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!

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

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.

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.