Playing Patient: Autistic People Can Learn Skills through ER Simulation

Drenched in sweat, this autistic patient kept screaming “no, no.” She was strapped to the stretcher, staring at a ceiling vent in the emergency room. For 40 minutes, she repeated the same word, “no”. She didn’t respond to questions that a physician asked. Unsure what else to do, the physician requested a psychiatric consultation. While waiting for a psychiatrist, the restraints were loosened for a physical exam. The patient immediately covered her ears — and went quiet.

This wasn’t a behavioral crisis. It was sensory overload.

Above her, the ceiling vent buzzed — high-pitched and constant. The restraints dug into her wrists. Monitors beeped every second. Her migraine made each heartbeat throb in her skull. Even whispers felt sharp, and her autism amplified every sensation.

Ever since I decided to go to medical school, I have been more drawn to Emergency Medicine, even though my PhD research was in Radiology. One of the reasons is that I want to address the unique challenges ER patients face, like this sensory overload experienced by the autistic patient. Anyone who has seen ER or The Pitt knows the emergency room is all about saving lives under pressure and with limited resources. I’ve watched every episode of both shows, and not once did I see a scene that focused on the comfort of autistic patients.

So, is the quality of autistic patient care not important in the ER?

The answer is No. For this autistic patient in sensory overload, her challenges led to unnecessary restraints and treatment delays. Unfortunately, this isn’t rare. A study shows autistic patients are 5 times more likely to face difficulties during triage, 4 times more likely to experience treatment delays, and 8 times more likely to be physically or chemically restrained. In fact, ~34,400 autistic individuals experience such barriers in Los Angeles County every year.

In my first month of medical school, I met Dr. Zenith Khan, my mentor for the Health Equity Challenge. As a family nurse practitioner at the UC-LEND Clinic, she led a small group discussion on caring for patients with disabilities as part of UCLA medical school curriculum. We watched a video showing how the clinic creates a patient-centered environment for patients with neurodevelopmental conditions, such as autism. For example, it talked about extending 20-minute primary care appointment to 40 minutes so that patients won’t feel rushed. And my immediate thought was, “What about the ER?” That moment sparked my idea to improve emergency care for autistic patients.

Then, I spoke with physicians, nurses, and other providers about solutions, such as re-designing hospital rooms or improving staff training. But as you see in ER or The Pitt, the emergency room runs on limited capacity.

But then, during a clinical simulation class, I came up with a new idea. Simulation trainings help medical students practice real-world scenarios in a safe, controlled setting. And I wondered: What if we used simulation not just to train providers, but to prepare patients? Specifically, what if we used it to help autistic individuals gradually adapt to the stressful, unpredictable ER environment? Similar to how cognitive behavioral therapy uses exposure to build tolerance, simulation could empower autistic patients to better manage ER visits — reducing fear, improving self-advocacy, and ultimately improving outcomes.

Simulation training isn’t a one-time event. As medical students, we learn as much as we can during each session, then reflect afterward. I want autistic participants to do the same — because this training can also spark meaningful conversations with their support systems, including caregivers and occupational therapists.

Changing hospital infrastructure or staff behavior is difficult, as I mentioned earlier. But as more autistic patients begin to self-advocate their needs during emergency care, medical teams will adapt. I hope, over time, this can shift institutional culture and improve the ER experience for the broader autistic community.