A practical handbook and visual communication toolkit that equips first responders with the knowledge and tools to assist people with Autism Spectrum Disorder safely and effectively during emergencies.
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People with Autism Spectrum Disorder (ASD) in Emergency Situations — A Guide for First Responders
General information
ISIG
A compact handbook and printable visual communication kit that equips first responders with the knowledge and tools to assist people with Autism Spectrum Disorder safely and effectively during emergencies.
The handbook introduces ASD from a first-responder perspective — explaining how to recognise a person with autism, anticipate atypical behavioural reactions in crisis situations, and apply practical communication strategies grounded in the principle of empathic rescue: creating trust, respecting dignity, and communicating in ways the person can process under stress. Its most operationally distinctive feature is a set of pictographic cards depicting emergency scenarios (fire, forest fire, flood, earthquake) and step-by-step rescue actions, which first responders can print, laminate, and carry on their vehicles ready for immediate field use. The handbook was developed jointly by the Pordenone Provincial Fire Command and the Fondazione Bambini e Autismo ONLUS, is freely available for download, and has been actively used in operational training seminars through at least 2019. It is designed for firefighters but explicitly extends to any professional — police, emergency medical services, civil protection volunteers — who may interact with people with ASD in emergency contexts.
Italy experiences recurrent multi-hazard events — fires, floods, earthquakes — during which first responders regularly encounter people with cognitive or communication disabilities. The Italian National Fire Corps has a longer institutional history of disability-inclusive rescue: a predecessor document, "Il soccorso alle persone disabili: indicazioni per la gestione dell'emergenza", was published by the Ministry of the Interior / Fire Corps as early as 2003, covering motor, sensory, and cognitive disabilities including coordination with the Fire Corps. The ASD vademecum builds directly on this tradition, focusing specifically on the particular challenges that autism presents in emergency contexts.
For individuals with ASD, emergency situations are especially hazardous: sudden changes, sensory overload (sirens, lights, crowd noise), disruption of routine, and inability to understand instructions from strangers can trigger panic, flight, or aggressive behaviour that places both the person and responders at risk. According to DSM-V, approximately 1% of the population has an autism spectrum disorder, with males affected at a ratio of 4:1 over females — meaning first responders can expect to encounter people with ASD across all types of emergency operations.
Prior to this initiative, no standardised operational guidance existed in Italy for first responders interacting with people with ASD during emergencies. The vademecum emerged from a long-standing collaboration between the Pordenone Fire Command and the Fondazione Bambini e Autismo ONLUS, formalised through an inter-institutional protocol signed in 2013 between the Prefecture, Police Command, Fire Command, Carabinieri, Guardia di Finanza, and key municipalities of the Pordenone province. The guide was presented publicly at the Prefecture of Pordenone in late 2017 and subsequently used in practical training seminars at the Fondazione's rehabilitation centre.
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Topics For Preparedness
Hazard Type
Geographical Scope - Nuts
Population Size
Population Density
Needs Addressed
People with ASD present unique and often unpredictable behavioural responses during emergencies. They may not recognise danger, may flee from responders they perceive as threatening, may be unable to follow verbal instructions, and may react to sensory stimuli (sirens, lights, physical contact) with acute distress or aggression. Critically, people with ASD cannot be identified by physical characteristics — recognition depends on observing how they interact, noticing behavioural indicators (which are not always present), receiving information from a family member or caregiver, or finding an ID card or indicator on the person. In an emergency, where time is short and context is chaotic, this identification challenge is significantly harder. First responders without prior knowledge of ASD often cannot distinguish these behaviours from non-compliance or aggression, which can escalate situations, result in failed rescues, or cause harm to both the person and the responder. This handbook addresses the gap by providing accessible knowledge of ASD, practical interaction strategies grounded in empathic rescue, and a ready-to-use visual communication system for the field.
The primary target beneficiary group is people with Autism Spectrum Disorder of any age — the handbook addresses both children and adults with ASD. The guide also recognises that people with ASD may have co-occurring conditions (epilepsy, intellectual disability) that further compound vulnerability in emergencies.
The handbook was developed in a multistakeholder context — bringing together a national emergency corps, a specialist civil society foundation, the Prefecture, law enforcement agencies, and local municipalities under a formal inter-institutional protocol.
However, the solution is transferable across a range of governance arrangements:
1) the handbook can be adopted top-down, integrated into national training programmes, and mandated or recommended for all fire, police, and emergency medical services;
2) where municipalities or regional authorities manage their own emergency services and training independently, individual local commands can adopt the guide autonomously, partnering with local autism associations or disability organisations to deliver training without requiring national-level endorsement;
3) the solution works best when formalised through a protocol or memorandum of understanding between emergency services and the disability/autism community, creating shared ownership, sustained training delivery, and a feedback loop between operational experience and specialist knowledge.
The solution targets an identified operational gap in organised emergency response: it assumes a functioning emergency services structure and seeks to improve the inclusiveness and effectiveness of existing rescue operations. It does not require advanced preparedness infrastructure to implement, but does not function as a standalone substitute for basic emergency management planning.
The solution requires minimal infrastructure: a printed or digital booklet and laminated pictographic cards carried in a rescue vehicle. It is designed to function even in severely disrupted environments, requiring no digital devices, connectivity, or specialised equipment beyond access to a printer. The Pordenone Fire Command's operational model (a carabiner with laminated cards stored in the vehicle) demonstrates that the tool is immediately deployable in the field at negligible cost.
Engagement serves two connected purposes. The first is capacity building within the first-responder community: by involving the Fondazione Bambini e Autismo ONLUS as a co-author and training partner, the initiative ensures that operational guidance is clinically grounded and reflects the real experience of people with ASD and their families, rather than being developed by emergency services in isolation. The second is improving rescue outcomes for a vulnerable population: engagement with the ASD specialist community translates directly into safer, more effective emergency interactions — reducing the risk of failed rescues, physical harm, or traumatic experiences for people with ASD who cannot advocate for themselves in a crisis.
- Co-authorship and co-design: the handbook is written jointly by Fire Corps personnel and clinical/educational specialists from the Fondazione, ensuring both operational feasibility and specialist accuracy.
- Practical training workshops: firefighters participate in hands-on sessions at the Fondazione's diagnostic-rehabilitation centre, allowing them to apply the guide's strategies in a real ASD environment and receive direct feedback from specialists.
- Inter-institutional formalisation: the 2013 protocol signed by the Prefecture, law enforcement agencies, Fire Command, and local municipalities created a structured framework for ongoing collaboration, elevating the initiative beyond a one-off project into a sustained multi-agency commitment.
Dissemination through training seminars — confirmed active through at least 2019, extended these engagement methods over time.
Operational decisions during an emergency remain with the first-responder team leader. However, the handbook explicitly repositions the person with ASD as someone whose behaviour and capacity must be understood and worked with — rather than overridden — wherever safety conditions allow. The empathic rescue framework shifts the responder's approach from directive to adaptive, giving people with ASD greater implicit influence over how the interaction unfolds. The dual competence model shown in the 2019 training presentation makes this explicit: it maps both what the responder needs to bring and what the person with ASD needs to be supported to do, including responding autonomously for their own safety and relating to rescuers, framing the encounter as a two-way interaction rather than a one-directional rescue.
The handbook builds long-term operational capability by embedding knowledge of ASD into emergency response culture. The empathic rescue framework and the practical scenario exercises translate written guidance into practised routines. Over time, this reduces responder uncertainty, improves response quality, and protects the safety of people with ASD in emergencies. At the system level, the inter-institutional protocol and hospital pre-alerting guidance extend this empowerment beyond individual responders to coordinated multi-agency readiness.
Vulnerable Groups
Governance
Emergency Preparedness
Engagement Level
Empowerment Level
Implementation
- The handbook's dual-layer design: it functions both as a knowledge reference (read during training and kept for consultation) and as a field communication tool (the pictographic card system). The cards allow a first responder to show — rather than attempt to explain verbally — what is happening, what action is required, and what will happen next. This is grounded in the well-established clinical principle that many people with ASD process visual information more reliably than verbal language, particularly under stress.
- Explicit framing of ASD rescue around the principle of empathic rescue: creating an atmosphere of trust, respecting the dignity of the person, and being present and welcoming — not merely technically competent. This reframes rescue from a directive interaction to an adaptive, relationship-informed one.
- Carabiner clip system: the most essential pictographic cards are laminated and clipped together on a carabiner attached to the rescue vehicle, ensuring they are always immediately available at an incident without requiring any search, charging, or preparation. This converts a printed guide into a passive operational readiness asset.
- An empathetic framing device — a narrative inviting responders to imagine arriving on an unknown planet, unable to understand the language or social rules — to build genuine understanding of the ASD experience and motivate adoption of the recommended strategies.
- Training sessions also introduced participants to complementary digital resources. The HelpforAll app, developed separately, was flagged during 2019 training sessions as a related tool that extends inclusive rescue guidance to a broader range of disabilities including motor, sensory (deafness, blindness), and cognitive (autism, Down syndrome), with operational guidance integrated with video and images.
Italian
The guide was developed by the Pordenone Provincial Fire Command in collaboration with Fondazione Bambini e Autismo ONLUS. In other contexts, equivalent implementation could be led by: national or regional fire and civil protection corps; emergency medical services; civil protection volunteer organisations; or specialist disability organisations in partnership with a first-responder body.
The Corpo Nazionale dei Vigili del Fuoco is Italy's principal fire and rescue service with a full national emergency response mandate and a documented institutional history of disability-inclusive rescue dating to at least 2003. The Fondazione Bambini e Autismo ONLUS is a recognised centre of excellence in ASD diagnosis, therapy, and community inclusion, with documented experience in developing emergency protocols for ASD including hospital emergency department reception protocols. The collaboration pairs emergency management expertise with specialist clinical and behavioural knowledge.
- Fondazione Bambini e Autismo ONLUS (Pordenone) / Children and Autism Foundation ONLUS — scientific and specialist content, co-authorship, training delivery, and hosting of the downloadable resource. The Fondazione is led by a parent of a person with autism and has developed parallel emergency protocols including an ASD reception protocol for hospital emergency departments.
- Pordenone Provincial Fire Command / National Fire Corps — co-authorship, operational framing, validation, dissemination through training seminars, and national institutional hosting of the resource.
- Prefecture of Pordenone (the local representative office of the national government) — institutional endorsement and public presentation venue.
- Carabinieri / Military Police Force — signatory party to the 2013 inter-institutional protocol; secondary audience for the handbook.
- Questura / State Police Command — signatory party to the 2013 inter-institutional protocol; secondary audience for the handbook.
- Financial Police / Border and Customs Guard — signatory party to the 2013 inter-institutional protocol; secondary audience for the handbook.
- Local municipalities of Pordenone province — parties to the original 2013 protocol; relevant adoption context.
- Abili a Proteggere / "Able to Protect" — a national disability and emergency platform linked to the Italian Civil Protection Department — dissemination and secondary documentation.
- Download or reproduce the handbook and pictographic cards (freely available online at no cost).
- Adapt card content if necessary to local hazard context — the handbook recommends supplementing standard cards with real photographs taken on-site via mobile phone, as these are more recognisable to people with ASD than generic illustrations.
- Deliver awareness and familiarisation training for first-responder teams in collaboration with a specialist ASD organisation, covering both theoretical content (what ASD is, how it presents, the empathic rescue framework) and practical simulation (rehearsing communication strategies and card use in scenario exercises).
- Laminate and clip the core pictographic cards on a carabiner in each rescue vehicle, ensuring they are always available without preparation.
- Integrate the handbook into standard operational briefings and recurring emergency management training cycles.
- Where possible, notify emergency dispatchers of the ASD response protocol, so that when callers flag the presence of a person with autism, the responding team can be informed and activate the adapted approach before arrival.
- Pre-alert receiving hospital emergency departments when transporting a person with ASD, enabling them to prepare adapted reception procedures.
- Consider complementing the printed handbook with the HelpforAll app for digital access to inclusive rescue guidance across a broader range of disabilities.
Staff time for initial training and familiarisation; printing and lamination costs for the pictographic cards; facilitation capacity from a specialist ASD organisation for training workshops; basic distribution capacity (digital hosting or physical printing). No technology infrastructure beyond standard office and printing equipment is required.
The guide is immediately deployable once printed. Training integration is a short-to-medium-term process. Full embedding into standard emergency response training constitutes a medium-term phase. The Pordenone model shows that this process can develop progressively: from inter-institutional protocol (2013) to guide publication (2017) to active training seminars and dissemination (2018–2019 and beyond).
Experience of the Implementing Organisation in DRM
Target Audience
Resources Required
Timeframe & Phases
Participation Results
The Pordenone experience demonstrates that inclusive emergency response for people with ASD is operationally achievable without high cost or complex infrastructure. Key lessons embedded in the solution are:
- visual communication tools outperform verbal instructions under emergency stress for people with ASD;
- real-incident experience is the most effective complement to written guidance;
- inter-institutional protocol formalisation creates the organisational legitimacy needed for sustained adoption;
- and the handbook's utility extends beyond firefighters to any professional who may interact with people with ASD in a crisis.
The 2019 training presentation confirms that the approach continued to be actively taught and refined two years after publication, suggesting strong institutional ownership.
The primary implementation challenge is irregular uptake: without institutional mandating, individual fire commands and emergency services may not prioritise ASD-specific training, particularly where awareness of disability-inclusive emergency management is still developing. Adaptive strategy: early inter-institutional formalisation (the 2013 protocol in this solution) and the public presentation at prefectural level, which simultaneously raised the profile of the initiative across all security forces in the province.
A second challenge is maintaining readiness between events. First responders may be trained but then rarely encounter a person with ASD in an emergency, causing knowledge to fade. The physical card system directly mitigates knowledge decay: it requires no recall, no digital device, and no preparation — the tool is simply always present in the vehicle.
A third challenge is identification under time pressure. People with ASD cannot be identified by physical appearance, and in a chaotic emergency environment the behavioural signals may be easy to misread as non-compliance or aggression. Adaptive strategy: training responders to recognise interaction patterns and explicitly advising that calm, patient, non-coercive approaches should be the default before any escalation.
A fourth challenge is sensory context: emergency environments are inherently high-stimulus, which are precisely the conditions most likely to distress a person with ASD. Adaptive strategy: operational micro-adaptations — turning off the siren on approach where possible, moving the person away from noise sources, speaking quietly — that are low-cost and immediately applicable.
The main implementation risks are:
- Low institutional adoption (mitigated by inter-institutional formalisation and national Fire Corps hosting);
- Knowledge decay without refresher training (mitigated by the card system and integration into recurring training cycles);
- Risk of physical harm if coercive rescue is required (mitigated by explicit guidance to use the least traumatic methods possible when physical intervention cannot be avoided);
- Language/accessibility risk for international transfer (mitigated by the guide's concise, visual-first format which minimises translation barriers).
Risk & Mitigation Plan
Scalability and Sustainability
The handbook follows an open-access, institutionalised guidance model. Once adopted and integrated into standard operational training, it requires no ongoing funding beyond minimal staff time and materials costs. Sustainability is strengthened by the national Fire Corps' institutional hosting of the resource and by the informal dissemination network of Italian ASD associations, which functions as a no-cost amplification mechanism. The active use of the guide in training seminars through at least 2019 confirms that sustainability is not merely theoretical.
The solution is highly scalable in concept and low-cost to replicate. The handbook is openly downloadable at no cost, and the pictographic card system can be printed and laminated by any emergency service with access to basic office equipment. Adaptation to other languages or national hazard contexts requires only translation and minor content localisation.
The solution has already demonstrated informal national scalability: it is referenced by autism associations and emergency management networks across multiple Italian regions and is hosted on the national Fire Corps website. Formal international transfer would require partnership with a local ASD specialist organisation to validate the communication content and deliver accompanying training. The pictographic card system is also adaptable beyond ASD to other communication-disability contexts with appropriate specialist input — a direction already explored by the complementary HelpforAll app, which covers motor, sensory, and cognitive disabilities more broadly.
Innovation is primarily methodological: the handbook applies Augmentative and Alternative Communication (AAC) principles — well established in clinical ASD practice — to emergency response contexts where they had not previously been systematically used. The HelpforAll app, a separately developed tool flagged in training sessions, extends a similar inclusive-rescue approach into a digital format with video-integrated operational guidance across a broader range of disabilities.
No public figure for the original development cost has been found in the sources reviewed. Development was supported within the existing collaborative and institutional framework of the Fondazione and the Fire Command without a reported dedicated budget line.
The guide is freely downloadable with no licensing cost. Direct costs for an adopting organisation are limited to printing and laminating the pictographic cards, staff time for guide familiarisation, and ideally one or more training workshops in collaboration with a local ASD specialist organisation. For a typical fire station or emergency service unit these costs are very low — materials costs for the laminated card set are minimal; workshop costs depend on whether delivery is by a paid specialist or through a pro-bono partnership with a local autism association.
Recurring costs are limited to refresher training integration within existing emergency management training cycles, periodic replacement of worn card sets, and any future translation or content updates. These costs are negligible relative to standard emergency service training budgets.
- Designing a tool that is low-cost, physically portable, and operable without digital infrastructure is a core sustainability feature — the carabiner card system remains a passive readiness asset in the vehicle indefinitely.
- Formalising the collaboration through a multi-agency protocol at prefectural level created institutional legitimacy that sustains the initiative beyond any single advocate.
- Co-development with the specialist ASD community ensured clinical credibility and community trust, reducing resistance to adoption.
- The existence of a digital complement (HelpforAll) provides a potential pathway for future digital scaling without requiring the core guide to be replaced or redesigned.