Autism in the ED

What makes an emergency department autism-friendly—and how do we know whether its changes are helping?

In the final episode, Hamish and Jeremy move from individual encounters to service design. They explore communication options, sensory adjustments, reliable handover and the role of autistic people in shaping care. Alongside the practical challenges of crowded departments and limited resources, they ask how services can measure meaningful improvement and make accessible care dependable across every shift.

A familiar person can bring knowledge that transforms care—but how do we make room for their contribution while keeping the autistic patient central?

Hamish and Jeremy explore the roles of families, partners, carers and support workers in the emergency department. Through a composite encounter, they discuss communication support, differing accounts, privacy and the distinction between helping someone decide and deciding for them. They also consider the burden placed on supporters when accessible care depends on their constant presence.

The patient is not the only person under pressure in an emergency encounter. What happens when we turn our attention to the clinicians?

Hamish and Jeremy examine how staff stress, competing instructions, hierarchy and clinical authority can shape an escalating situation. They explore clear leadership, practical team resets, handing over a difficult interaction and repairing communication when things go wrong. The discussion brings patient dignity and staff safety together, while asking what responsibility belongs to the wider organisation.

When distress becomes severe, how do we protect safety while continuing to understand what the patient needs?

Hamish and Jeremy explore meltdowns, shutdowns and the danger of assuming that a quiet patient has recovered. They discuss reducing unnecessary demands, maintaining clinical assessment, the boundaries of restrictive intervention and what patients and staff need after a crisis. Throughout, the focus remains on proportionate action, dignity and ongoing care.

What can an emergency department change before distress becomes severe?

Hamish and Jeremy follow a composite patient’s journey through waiting, assessment and imaging, exploring how noise, uncertainty, repeated questions and unexpected touch can add to an already difficult encounter. They discuss practical adjustments, honest updates and carrying useful information through handover—while recognising that good preparation cannot prevent every crisis.

What happens when a patient has something important to tell us, but the way we ask gets in the way?

Hamish and Jeremy explore how pain, overload and the pace of the emergency department can make communication harder for autistic patients. Through a composite patient encounter, they discuss processing time, typing, communication aids and the difference between speech, understanding and decision-making capacity. Together, they consider how clinicians can build shared understanding, involve supporters and keep the patient at the centre—even when time is short.

Episode 2: When Behaviour Speaks

When an autistic patient’s behaviour changes, what is it telling us—and what might we miss if we assume we already know?

Hamish and Jeremy explore this question through a composite ED encounter, examining pain, illness, distress and communication differences. Hamish probes why appearing calm does not settle the clinical story, while Jeremy explains the limits of interpreting behaviour from the outside. Together, they discuss how listening to the patient, drawing on familiar knowledge and adapting the encounter can inform assessment while keeping urgent care moving.

What happens when an Emergency Medicine physician experiences the healthcare system from the other side — as the father of an autistic child?

In this opening episode of Autism in the ED, Hamish and Jeremy introduce the personal and professional perspectives of Dr Bassam Nuseibeh, exploring the intersection of emergency medicine, autism and parenthood.

Why can an emergency department be overwhelming for autistic patients? What do healthcare professionals sometimes overlook? And how can we make emergency care more understanding, compassionate and inclusive?

A conversation about seeing familiar clinical environments through a very different lens.