Using a toilet as a first aid room

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First aid room toiletYou were having a nice day out until you took a tumble and you’re now bleeding profusely from your knees and elbows …. off to the first aid room you go.

Would you accept treatment if the first aid room was a toilet / restroom and the ‘seating/rest’ area was a bed near the toilet that had previously been used to change a filled nappy?

Would you be thinking ‘surely this isn’t the right environment to treat an open wound?’

When a first aid room becomes a toilet room

I think most of us would be quite shocked to know that first aid rooms at some public venues / tourist locations are being offered up as ‘toilets’ to disabled people? Did you know that disabled people are having soiled pads changed on first aid beds? Some disabled people may be using camping toilets or commodes in the same space.

Should this be allowed? Let’s look at the issues.

[Article by Louise Watch. Louise has formerly worked for 7 years managing mobile and static first aid posts at public event and venues. Louise also uses a wheelchair and hoist].

Why is it happening?

There are large numbers of visitors to public events who can not use standard ‘accessible toilets’. On a number of occasions first aiders and ambulance staff have had to help people who have not been able to get up from the toilet or who have fallen – usually because the space has been too small to use safely.

Some people need carer support, space, a hoist to transfer from wheelchair to toilet or a bed to lay on to remove clothing, use a catheter, have a continence pad changed. However, venues across the world have been declining to put in suitable toilet facilities known as Changing Places, and instead are telling visitors with these requirements, to use the first aid room.

Safety and practical concerns

  • The obvious first problem is that this assumes that older and disabled people are incontinent – and use adult nappies. So they can just lay down on the bed and change, right?

Wrong. Most are not, they just need a toilet in a room with enough safe manoeuvring space or a hoist available … and first aid rooms do not have a toilet in them. They also do not have hoists or the space to use them.

I have been in hundreds of first aid rooms whilst looking after sick and injured visitors and never once seen a toilet inside. Usually there is a cupboard with medical supplies and a bed, chair, sink and maybe a privacy curtain. So how the offer of a first aid room is going to help continent disabled and older people is a mystery.

  • Are they thinking about supplying a commode or camping toilet?

Maybe – but it’s not something a first aid room would have as standard and commodes vary a lot and come with their own hazards eg stability, wheels that need breaks on, variable heights and seat types. People can easily fall if it’s not suited to their balance or abilities. Proper accessible toilets have specific features for a reason eg

  1. gently curved toilet seats or specific shapes that support hip stability and protect pressure sores.
  2. a toilet that is anchored to the ground and won’t tip over
  3. a seat specially designed to withstand ‘rough’ transfers,
  4. support rails at a particular height either side
  5. if a person stays in their hoist sling then this is a total body support in itself.

Commodes can be dangerous if they don’t match the needs of the person and can cause serious accidents.

Commodes also need to be cleaned/emptied between different people and human waste and menstrual blood has to be disposed of correctly. First aid rooms are not equipped for this which means someone will have to walk the filled pan to a nearby toilet to flush away. Will that be staff or visitors?

It is also questionable whether hygiene standards for spills and splashes could be dealt with in a first aid room environment. Infection control becomes a big issue that would probably need a full risk assessment.

  • What about people who just need a bed?

People who need a bed to have a soiled pad changed could possibly use a first aid room but there would have to be a full risk assessment to look at the following areas:

  1. If a hoist is needed, is there sufficient space for a portable or gantry hoist? In my experience, there is rarely enough room.
  2. Infection control is needed if urine, faeces and other fluids are likely to have touched the bed. It might be possible to risk assess alongside the usually assessments for cleaning up body fluids such as blood, vomit and saliva wipe down methods for infection control. This should be in place in a first aid room as standard. Carers/assistants are likely to already be familiar with this when using Changing Places toilets and home facilities.
  3. There is, however, a greater risk if a proper cleaning procedure has not been followed by staff or carers – eg if the next casualty to use the bed has open wounds. Equally, an immune compromised disabled person may be at risk if a casualty has used the bench and has an infection and has vomited over the bed as is often the case. I have seen some pretty poor hygiene and infection control practices in first aid locations.
  4. Access to a sink for water to clean and wipe the person should be available from the first aid room sink – again infection control protocol could be used and general wipe down procedures that toilet cleaning staff might also utilise.
  5. There would need to be access to human waste and sanitary bins not provided by first aid rooms.

Duel use at the same time

The other challenge to turning your first aid room into a toilet is that it can take 40-60 minutes to hoist a disabled adult onto the treatment table, change and clean them, then get them back comfortably in their wheelchair. Then add on another 15 minutes for cleaning and disinfecting. What if there is a casualty who needs treatment during this time. Both can’t use it at the same time unless you have a first aid room laid out like a hospital with cubicles and more than one treatment area/bed.

Should first aid rooms be offered as toilets?

In light of the above – no, unless the first aid room is very large and more like an A&E department with staff training to match regarding infection control and clinical waste disposal.

Even if I was offered a commode, hoist and private cubicle I would find it insulting and undignified to have to visit a first aid room, where patients might be, to use the ‘toilet’. This would not be equality in terms of bathroom provision. It is certainly not an appropriate solution for the hygiene needs of older and disabled visitors/guests.

Helpful or not – petitions

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There are over 80 petitions on Change.org calling for signatures to back calls to governments and businesses for accessible toilets. Most are by individuals calling particularly for Changing Places toilets.

Are petitions helpful?

Psychologically petitions and demonstrations by disabled people and carers are useful – providing the 'I feel I am doing something rather than nothing'. People who sign genuinely want to say 'this needs to change'. However, the reality is that petitions rarely achieve results.

No amount of signatures is going to change the law or monitor adherence to building regulations. In the UK, the government have heard, via parliamentary debates, how we need accessible toilets. They end with empty promises.

As we speak the draft of revised access standards has been drawn up – setting British standards for what could be used in buildings which last over 50 years. They don't include any change to toilet provision. They are based on the dimensions of wheelchairs, for example, from 20 years ago. Petitions won't impact these.

Dilution of support

Petitions aim for x number of signatures …. people might sign one or two but 80? If campaigns were centralised into one petition there could be thousands of supporters rather than a few hundred.

Change in strategy

The movement to ensure toilets for all is disjointed. Often it's based on promoting the needs of children rather than the needs of disabled people of all ages. People with obesity, dementia and autism are often totally ignored. Many campaigns are based on the need for hoists and changing benches – yet we still have toilets being built that are supposed to follow strict building regulations, but don't for 'independent' disabled people. There are failings at every level. Equality laws do nothing to persuade businesses that disabled people need accessible toilets.

What can we do to actually make a difference?

  • Share a petition rather than recreate one for yourself
  • Look out for opportunities to comment on building regulation guidance, local access consultations, health consultations etc.
  • At every opportunity provide feedback about toilet access. Use social media, review websites, council feedback forms, patient feedback cards at hospitals etc.
  • Use formal complaints procedures.
  • Write to your MP
  • Provide witness statements for parliamentary debates

Sounds like a lot of effort? That's why it's easier to sign a petition and have our social guilt relieved – we've done all we can, right? Now everything will be ok?

No it won't – but deep down you know that.

Poo at the zoo.

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This week is Love your Zoo Week run by BIAZA. The British and Irish Association of Zoos and Aquariums (BIAZA) is the professional body representing the best zoos and aquariums in the UK and Ireland.

Baby elephant

Chester Zoo

 
1.3 million people visit member organisations every year. Only a small percentage are disabled people and their friends/families because few venues provide toilet facilities with 

  1. a hoist and changing bench, 
  2. space for modern wheelchairs or 
  3. one that is fully equipped for able wheelchair users and those with other impairments e.g. Bowel/bladder disorders, autism, mental ill health, epilepsy, obesity, shortened height.

 BIAZA members contribute over £650 million to the national economy.

If the venue doesn’t provide a hoist or height adjustable toilet, this means a lot of people can’t visit. People with poor balance, weak legs or arms may not be able to stand up from an accessible seat. 

People with muscle and nerve disorders, balance or co ordination difficulties or frailty from old age may need this equipment.  They may not necessarily use a wheelchair.  

There are no height adjustable toilets in any zoo, aquariums or wildlife parks in the UK.

If standing up from the loo (or standing by the loo) is impossible, such individuals have to be lifted up / carried in the arms of relatives or find a toilet with a hoist and changing bench. Wheelchair users with weak arms/legs also need hoist facilities.

Hoist, toilet and changing bench

Chester Zoo


There are a number of zoos etc who provide such essential equipment and the space to use it. 

These are:

  • Marwell Zoo (first in UK to equip toilets for all visitors)
  • Bristol Zoo Gardens
  • Blair Drummond Safari Park
  • Tilgate Park
  • Chester Zoo
  • Chessington World of Adventures Resort
  • Tropical Wings Zoo (opening soon)
  • Folly Farm Adventure Park and Zoo
  • Cotswold Wildlife Park
  • Colchester Zoo
  • Yorkshire Wildlife Park (hoist and toilet)
  • Wingham Wildlife Park
  • Pili Palas Nature World
  • Camperdown Wildlife Centre (opening soon)
  • Edinburgh Zoo (hires in a bed and hoist for 1 week per year)
  • Whipsnade

(List excludes bird and wildlife reserves and parks/forests).

Possible future venues:

  • Living Coasts
  • Paignton Zoo
  • Newquay Zoo
  • Twycross Zoo
  • London (only hoist and bench currently – no toilet)

Specifically stating no hoist facilities:

  • Woburn Safari Park

However, there are over 100 venues who do not offer usable toilet facilities – not even for people who don’t use a hoist.

Why do they exclude disabled people?

Museums and accessible toilets

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Are museums no go zones?

Museum of London, Docklands

Have you ever been to a museum that hasn’t had a toilet for visitors, staff and volunteers? If it’s a medium to large museum – probably not. They are probably high on the list if not essential.

Disabled people are potential employees, volunteers and visitors, yet still so many museums fail to provide usable, safe toilets for people with access needs. 

I’ve been to hundreds of UK museums of all sizes, only 2 fully met my needs. If I am with my care assistants I can only visit places with hoists.

If a museum provides accessible and usable toilets for people, the benefits are perhaps obvious:

  1. Larger pool of employees to choose from
  2. Disabled and older people can visit
  3. More attractive to disabled and older volunteers
  4. More attractive to schools who have disabled teachers or students

This leads to increased community outreach, education, visitors and profits / grants.

Without usable toilets, museums and galleries are choosing not to welcome and exclude disabled people. 

We have accessible toilets

You have to be very ‘able’ to safely use ‘standard’ accessible toilets. You have to have either strong arms or legs (to transfer from a chair or stand/sit), good balance, good dexterity and grip to hold support rails. Many people are not that ‘able’ e.g. people with MD, MS, MND, arthritis, CP, paralysis, stroke, short limbs, learning difficulties, autism, anxiety … that’s collectively millions of people!!

Florence Nightingale Museum


This type of toilet might meet most of the standard criteria but only for the very able. 

Museums need to:

  • Audit standard toilets against the most recent recommendations for access 

This one below has a raised seat which is not part of access criteria and can make it extra difficult or impossible for wheelchair transfers. The toilet roll is high up and the emergency cord is wrapped around the support rail.

Horniman Museum

  • Install either a space to change toilet or Changing Places. These have essential space and equipment like a hoist and changing bench. 
  • Install a ceiling hoist over standard toilets to increase the number of visitors/staff who can only get out of their wheelchair with a hoist (like Lincoln Castle has below).

  • Advertise your facilities or people won’t go if they are not confident there is a usable toilet.
  • Show pictures of your toilets in access guides and provide clear signage.
  • Have regular reviews of toilet access.

It is still disappointing that so many museums exclude people. Most of the big museums across London for example do not provide usable toilets (notably Cardiff and Edinburgh have full facilities in key museums) .  When these London venues are approached they don’t want to know. 

“In Kent there are no museums with hoists in their toilets – so I can’t visit at all.”

Attitudes must change if disabled people are to get inside museums – it doesn’t matter how many tactile maps, quiet areas and ramps you have if people then have to worry if they will wet themselves and have a miserable stressful day out.

Train travel and toilets

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This week we heard about Anne Wafula Strike in the news – not being able to access the toilet on a long train journey.

The fear of not finding a usable toilet (and risk urinating in your underwear or damaging your bladder and kidneys) is very real. It leaves disabled people choosing the more dignified option – to not make any long journeys by train or car. This leads to major life restrictions around work, health care, leisure and socialising or seeing family.

Until 6 years ago, I had never been on a train. I then had to get into London for specialist hospital services so we started using trains. With my husband, we carefully choose our stations – they have to be 

  1. staffed – to set up ramps to get on and off . (Not all stations have staff present.)
  2. Step free access to the platform. (Some stations have no access to platforms or only access to some platforms in one direction).

It is here we bring into the equation – where will I be able to use the loo along the way.

Where are the usable toilets?

Our main route has been from Tonbridge to London Bridge and Maidstone to Victoria. From the moment I last use the loo at home, the clock starts ticking. I won’t drink anything that day to reduce the need for the loo.

Around an hour has passed and I’m at the station. The toilet door opens straight onto the platform – so my husband who lifts me out of my chair to/from the loo will have to slink out whilst I use it (without exposing me to people on the platform). He will then have to loiter and listen out for me to call him back in. He will get some funny looks – but that’s ‘normal’ for us. It’s not a private affair. 

There is no hoist – so he will have to lift/drag me to the seat. On the plus side it’s clean and has all 3 of the standard set of support rails to cling on to. 

I can’t travel by train to London with my personal assistants as they can only use a hoist to lift me and there are no rail stations with hoist equipped toilets on my route or at my destination. 

On the train

On the train, I need to get assistance into the accessible carriage. This is where the accessible toilet is located. However, on the way home we are sometimes just put in the doorway area because not all trains have accessible carriages or are too full at rush hour. They have no access to the toilets. Staff just want to get people on trains or are they see the accessible coach is a long way away – so they try to board you into the nearest coach with no wheelchair space. 


I can’t use the toilets on trains because my small powerchair won’t fit and there is no space for my husband to lift me. They don’t have hoists. You can see here that if my chair was next to the loo – my husband would not fit in at all. Alas I haven’t mastered levitation.

I often see they are out of order. If I needed the loo I’d have to get staff to cancel the ramp at my destination- and make new arrangements for me to get off at another station –  and back on another train after using the loo. As I’ve just said, stations might be no go areas because they are not step free or staffed.

If it is possible to get off at another station, what if the toilet on that station isn’t usable? Not every toilet has the ‘standard’ space, suppport rails etc. Take this one for example.


We were a few hours on a train for a day out at Ely. My husband had worked out we could use the toilet at the station. He’d even seen a picture on the station’s website. However, we headed straight for the loo only to find the support rail was not standard / too far away from the toilet to hold on to. I would have fallen on the floor. I had heart failure because we were in a new place with no idea where to find a toilet. 


On our way back from Ely to Kings Cross the same problem but thankfully on the left hand side (I need a right hand side rail as it’s the only way I can lean). For someone else this won’t be usable. This toilet is also higher than the recommended standard for safe and manageable transfers from a wheelchair. 

Trains and stations – will they ever be accessible?

I haven’t heard that newly refurbished stations like London Bridge or Cross Rail will have made any improvements to accessing toilets at stations across London. No toilets with larger spaces or hoists being put in. No refurbishing or auditing of current toilets to ensure all access features are present and correctly positioned or offer better privacy.  

I’ve been part of consultations on toilet provision on new trains. The designs did not involve larger spaces or better layouts for wheelchair users. 

There is never a guarantee the toilet will be in working order – but if all stations had improved, usable wheelchair accessible toilets on all platforms, we could at least get off the train at the next staffed station and be confident that I could pee into the loo and not into my knickers. 

All about the Hollandica Superferry

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This was a trip in 2010 and I have re published for archiving one this project.

Journey: Hook of Holland to Harwich via Stena Lines – Hollandica Superferry

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This ferry was launched this year (April 2010) and will join another Superferry in Autumn.  These cost £375 million pounds.  Shame they didn’t spend much on thinking about the overall experience for disabled people. Granted the ship had some nice touches but compared to our first crossing, the staff support was very poor.

 

 

Cabins.

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Again, we pre booked a cabin with wheelchair access. We had our tickets printed at the car booth which they told us also acts as your room key. This was the same as our first journey.

On locating the cabin (which had us wandering the isles of cabins to work out the number system) we found the door had a small low touch pad with a slot to insert the room key card. It also had a normal handle on the door.  I believe the door was supposed to open automatically.  I say supposed, because it didn’t work.

My husband tried several times and the light flashed but nothing opened. Eventually a member of staff said we had to have a normal key to put in the door.  What use is that!  The automated door was not working and when we got in we could see why – the opening door arm was not fitted but the electronics were there. It was also kind of … orange!

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The bathroom featured a level entry (roll in) shower area with seat and lots of grab rails. The toilet had two grab rails either side and room to side transfer to one side. I’m not that fat but due to scoliosis, lean to the right side. When the grab rails come down they basically wedged me onto the toilet and are closer than what you would find in your average UK accessible toilet. The floor surface is very soft, with good grip but like the previous ferry, the sink is not suitable for hair washing and difficult to reach for me personally.

The bathroom is rather nice but the flat push panel to open the bathroom automatic door is situated above the side unit of the bed on the left of the cabin. So if you have to sleep on the right bed (which I do because of my spine) you can’t press the button from bed.  However, if you are a wheelchair user, how someone could sit on the bed, press the button, transfer into their chair and then get through the door before it closed again in about 10 seconds is beyond me anyway!  The bathroom door swings back and because it is wide, there is only a few set places your wheelchair can go or it hits you and closes again.  If you are standing in the way of the door the force would knock you off your feet – my wheelchair would rock with the force and it’s a weighty machine.  The location of the switch hasn’t really been thought through in the overall design I felt and the close mechanism is rather violent (but possibly needed to close a large heavy door).

The cabins were nice though putting these problems to the side even if they did vibrate something chronic.

Customer service.

I was a bit miffed that the free wifi was only for 3 hours and the ‘reception all over the boat’ meant one bar if you’re lucky.  We also got an incredibly poor service when purchasing food as what we wanted from the menu wasn’t actually available and my husband ended up with a microwave meal and I ended up with a chicken burger that makes McDonalds look like a 5 star restaurant.  The guy who ‘cooked’ our meal was more interested in the football on the plasma tv installed in the food court than customer service. We had no offer of help to carry the tray and no ‘quiet area’ as in my previous blog.  Too much money spent on umpteen plasma screen tvs and bars than on customer care I think.