It may involve allowing the child to hold the smoke detector on several occasions to reinforce in the child that the smoke detector will not hurt them. From there, it may involve “smothering” the smoke detector and activating it so that it is not as loud as it normally would be. At some point, we may let the child press the test button after they watch us press the test button. In any case, what works for one child may not work for another.

A child who is deaf will not hear the smoke detector; we need to encourage the parents to acquire smoke detectors with a light that will turn on when the smoke detector is activated. All of the smoke detectors should be wired together so that when one is activated, all the smoke detectors in the house are activated.

Two ways out

This sounds pretty simple: one way is out the door; the second way is out the window!

We have worked with the family to encourage them to keep the bedroom door closed, even though this could be scary for a child with special needs. We worked with the family to lessen the fear of the smoke detector that the child with special needs may have.

Next, we need to put that together and teach the child not to open the door if they hear the smoke detector. This will be challenging for the child with special needs because this child will want to open the door and leave their room just like they always do. Remember, many of these kids will have a difficult time with change.

Evacuating a building during a fire will be a different experience for the child with intellectual challenges, thus the importance of regularly conducting fire drills. It may even be beneficial to support a family’s fire drills with an engine company standing by to help lessen the fears that the child might have for people in uniform.

As for windows. there are a bunch of challenges here, for both the child and the firefighters.

The windows in the room of a child with intellectual challenges may be locked in such a way as to prevent the child from opening the window. In some cases, the window glass could be made of safety glass to prevent the child from breaking the glass. Although installed in the interest of keeping the child safe, they may actually create a hindrance in exiting a building during a fire for the individual with special needs as well as making it more difficult for firefighters to gain entry to perform a rescue.

We encourage homeowners to purchase escape ladders for every room on the upper floors of a structure. Can a child with intellectual challenges open the window, place the escape ladder and climb down it? What about a child in a wheelchair?

As a side note, it is not uncommon to see an elevator in new homes to accommodate the individual with mobility challenges. Newer homes are also being built with a closet on the second floor above a closet on the first floor so that an elevator can be added later. Just because the home doesn’t have an elevator in it this year, doesn’t mean that it won’t have an elevator in it next year.

Rescue concerns

Children with special needs may require a great deal of time and socializing before they are no longer afraid of a “new” friend. Children with special needs can be easily frightened by firefighters in uniform. The firefighter in turnouts and breathing with a SCBA could be very frightening at night in the bedroom. The fire situation will multiple this fear. When attempting to rescue a child with intellectual challenges, you may have a battle on your hands, especially if the child does not like to be touched.

Regardless of how time consuming it may be, firefighters need to spend time with children with special needs to lessen their fears of people in uniform. An excellent solution to this issue may be having uniformed firefighters – and other first responders – visit the schools and read stories to all of the kids, not just the children with special needs.

All children, including those with special needs and especially children who are visually challenged, should be allowed to meet firefighters while they are wearing full turnouts with SCBA. Let the child touch the firefighter’s PPE so that they know what it feels like. Have the firefighter speak while using the SCBA so that the child knows what a firefighter sounds like. We do this already with children, but it is especially important to do this with children with special needs.

A child with physical challenges, such as cerebral palsy, may be confined to a wheelchair. Under normal conditions, this child will regularly experience muscle spasms. If a firefighter tried to hold this child, especially an older child or adult, in a normal situation, it could be quite difficult. If this child is in a stressful situation, like a structure fire, the frequency and severity of these spasms will be intensified.

How would you remove this child from a structure via a second-floor window? Could you carry this child down a ground ladder? Could the child’s spasm cause you to be knocked off of the ladder? If you’re a paramedic, administering a muscle relaxer may have no effect on the child. As one parent told me, “Muscle relaxers don’t work! If muscle relaxers worked, they would be using them already!!!”

As a side note, many two-story or higher schools will have children with physical challenges on the upper floors of the school. The schools are required to have a fire escape plan. In this plan, the school should address how to remove the child with physical challenges from the upper floors. However, the procedure may not be practiced.

As an example, I learned of a school whose escape plan stated that a teacher will carry a child with physical challenges down the stairs during a fire. However, during fire drills, they take the children with physical challenges to the lower floors of the school in the elevator. In the interest of safety, they do not want to carry the child down the stairs. The child in question has spastic cerebral palsy as described above. When the parents looked into this, they were surprised to learn that the procedure for removing their child from the school via the stairs had never been practiced or attempted. Remember, if the child has spastic cerebral palsy, in a fire situation, the spasms will be intensified.

I’m quite sure that as some of you read this, you are thinking of stair chairs. Many schools with multiple floors do not have stair chairs. In most cases, this is because of the cost.

I heard of a school, that when questioned about acquiring a stair chair, replied that the fire station is only a minute or two down the street. The fire department’s ambulance carries a stair chair, so they were going to depend on them to evacuate the child with physical challenges. Does this school’s emergency evacuation plan compliment or conflict your pre-incident plan for this school?

Once you have removed a child with intellectual challenges from the structure fire and you have checked them out and they appear to be uninjured, remember to not leave this child unattended for a second! Having been removed from a burning building will be very scary for this child. They will desperately want to feel safe; they will want to return to a safe place. Their home is a safe place! Yes, they may try to run back into the burning house because it is their safe place!

Summary

I have had the opportunity on many occasions to talk to parents of children with special needs about their emergency plans. In many cases, the parents have no plans. When asked, most of these parents had no clue as to how to develop an emergency plan for their home with considerations for their child with special needs.

As firefighters, we strive to provide the best service possible to our customers, the taxpayers. But are we adequately serving all of our customers? Children with special needs are no more or no less important than any other child. Are we making every effort possible to ensure that a child with special needs will be able to escape a fire in their home?

Each and every child with special needs is different. Some will have challenges more severe than others. As we work with the parents of a child with special needs, the rewards and benefits will be appreciated not only by the parents but will be felt by you and every member of your department.