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.

FAQ: The RADAR accessible toilet key

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What is a RADAR Key? [updated March 2018]

The RADAR key Company have manufactured the vast majority of keys many know as RADAR keys over the past 25 years. They are needed to open a large number (10,000 plus) of accessible toilets in the UK which are part of the National Key Scheme (NKS).

History of the key

RADAR is an organisation that no longer exists – it became part of a new company Disability Rights UK (DRUK). They started the National Key Scheme in the UK.

The RADAR Key Company no longer supply keys to DRUK but continue to make the keys for the National Key Scheme and improve on them.

What toilets do they open?

The keys open toilets fitted with the RADAR National Key Scheme (NKS) locks. Toilets fitted with these are for the use of disabled people and are found all over the country (e.g. pubs, restaurants, leisure venues, tourist places, shopping centres, stations, airports etc).

What types are there?

There are two types – one with a small head and one with a very large head for people with grip or dexterity difficulties. Both used to be silver with the word RADAR Key embossed on them fit into an NKS door lock or NKS padlock . The door locks often look like this:RADAR_lock

Keys now look like this:

A new solid brass key.

They are long handled to bypass vandal protection blocks built into doors.

Who can have one?

Any individual with an impairment / medical condition who needs access to these larger toilets or hygiene facilities or needs facilities to assist mobility or navigation (such as hand rails, lower basin, contrasting colours, different toilet height or seat arrangement, changing table, hoist for example).

One downside is that you do not need proof of need to purchase one so parents and non disabled people can abuse the scheme.

Where do I buy a genuine key from?

You can buy brass (improved) genuine (tested and guaranteed to work) keys from the makers of the original key :

Radarkey.org

price £2.50

Other sellers of ‘genuine’ keys include this one from Disability Rights UK (4.50). [personally I prefer the improved brass one as opposed to a love heart blue key that is rather stigmatising. Some may prefer it if they want it to stand out and know they have it in their bag].

I have seen them for sale elsewhere – do they work?

Fake RADAR Key Fake RADAR Key

There are hundreds of places claiming to sell ‘genuine’ keys including many prominent charities and mobility shops. Most have a red handle and are mass produced in China. I strongly advise against these keys.

One of the reasons for making a new brass key is to avoid people being ripped of by fakes that may be so rough cut and out of shape that they don’t easily open toilets, if at all. Keys may not be tested by a master locksmith or damage locks.

Tom Gordan from their sales team told me:

“Disabled people need genuine Radar keys because they are dependent on them to open what is often the sole toilet which they can use. 
Genuine keys genuinely work all the locks because they have extra machining processes and are more reliably cut and also more accurately cut.
Each one is tested on a radar toilet lock (not the padlocks which are a more basic mechanism) by a master locksmith to guarantee that a disabled person does not suffer.
Identification of genuine keys is easy – if it says “radar” and ‘NKS’ on it, it is a genuine radar key. If it doesn’t then it is an inferior copy.
Including postage, the majority of the dodgy keys are sold for more than genuine ones direct from us at the RADAR Key Company, so the confusion leads to those copies creating both awkward situations and extra cost.”

How do I find a toilet?

A free App is available for Changing Places toilets and coming soon will be one for other accessible toilets. This is available for Android and Apple phones and on the web.

A booklet for regional locations is available on the DRUK website costing £3.50. However, it will cost you £70 to purchase all regions!! I’d download a free App to find their locations made by the RADAR Key Company!

The majority of toilets use the scheme so it’s probably best to just follow signs to toilets/accessible toilets as anyone would do.

Why are accessible toilets often locked with these in the UK?

Many places choose to install NKS locks on their toilets to keep them clean and reduce the chance of them being abused by people who don’t need to use them, vandalised or used for drugs, sexual activity or a wide range of other things!

Child Protection: Campaigning with dignity

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This article is about safeguarding and contains information that every parent campaigner should know. Warning, may involve triggers related to sexual abuse.


When it comes to campaigning for Changing Places or Space to change toilets, a large number of campaigners are parents of disabled adults and children. Children and adults vary in age range and mental capacity, some having severe learning difficulties.

In this article we refer to disabled children but equally this applies to disabled adults with reduced mental capacity regarding consent to the use of their image.

Important information can be found on:

NSPCC image use in child protection

Images in campaigning

Parents will generally want to share images of their disabled children (or send them to other parents or organisations ) so that they can be used on posters, in booklets, attached to Tweets, made public on Facebook or printed in letters / e-mails for example.

Many images involve a child laying on a toilet floor, others show a child in distress or semi clothed/wearing only incontinence pads from the waist down.

Losing control over images of disabled adults and children.

Every potential campaigner, organisation or business who provides or collects an image of a child/adult, needs to be aware of how to protect their dignity and privacy and safeguard them from abuse.

The potential for misuse of images can be reduced if organisations are aware of the potential risks and dangers and put appropriate measures in place. [NSPCC:2018]

This is particularly important when each campaigner is acting as an individual (there is no ‘single campaign’, rather a shared desire to raise awareness and encourage the provision of more accessible toilets).

We have a safeguarding policy for project participants and a code of conduct which you can view here.

What every parent needs to consider.

  • First and foremost the privacy and dignity of every child should come before any campaign gains.

Every disabled adult and child, as a human person, has a right to dignity and privacy.  Whilst it can be argued that laying on a toilet floor is undignified, this doesn’t mean the person should be open to further enduring indignity (and loss of privacy) through having their photograph made public on the Internet for example.

If your child is too old to be placed on a baby changing unit, they are probably to old to be shown in a photo wearing a nappy/pad/pull ups.

  • If your child had full awareness / understanding about the Internet and who would see their image (friends, teachers, families, random members of the public, paedophiles etc) would they agree to you posting that particular picture?

An image example that was shared across the world via social media involved a 14 year old girl with severe learning difficulties, laying on a public toilet floor in her incontinence pads. There are probably no 14 year olds without an impairment who would consent to such images going public – so consider age appropriateness when thinking about dignity, privacy and consent.

  • Question who is asking for this photo – how well do you know them?

Just because a person says ‘please share your image for the campaign’ doesn’t mean they are genuine. Anyone can create a Facebook or Twitter profile and appear to be an understanding parent in the same position.

  • Who is using the image of your child?

Remember, once you share a photo with any individual campaigner (privately or via social media), you have no control over what this person will do with it – or what the next recipient it is passed on to will do with it.

Did you know, we are often sent images of disabled children, not from their parents but from other campaigners and told to ‘use the images as we see fit’. You probably don’t know I have them nor what I intend to do with them. *Note we immediately delete these images.

  • Never share your child’s image with a business, charity or organisation unless you see a copy of their child protection and safeguarding policy.

Use of your child’s image in sexual ways or to locate them in person

You have no control over how the photo you provide to people will be used (it might even be used for a different disability campaign, in any country). You have no control over who will store the photo, if the image will be altered, in what format it will be kept, how secure it is, and how long it will stay there.

It could turn up in the hands of a paedophile or be shared amongst a secret Facebook group of people who will find them sexually stimulating. No parent wants their child’s image to be used in this way?

By posting your photo, where your child may have their face showing, and saying ‘please have a picture of [x]’ you have given your name and that of your child.

A sexual offender or ‘admirer’ [someone who has a sexual preference for a person with specific impairment or medical issue such as being a continence pad user] now knows enough to start following links to seek more information or imagery.

They can visit your profile and see anything you have made public, find out where you might live, perhaps match up your children’s image with anything from a local newspaper/charity/school or blog. Very soon they could pinpoint you to an actual school, know your routines, start befriending you, maybe meeting in person several months down the line as a ‘similar parent’.  They have your whole profile and possibly that of your family and friends (whom they can also contact and befriend).

Gradually they get ever closer to their prize – your child. Then one day you meet up, they offer to sit with your child whilst you pop to the loo. Very slowly your have, unknowingly, compromised the safety of your child … all because of a photo you shared a few years ago on the Internet.

Does this really happen – yes it does. A man contacted me and several other disabled men and women. First the conversation was about what type of mobility equipment/wheelchairs, medical equipment did they use – as if asking for peer advice. A few conversations later the topic turns to asking about the best incontinence pads to use … then asking for pictures of people in their wheelchairs, asking to be friends, liking photos and asking to meet in person. The person found that seeing a particular type of impaired person, in a wheelchair, knowing they were incontinent was sexually stimulating … and they quickly deleted their profile and resurfaced under another name when the disabled community felt that something wasn’t quite right. They wanted images and a visual viagra. They would start to bully and harass people if they did not get their fix. This happens. Be aware and be safe.

  • Once an image is ‘loose’ on the Internet, you will have no control over where it goes or who keeps it or for how long – and will not be able to ‘get it back or delete it permanently.
  • Schools, local authority staff, local authority foster carers, care workers have to work within strict policies about photographing children for posting on the Internet or elsewhere. Images of children have to be ‘appropriately clothed’ and pictures of children in a toilet would be a safeguarding concern and investigated.  As a parent, you will know that you have to consent in writing for every photo a school uses and be informed where it will be shared and how it will be stored. A school has to classify it as personal data under the Data Protection Act 1998.

If a school teacher, care worker, foster carer can’t share images of children who are not appropriately clothed (i.e. in knickers/pants/pads) then you might want to think twice about sharing and the implications this can have.

  • If you are invited to make a photo as ‘shocking as possible’, consider that ‘shocking’ is likely to impact the dignity and privacy of your child.

Be aware, be safe, protect your child’s image.

Tell it as it is – for world toilet day.

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19th November is World Toilet Day , a global opportunity to explain how lack of toilets impacts many aspects of life.

Join our Tell It As It Is event to share your story about the lack of usable and accessible toilets in the UK.

Starting on the 18th of November, we will be putting up a Facebook post on our page – inviting you to tell it as it is.

How does the lack of usable / accessible toilets impact your life?

Whether it’s just a sentence or a short story or photo – please do drop by and share your story by replying to that post on the 18th or 19th.

You can also join our Twitter hashtag #tellItAsItIs and also use the main tag #WorldToiletDay

*All replies will be moderated and those advertising a product or not meeting our adult and child protection policy will not be displayed.

Draft of BS 8300 -2 available for comment

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British standards are helping businesses thrive. Some of them define access for disabled people outside and inside public buildings.

What is a British Standard?

Standards define best practice in many different areas. They’re put together by groups of experts and come in a number of different kinds, from a set of definitions to a series of strict rules. 

… Standards are not the same thing as government regulations, but they’re often used in legislation to provide the technical detail.

(BSI, 2017)

Standard BS 8300 defines access requirements from ‘set down points’ in car parks to the distance to the toilet or width of lifts. There is a section about toilet access, dimensions, fixtures, fittings etc which is best practice. 
A new draft for BS 8300 is available to read and comment on. There are two parts – the toilet section is on 8300-2.

Link to draft BS 8300-1 and BS 8300-2 (enter 8300 in the search). 

Gender neutrality and accessible toilets

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Accessible_toiletSo for the last 6 months or so there has been much discussion on gender neutrality and which toilet you use.

Followed by ‘if anyone can use a toilet, what sign do we put on the door’.  Oh my goodness – do you put a man and a woman, both, half and half, something totally different …. or maybe just a picture of a toilet would be pretty sensible?

Whilst the world goes crazy trying to figure this out …. accessible toilets have been caught in the cross fire.

Our ‘unisex’ toilets don’t have any gender specific symbol

gender_wheelchair_toilet.jpgYou see, we never had any gender identity to begin with. Someone thought ‘we’ might be best represented by a genderless person, usually with no neck, sitting rigid (probably because they sat on a broom handle or something)  in an odd shaped wheelchair.

If we had gender then wouldn’t we have had this toilet sign?

 

 

We don’t think – is this representing a man, woman etc to decide whether to go in or not …. we just see the symbol, on a single occupancy room, and know that beyond the door is a toilet which is hopefully surrounded by adaptations and space to use it.

This symbol isn’t even toilet specific – it might not be a toilet behind the door it could be an ‘accessible’ anything because this is just a universal symbol for access in relation to disabled people.

Not only genderless but not representative

One of the issues is that this symbol doesn’t even represent three quarters of the people who can use an accessible toilet – anyone with a medical condition who needs the adaptions or quick toilet access.

It doesn’t represent people who have an impairment but don’t use a wheelchair. It’s also a major barrier for people who think the symbol represents disability and they don’t identify with being disabled (e.g. older people, people with IBS and mental health problems often do not define themselves as disabled and feel the toilet is for ‘others’). How do you get over that?

Do we need a totally new, universal accessible toilet symbol – and how on earth could we pick something meaningful to everyone. This has been the problem and reason why most countries stick to keeping the symbol of a wheelchair user.

Why this symbol does not make it the designated gender neutral toilet.

Because of the rise in people speaking out about needing a toilet that is gender neutral, some businesses are saying ‘ we already have a toilet just for you [points to the accessible toilet].

This is not a toilet for ‘anybody’ to use … if people don’t have an impairment then they shouldn’t be taking up a toilet with adaptations.

People looking for a gender neutral toilet don’t want to be taking up facilities that are for disabled people. It’s awkward and discriminatory, all round. People just need a toilet. One with adaptations and one without. It’s simple.

Disabled people might need quick access to the toilet because of their medical condition (and may need to go more frequently and stay longer). Every ‘other’ person (be it a parent needing baby changing or a transgender person etc) is taking away the accessibility feature of ‘availability’ every time they use it.

gender_neutral_wheelchair_toilet

I sincerely hope that we don’t start seeing this sort of thing become the norm. A sign to represent a gender neutral toilet – attached to what used to be an accessible toilet only for disabled people. I am hearing that this is starting to happen though and it’s worrying.

This will cause so much distress to disabled people who need quick toilet access but may now have to wait because the toilet has been opened up to anybody – all because of a sign.