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).

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.

Slings, hoists and money pits

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Another disability money making scheme?

Recently I had the annual inspection of my ceiling hoist. My hoist covers the area from my bed to my toilet and wheelchair. The inspection includes a visual check that my sling is safe to use. In fact, the law requires a sling inspection twice each year. It costs around £100 for a hoist and sling safety assessment.

My sling is as rugged as hell – in fact I can’t imagine how it would get torn or ripped without slashing it with a knife several times!! Basically it would probably last me 20 years.

However … and here is the rip-off, the sling can fail and be declared instantly unusable if the serial number can not be read.

Now, slings are made to be washed – and just like clothes, the little cloth tag can begin to show faded writing. So my £500-600 sling could be assigned to the bin after a years worth of washes! A perfectly maintained and safe sling, thrown away because of a faded number.

Will companies make a serial number that is permanent that can withstand several washes? Apparently, the word on the street is that key companies were asked to do just that but refused because it brings them greater profits by forcing everyone to repurchase new ones. Imagine schools and hospitals having to pay out thousands each year to get new slings that are otherwise safe to use.

Equally, a company can say they no longer ‘support’ a particular hoist model and the user also has to throw that out within six months as they are automatically deemed unsafe.

The overall result is that individuals, schools and hospitals, public swimming pools, social services and companies who have Changing Places hoist equipment are throwing away large amounts of equipment that may still be usable for a number of years.

Products that are purchased are now being chosen because they are cheap to replace and not because they are safe, dignified, comfy and the ‘right one’ for the user.

Calling all manufacturers…

I invite manufacturers of patient slings and hoists to comment on their policies and manufacturing processes where efforts are being made to ensure serial / product numbers can last the lifetime of any sling and that ‘discontinued’ products can still be supported for the life of existing equipment . These would also come under the companies policy to cut down on environmental waste.

When surgery is the only option.

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Every day, disabled women are choosing surgery because there are no usable toilets outside their home.

Sometimes it's an ostomy bag for poo or more frequently a supra pubic catheter.
A catheter allows urine to drain from the bladder [through a hole in the skin] into a
bag or through a valve into a bottle/toilet. It's a big life changing decision.

Getting surgery for a catheter is the most talked about topic within women's forums and social media groups.

Read above one woman's experience.

The reason is not often for medical purposes – but simply because toilets are not accessible / available. They don't have the right amount of space or equipment to be usable. Sometimes they aren't provided at all or are padlocked. If you need a hoist then you only have a choice of around 1000 toilets – across the whole of the UK or Northern Ireland. There may be none in the county you live.

Catheters can cause regular infections and several other medical problems – yet bring an element of liberation and the ability to leave the house. They don't remove the need to manage menstruation hygiene though and many women also choose contraceptives or surgery to control this (oral contraceptives pose a high risk for blood clots in women who aren't active) – because they can't get on the toilet.

Disabled women experience the most discrimination when it comes to using toilets. They take the most life changing health risks. This has to change.

Have you had surgery because of no usable toilets? Tell us in the comments below.

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.

 

 

Launching our new campaign

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Today we launch our new campaign #BiggerIsBetter [Bigger Is Better].

We hear over and over again how much people struggle with the size of wheelchair accessible toilets.

Unfortunately, the size suggested by building regulation guidance is far too small for the types of wheelchairs and scooters that people use today.

We need to raise awareness and explain why meeting  building regulations does not mean they are meeting their legal duties to provide usable toilets under the Equality Act [Disability Discrimination]. Very few businesses are aware of this.

Wheelchair users can often not get into these toilet spaces, turn around or transfer safely. They become unusable. An unusable toilet might as well not be built.

Every toilet that gets built to this size could mean decades of  being unable to use that toilet. If nothing happens now – the future will remain bleak.

If the standards are not going to change, then the only way forward is to reach out to as many businesses and new developments as possible and encourage them to see that bigger is better.

 

We need to encourage larger spaces and where possible Space to Change or Changing Places. Without larger spaces, wheelchair and scooter users will continue to struggle to live as equal citizens in the UK.

Please join the campaign and help spread the word. Share our posters, pictures and your experiences.

Bigger_Is_Better_Poster1.jpg