Using a toilet as a first aid room

Standard

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.

All change for changing places

Standard

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:

Slings, hoists and money pits

Standard

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.

Standard

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.

Helpful or not – petitions

Standard

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.

Draft of BS 8300 -2 available for comment

Standard

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). 

Utopia Fair – what is World of Accessible Toilets doing?

Standard

Earlier this year I was delighted to be invited to contribute to the Travelling Toilet Tales film – where a number of us shared our story about planning journeys around toilet requirements. At home I have the right facilities, space, design etc … but outside the home and on holiday it’s a different story.

I chose to contribute via narrating a poem about how difficult it is to go on a day out and find a toilet that is suitable – even with the basics!

Pop to the festival to find out more, listen to our contributions and chat with those attending. I can’t go in person but I will be around on Twitter and our Facebook page to chat about the weird and wonderful (and hugely varied) toilet designs and how this can impact disabled people.

The Utopia Fair will be hosting 35 representatives from contemporary utopian movements from all over the UK on stalls in the Somerset House courtyard. The Travelling Toilet Tales stall will offer the public an exciting first glimpse of a draft of our animated Toilet Tales film. Featuring stories from a range of toilet users, including truckers, disabled parents, and non-binary people, the film is an exploration into the ways in which everyday journeys are planned around the un/availability of a suitable toilet. Visitors will also get the chance to listen to the individual toilet stories in full, browse our postcards and artwork, and talk to the special guests joining us on the stall.

Next door, the Servicing Utopia project will be joined by artists who will invite visitors to create utopian toilet models. This weekend will also present the first opportunity to view the interactive digital Toilet Toolkit and short animated film produced by the Servicing Utopia team. The toolkit is aimed at architects and other design professionals to promote the accessible design of toilet spaces and will allow users to virtually ‘walk around’ toilet spaces and interact with items within the space.

 

Our newest research projects, Travelling Toilet Tales and Servicing Utopia, will both appear at the Utopia Fair in Somerset House in London this weekend (24th-26th June). The Utopia Fair will be hosting 35 representatives from contemporary utopian movements from all over the UK on stalls in the Somerset House courtyard. The Travelling Toilet Tales stall […]

via Utopia Fair – Join us this weekend (24 – 26 June)! — Around the Toilet