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.

Toilet finding/rating Apps

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Toilet finding Apps /websites

The usefulness of toilet finding/rating Apps rely on many things such as:

  • Reliability – rating Apps rely on personal opinion and finding Apps need to be regularly updated.
  • Accessibility of the App or website for people with impairments can often be neglected.
  • Not all toilets are listed on all sites – so you may have to look through several to get a better picture.
  • There may be more than one toilet at a venue and it may not be clear exactly where the accessible ones are (or which one was reviewed if more than one).

Here are a few worth looking at – each had its own merits so tell us what you think (and let the website/App developers know so they can hopefully make them better suit your needs).

They are all free at the time of listing.

I thought this App had great potential and the developers responded positively to feedback. This is both a rating and finding App. You can rate virtually every toilet feature including access features and cleanliness. Changing Place toilets are included as a review type – and a photo can be submitted for elements you wish to highlight. Reviews are personal reflections which is something to consider but with enough contributors and a date the reviewer visited that facility, this could become a leading database to look at.


This App is by the RADAR Key Company and is free to download:

https://www.changingplacesmap.org

You do not have to enter your e-mail to go into the App. A web version also exists with enhanced features. This is a toilet finding App for Changing Places toilets which have a hoist and changing bench. The title is somewhat misleading as this is not the Changing Places Consortium map. Here are some screen shots. The inclusion of data such as whether you need to pay, need a NKS (RADAR) key or if locked is very helpful.

A quick test did not reveal all the sites registered on the CP Consortium map – but it did list toilets that didn’t meet the full CP criteria which was useful. You can let them know if a toilet is missing.

Tom Gordon from the company who is involved with the App tells us:

“Our updated Changing-Places-Toilet-Finder website and phone apps (Apple and Android) are free from http://www.loo.org

Ours was the very first one, has 200 more toilets than the British Toilet Association have on theirs, more accurately described and with a more intuitive design of programme.

A similar free website for accessible toilets will follow, so the 5 year old sheets from Disability Rights UK will then be able to be binned.


Next is map that is perhaps the most familiar to hoist and bench users.

The Changing Places Consortium have their own map of registered CP toilets viewable at:

http://www.changing-places.org/find_a_toilet.aspx

The one function I’d really like to see developed is to search by venue type eg to search for ‘zoo’ or ‘restaurant’ rather than just by location. I’d also like a map somewhere of hoist assisted toilets for people who don’t need a bench or perhaps more info on equipment eg if a toilet riser or bidet is provided.


Speaking of bidets, Closomat have a map where you will find their toilets – also useful if you want to try one out.

http://www.clos-o-mat.com/index.php/away-from-home/closomat-toilet-map.html


Lastly this website seems to have lost its place (and funding). You can enter toilet data in a basic format but to be honest, it’s pretty poor.

https://greatbritishpublictoiletmap.rca.ac.uk

As you can see it never found any toilets near me.


Other sites that list some details about toilets at venues include Euan’s Guide ( a review site where people can describe accessibility of venues including the toilets)

Our profile on Euan’s Guide

and Disabled Go (lots of information but not every toilet at a venue is described).

Pop up toilets with a hoist and changing bench – Part 1

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This month we invited companies to tell us about their alternative solutions for venues who want to provide accessible toilet solutions for people who need a changing bench and/or hoist.

This week features MigLoo … and here is what they told us.


MigLoo

Summary

  • Mobile, set up/take down system as and when required.
  • Three types (MigLoo Freedom, MigLoo Festival and Naked MigLoo)
  • A gantry hoist system with a changing bed and camping technology for sink/toilet supply.
  • Cost: £6000 to purchase.
  • Hiring options.
  • Website: www.migloo.co.uk
  • Contact: Leave a message or telephone us on 07789 147663.

Where did the idea come from?

Director John Robinson’s concern at the difficulty people experience in finding suitable facilities. He started out by inventing a mobile Changing Place for Andy Loo’s in 2006. He got one of the very first Changing Places Awards during the launch of the Changing Places campaign at the Tate Modern, in 2006. John then realized there was a huge need for facilities that people could take with them. This gave him the idea of inventing an inexpensive yet completely versatile and fully mobile solution to these needs. This led to the three products we have today.

John was inspired by people with profound disabilities’ character and their neglected situation, which still continues today. He still feels that ‘we can do better than this!’

Why do these facilities make such a difference and what do customers and users think of them? 

Operation with MigLoo’s mean that facilities can be put where people need them, rather than having to seek them out. They also are low cost making it easy for people to make those ‘Reasonable Adjustments’ required under the Equality Act.

Users of the facilities (which means carers as well as wheelchair occupants) are delighted by the MigLoo’s and often moved emotionally that they can stay for a full event or that someone has bothered to provide what they need. We’re deeply moved by this and extremely motivated to develop MigLoo’s and the many other inventions in the pipeline.

How long have you been running and where are you based?

We started off in 2005 when John Robinson gave up his job running Pershore Day Care Centre to develop his inventions. Co-director John Morgan joined him in 2009 and the parent company, Protorus Solutions Ltd, was formed in 2014. However, the current MigLoo operation commenced in late 2017. The entire MigLoo manufacturing, production and operation is based in Pinvin, in darkest Worcestershire.

How many types of arrangement do you have and what areas do you cover?

We cover the whole of the UK with sales. We prefer businesses and organisations to buy MigLoo’s because of their very low cost. However, we also make some MigLoo Festivals available for hire when we have the capacity to do so.

There are 3 MigLoos

Migloo Freedom

The MigLoo Freedom (above) is 2m x 3m and has a changing bed, gantry with hoist and tent to cover. This means it is small and light and can be erected on fairly level sites by 2 people virtually anywhere.Migloo Festival

The MigLoo Festival is 4.5m x 3m and is an accredited Changing Place. It has everything that other Changing Places have, including a sink, water from a tap and a loo. It is self-sufficient, being independent of mains water or electricity, using camping technologies, which make it incredibly flexible and cost effective.Naked MigLoo

The Naked MigLoo is simply the MigLoo Festival without the tent structure. What we are doing here is providing pop-up Changing Place facilities that can be put into an empty suitable room ANYWHERE!

From businesses through shopping malls, supermarkets, museums, local authorities, empty shops on High Streets – essentially opening up huge amounts of otherwise redundant spaces into accredited Changing Places for profoundly disabled people to use.

We’re seeing this as a temporary solution to the lack of facilities; they are low cost making them a very reasonable adjustment and helping to prove the need for permanent facilities to be installed.

We also realize that MigLoo’s can also enable organizations to find the optimum site for a Changing Place, thus avoiding the embarrassing situation that some businesses/authorities have made in putting them in locations that few will use! Because of their extremely low cost, Naked MigLoo’s are also perfect “standby” Changing Places for when the permanent Changing Place breaks down.

  • A Naked MigLoo takes only 30 minutes to be erected and become fully operational.

Can they be installed/hired for a few days or nights?

Yes. We will hire them out for anything from 1 night to many, although installing at a great distance simply isn’t feasible or cost effective as it would be too expensive for a relatively short period.

Does anyone stay with the set up to help learn how to use that particular hoist/gantry or empty commodes etc?

No, not really. The equipment is easy to use and we make sure hirers are trained, thus having someone who can advise on hand when folk use it. We sort the waste out.

Can any disabled person or carer use your facilities or are they only for hoist/bench users (and their carers/assistants)?

This is really for the event organizers. The Elsan loo we have has armrests and a backrest and is designed for those who need support, but there are not the grab rails you would find in an ordinary wheelchair loo. The organisers may well feel that users with profound disabilities should have priority and should not have to wait for someone in a wheelchair, who has an alternative loo.

For people who might use them, would they be allowed to leave their sling with you in a locker or do they need to carry it around the venue?

They would need to take the sling around with them, as we have no locker, but it is something we could consider. By the way, it is looped slings that fit our hoists. This is because most people use this type. We could cater for clipped systems, but this would need advance notice and be a little more expensive (as they are not used very much).

What types of venues have you been to and how do people know if you are attending?

Here’s a list of what we’ve done so far; Fun Days in a football club, Fetes, Disability Awareness Days, Children’s Play Schemes, College Events, Exhibitions, School Events, International Theatre, Conferences, 7 day Festivals….. We put the events on our website and social media and make sure the organisers advertise that a Changing Place will be available; after all; ‘If you billed it they will come’ – but not if they don’t know about it!

If I wanted one for a day at my event/venue, what space would I need and where is the best place to have one e.g. inside the event, in the car park etc.

The MigLoo Freedom is 2m x 3m, the MigLoo Festival 3m x 4.5m but some space is needed around the structure for guide ropes if it is windy. It is best to put the facility as near to where it is needed where people are, rather than making them have to go some distance away (it’s often hard work wheel chairing!).

Do I need a permit or special insurance to have one near/in my event?

No, though we would ask that you insure the facility, just to cover any damage. Our parent company, Protorus Solutions Ltd carries £10m in public liability insurance.

How can people find out the cost of hiring a Migloo arrangement and attendant?

Just go on our website www.migloo.co.uk and leave a message or telephone us on 07789 147663. We don’t provide an attendant as this will push the costs way up and normally the event puts someone in charge. Carer’s also know what they need to do when they see the very familiar set up inside the MigLoo. We could consider this, however, and supply an attendant if necessary.

What do you hope for the future of Migloo?

Simply to support as many people that need it as quickly as possible. There is a desperate need in the UK for these facilities as we have all seen in recent national TV and other media coverage. Our MigLoo family offer real “reasonable adjustment” and the Naked MigLoo is potentially a game changer, changing many many lives for the better, once it has become more recognized. We would also like the low cost MigLoo concept to be taken on by the “event loo” industry in the UK and make it available to other countries. As MigLoo grows, we will employ staff to run the operation.

Can people find you on social media?

Yes, on

Twitter @MigLoo4U #GotaRoom4CP

Facebook : MigLoo4u LinkedIn :      www.linkedin.com/company/migloo

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.

All change for changing places

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News from The Changing Places campaign:

We wanted to share the news that Muscular Dystrophy UK is taking over from Mencap to lead campaigning activity across England, Wales and Northern Ireland, and will co-chair the Consortium alongside PAMIS.

More about this news can be found at:

http://www.changing-places.org/news/changes_to_the_consortium.aspx

Aveso say:

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.

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.