Development and institutional implementation of a prehospital emergency care protocol for individuals with autism spectrum disorder

OBJECTIVES: Prehospital emergency environments are characterized by high sensory load, time pressure, and unpredictable dynamics - conditions that may exacerbate distress and behavioral dysregulation in individuals with Autism Spectrum Disorder (ASD). Despite increasing emergency service utilization among individuals with ASD, structured prehospital protocols tailored to their needs remain limited. To describe the development and institutional implementation of a prehospital emergency care protocol adapted for individuals with ASD within a state-level emergency medical service system. METHODS: A structured, multi-stage protocol development process was conducted between September 2023 and October 2024. The process included (1) targeted literature review on ASD-specific emergency care, (2) interdisciplinary expert meetings involving a psychologist, physician, ASD researcher, and emergency medical services trained firefighter, and (3) iterative refinement of operational procedures adapted from existing institutional standard operating protocols. Consensus was reached through structured discussions until full agreement was achieved among panel members. The final protocol was formally approved and implemented by the Santa Catarina Military Fire Department (Brazil) as an official Standard Operating Procedure (No. 03/2024). RESULTS: The resulting protocol provides operational guidance across five stages of prehospital care: emergency call triage, approach to scene, on-scene primary and secondary assessment, in-ambulance management, and transfer of care. Key components include sensory load reduction strategies, structured communication guidance, caregiver involvement, behavioral crisis management considerations, and environmental adaptations during transport. Institutional adoption enabled integration into routine training activities and operational workflows. CONCLUSIONS: To our knowledge, this study presents the first institutionally implemented state-level prehospital protocol in Brazil specifically designed for individuals with ASD. The protocol offers a structured, operationally feasible framework to improve safety, reduce sensory distress, and support emergency responders in managing neurodivergent patients. Future research should evaluate its impact on responder confidence, care quality, and patient-centered outcomes.