‘Speaking Up’ in an Emergency Two SLPs lead the effort to train first responders to communicate with people who are nonverbal. Make It Work
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Make It Work  |   November 01, 2018
‘Speaking Up’ in an Emergency
Author Notes
  • Sharon Mankey, MAT, CCC-SLP, is director of the Communication Disorders Clinic at Purdue University Fort Wayne in Fort Wayne, Indiana. She is an affiliate of ASHA Special Interest Groups 11, Administration and Supervision; and 12, Augmentative and Alternative Communication. sharon.mankey@pfw.edu
    Sharon Mankey, MAT, CCC-SLP, is director of the Communication Disorders Clinic at Purdue University Fort Wayne in Fort Wayne, Indiana. She is an affiliate of ASHA Special Interest Groups 11, Administration and Supervision; and 12, Augmentative and Alternative Communication. sharon.mankey@pfw.edu×
  • Mariesa Rang, MA, CCC-SLP, is a limited-term lecturer in the Department of Communication Sciences and Disorders at Purdue University Fort Wayne. She is an affiliate of ASHA Special Interest Group 12, Augmentative and Alternative Communication. rangm01@pfw.edu
    Mariesa Rang, MA, CCC-SLP, is a limited-term lecturer in the Department of Communication Sciences and Disorders at Purdue University Fort Wayne. She is an affiliate of ASHA Special Interest Group 12, Augmentative and Alternative Communication. rangm01@pfw.edu×
Article Information
Augmentative & Alternative Communication / Professional Issues & Training / Make It Work
Make It Work   |   November 01, 2018
‘Speaking Up’ in an Emergency
The ASHA Leader, November 2018, Vol. 23, 28-30. doi:10.1044/leader.MIW.23112018.28
The ASHA Leader, November 2018, Vol. 23, 28-30. doi:10.1044/leader.MIW.23112018.28
Imagine being caught in the path of a hurricane or wildfire. Imagine being evacuated and out of touch with those you love for an indefinite amount of time. These would be difficult situations for anyone—but now imagine that you cannot speak.
What if the first responders who came to help didn’t know how to communicate with you? What if your communication system was left behind when you were evacuated? How would you—and the first responder—act and feel?
As communication sciences and disorders faculty at Purdue University Fort Wayne, we had the opportunity to improve this possible scenario for first responders and for people with communication difficulties. We were motivated by the lack of training programs for first responders on how to communicate with people who are nonverbal—including those with disabilities such as cerebral palsy, Down syndrome and autism, and people recovering from strokes or traumatic brain injuries—all of whom are more likely to be victims of crime. These crimes are often physical or sexual assault, according to studies by Diane Bryen and colleagues and by Joan Petersilia.
Raising awareness
At the 2012 International Society for Augmentative/Alternative Communication (ISAAC) Conference in Pittsburgh, we attended a session presented by speech-language pathologists from the Holland-Bloorview Kids Rehabilitation Hospital in Toronto, Canada. They hold an annual event, “AAC World,” to raise hospital staff awareness of the experiences of people who are nonverbal.
During the event, attendees experience what it is like to be nonverbal by performing activities of daily living—withdrawing money from a bank, buying an article of clothing or applying for a job in an employment office—using only AAC to communicate.
With permission, we replicated the program at our university with funding by a grant from the Anthony Wayne Foundation, a local group supporting people with disabilities. We targeted the general public, but we also sent written invitations to local first-responder groups, hoping to interest them in learning to communicate with people who are nonverbal.
Unfortunately, no police, fire or emergency medical responders came to the event, nor did they accept our offers to hold special emergency-related training at their stations.
“AAC World” became an annual event on our campus, and in 2016 a teacher of a student who is nonverbal brought along her firefighter spouse, Nick Clarke. As they were leaving, we asked them to speak with Casey, a young man who uses his toe to access his communication device. Despite initial reluctance—probably because the young man’s spasticity, hearing aids and vocalizations can make people uncomfortable—Clarke finally gave in.
Casey’s first question to Clarke was, “If I call 911 [with the AAC device] and tell them my father is having a heart attack, how seriously will they take my call?” Clarke’s initial reticence to talk to Casey turned into genuine concern as he shook his head and replied, “Casey, I honestly don’t know.”

The training participants pair up, and we give them scenarios of possible emergencies involving people who are nonverbal. One person role-plays the “victim,” while the other remains a first responder.

Breaking through
As the two talked for the next 30 minutes, we realized Clarke could help in our attempts to interest first responders in training. After we explained that we had no success in two years, Clarke scheduled training sessions for coworkers at his fire station.
We launched the AAC-training project on our own. We often wondered why no one had offered this kind of training for first responders, and then decided that we should just do it ourselves. Why not us? Why not here?
We polished our PowerPoint, adding short videos of people using AAC. We gathered supplies such as low- and medium-tech AAC systems—funded by our department and used in the department’s AAC class—and put hi-tech apps on our iPads to allow some hands-on experiences with the materials. We offered the training at Clarke’s fire station twice, and many of the 35 first responders who participated thanked us for the information, with several noting they didn’t realize the importance of communication problems.
We again called the 15-plus first-responder stations in Allen County, Indiana, but now—thanks to Clarke spreading the word about the value of the training—there was genuine interest from the Fort Wayne City police department, sheriff’s department, paid and volunteer fire departments from eight local towns, and two regional fire districts.
Hands-on training
In the 90-minute session, we discuss different types of AAC and the populations who might use them. We give suggestions on how first responders can improve communication and interactions with people who are nonverbal. We also have four short videos that show different people using their communication devices, so that the first responders realize AAC use is not one-size-fits-all.
The training participants then pair up, and we give them scenarios of possible emergencies involving people who are nonverbal. One person role-plays the “victim,” while the other remains a first responder, and the pair works through the situation. Some scenarios involve AAC devices (which we bring to the trainings), but some don’t, as we want to show that devices may not be available or working. We finish the session with a brief Q&A period.
We scheduled training for nearly every paid or volunteer agency within our county. By November 2017, we had trained more than 800 first responders. The reactions of first responders have been overwhelmingly positive, as they find the information practical and relevant to their jobs.
But there was still much to do. We continued free trainings within Allen County—we paid the only expense, which was gas to get to and from the station and an occasional meal. But we needed funding to go to other locations in the state. We received community-engagement grants from Purdue University Fort Wayne to defray traveling costs and to hire student assistants from our department for statewide training in summer 2018. Now, more than 1,200 first responders in Indiana have been trained.

We provide the framework—the basic AAC information, crime statistics, videos and hands-on experience with AAC systems—for any SLP to personalize with their own stories, new videos or additional role-play scenarios.

Spreading the word
Interest in our work spread. We’ve given presentations for the United States Society for Augmentative and Alternative Communication, the Indiana Emergency Response Conference, the Indiana AAC Summit, the ASHA Convention, the Indiana Speech-Language-Hearing Association Convention, and the 2018 ISAAC Conference in Gold Coast, Australia.
We can’t disseminate training by ourselves. We are working with other SLPs interested in continuing the work we started. When we were in university towns last summer, for example, we contacted SLPs at the universities and in the local communities to encourage them to continue the training in their counties.
We provide the framework—the basic AAC information, crime statistics, videos and hands-on experience with AAC systems—for any SLP to personalize with their own stories, new videos or additional role-play scenarios. Interested SLPs can email rangm01@pfw.edu for information and materials. We are exploring ways to make the materials easily accessible to people who are well-versed in the use of AAC.
Though results are not complete, early data analyses from surveys we gave to first responders who attended our training show they have learned practical information about AAC and are more comfortable with people who are nonverbal. In their responses, some shared personal experiences that demonstrate the need for and benefit of this training program.
Recently, one fire department chief emailed us that a parent came to the station, bringing her daughter and the child’s communication system. She was concerned that first responders might be called to the child’s new school, and wouldn’t be able to communicate with her. The mother, he said, was “impressed that the department had received training in communication devices.”
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November 2018
Volume 23, Issue 11