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).

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.

Utopia Fair – what is World of Accessible Toilets doing?

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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

What’s at Naidex in the loo department?

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So, it’s that time of year again where I laugh at have a serious look at what’s new at Naidex – the crazy convention showcase that is all things health/lifestyle/disability. We take a look at the exhibitors lists and play ‘spot the new toilet gadget’.

If you spot something we have missed – let us know!

First up – the Innovation Trail

This is the annual shortlist of products less than a year old or new ideas which are being launched at Naidex. Sometimes you see some crazy things you think ‘there is no way anyone will buy that’ through to ‘oh that’s a good idea’.

So what’s new in the toilet / hygiene department?

Well, forget taking a ride on the rotating shower tray (I kid ye not) and head over to Stand H37 for PDS Hygiene. They will be showing off their bidet shower chair (BSC-100) and what looks like a new model of their hand held powered travel bidet.

I’m not sure how the bidet shower chair would work over the Biobidet models BB1000 and later as they rely on skin contact with a sensor on the seat to power up.

If barrier creams are more your thing – then take a look at 3M’s stand over in section D38. They can show you their Cavilon Barrier Cream that can help skin that has become sore (or could become sore) from incontinence.

Geberit_AquaClean_8000plus_care.jpgThe new Gerberit AquaClean 8000plus Care (wow that is some name) might be worth a look (Left).

It’s a shower toilet that is compatible with many paediatric shower chairs being activated by button or remote control. I assume it is also compatible for for adult over the toilet chairs too. They are over on Stand G29B

Still on the theme of all singing and dancing toilets – Aquarius Hygiene (Stand D36) have their own version of a wash/dry toilet seat similar to the BioBidet range they are calling the Intelligent Bidet. It is powered by a tethered remote with other options available.

Looking at the picture, for my personal bum comfort, I prefer a wider and more contoured seat – and seat shape and comfort really matters as you sit through the wash and dry actions (and you have to be sitting in the right place!!). So, shop around and compare specifications according to what suits.

Other products and companies to check out.

All the usual exhibitors are back for 2016. You might also want to check out companies selling hoists and toilet slings – although some of the big names like Liko do not appear to have a stand listed if you believe the search function.

  • Product list searches do not appear to bring up all products shown within individual companies e.g. search for sling and it says there are only 5 products.
  • Toilet brings up 26 products – somewhat disappointing considering how critical/essential it is.
  • Could not find any ostomy products listed. Coloplast – are you there?

Aquarius Hygiene

As well as their new Intelligent Bidet, their other products include the Porta Bidet and Handy Bidet travel kit.

ArjoHuntleigh: 

Products include the Carendo over the toilet shower chair/hygiene chair and shower tables/changing benches.

Designability

Toilet Handles

Toilet_Handles.jpg

Ergolet – Hera Hygiene chair and changing trolley/bench amongst others.

Hera_hygiene_chair.jpg

Euan’s Guide – if you haven’t got their red cord cards, where have you been this last year! Go and take a look.

Made 2 Aid

Wheelable – an over the toilet shower chair.

 

Wheelable.jpg

NRS Healthcare: Bringing out the new SeaHorse models of toileting and shower chairs for children and young adults. (Stand J7)

Pressalit Care

“Our product range includes height adjustable washbasins, toilets, changing benches and shower seats”

Pressalit happen to have my favourite most comfortable toilet seats “accommodating different shaped toilets and people”.

 

1st Call Mobility

Baros_Commode.jpg

They have the Baros – a heavy duty heigh adjustable shower commode/ over the toilet commode for people with obesity

Finally the things that aren’t disability specific …

The BlueBadge Company are selling toiletry bags.

 

The future of public accessible toilets

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Further improvements are needed if we really want to make ‘away from home’ toilets truly usable for all disabled people. 

The best we have in the UK are those in new buildings which have followed guidance (Approved Document M) on meeting building regulations for access/features etc.

Most places provide single room, wheelchair accessible toilets to the UK wide specified design. A small percentage also provide Changing Places toilets (which take usability a step further by providing a high/low adjustable changing bench, hoist, toilet, sink and larger space). Changing Places are encouraged but not required in buildings. 

However, I feel we need to aim higher – because even these toilets aren’t always usable by a large number of people. It’s not just a case of whether someone can urinate or deficate – it’s about comfort for different body shapes, it’s about safety, dignity and hygiene. All these support people’s physical and mental health.

What might the future look like?

Changes in the law and building regulations.

  • Improved British Standards which would feed into
  • improved design within building regulations, for new buildings (e.g. more space)

Most importantly:

  • New laws on sanitation and equality for public toilets (both around access for disabled people and access for many other users).
  • Laws that make buildings older than 2004 upgrade their toilet facilities to the current specifications to meet duties under the Equality Act (2010) around disability.

*Currently buildings only have to provide disabled access to the level that was specified in the building regulation at the time of the build. Therefore, older buildings will not have the same level of access required today or may have no access at all.

Clear signage

There are so many different symbols, signs and words – which can be confusing for people looking for a toilet. A clear system of symbols would be helpful.

Usage

Promote the proper use of accessible toilets – many people need the facilities but don’t go in because of the words ‘disabled toilet’ or a picture of a person with specific, visual, impairment (e.g. wheelchair symbol/person with a stick). We need more public awareness that toilet like these are for anyone who needs the more specialised facilities inside.

Clearly stating that baby changing should be in an accessible parent/child location would make them more easily available to those with urgency needs.

Use of technology / equipment provision to open up accessibility to more people

Significantly high numbers of people need more than just a standard toilet, shelf and sink to meet their hygiene/toilet needs.

  1. Automatic washing and drying toilets

There are hundreds of thousands of people that are unable to clean themselves easily, or where it causes them great pain or puts them at risk of falls.

  • People with upper body limb loss
  • People with muscle weakness or paralysis
  • People with back problems who can not bend or twist.
  • People with severe arthritis 
  • People with obesity
  • People with dexterity/grip difficulties
  • People with balance and coordination difficulties.
  • People with bladder/bowel disorders/ incontinence
  • People with shortened arms
  • Disabled women particularly during menstruation.

2. Toilets which can be adjusted in height

These are essential for wheelchair users where modern chairs come in a range of heights (and people generally need to be at the same height to manually transfer from chair to toilet etc). Also, people with muscle weakness, neurological impairments or those who have difficulty moving their joints may not be able to stand up from the toilet unless it can be raised up to a height which suits them.

Variable height toilets also suit many lower limb amputees and people with short legs. Adjustability is key to prevent falls and enable people to sit/stand safely and more easily.

3. Sinks which can be adjusted in height

These facilities are only ‘desirable’ and not necessary within current guidance.

Safety

Toilets do not always have none-slip floors or alarm cords. Shouldn’t these be standard in every accessible/adapted toilet?

Space

Did you know that 82% of powered wheelchairs for sale will not fit into the transfer space inside an ‘accessible’ toilet and their is not enough room for assistance (or ambulance staff to get in to help if you fall)?

Increased number of toilets

Large venues like a shopping centre or stadium may have several visitors who need highly adapted toilets – providing one Changing Places is not enough.

What about the cost?

When someone pays for a new building – an office block, hospital, cinema/shopping mall, airport, train station … there is never a question of ‘do we need to put any toilets in the building – because we might not be able to afford it’. It is a ‘given’ that for public health, toilets must be provided. So if a place is going to provide toilets – they need to be usable by everyone (or they are as good as no provision). 

Of course, accessible toilets may have additional costs to ensure the space, technology, maintenance, security etc of the above. Those with an adult changing bench and shower need even more space.

Well, how much do you value disabled people as part of your community or workforce? How much do you want their custom (and their friends/carers/family etc)? How do you put a price on doing the right thing and enabling people to leave their homes and participate in life? What about complying with the Equality Act regarding Disability Discrimination?

Let’s be blunt – how much money are you making in your business – because most of the technology and space adaptations could be done for around £10,000 – £15,000 for the full works and is very affordable.

In my own home I have space, a ceiling hoist and a height adjustable toilet that also washes and dries – for around £5000.