Continuing in evaluating the Hazards of Hoarding, I am going to highlight one of the most pressing concerns we address with our clients. This is Part 2 of my series Hazards of Hoarding. If you missed Part 1, feel free to go back and read Hazards of Hoarding: What You Need to Know About Treating For Bed Bugs here. Today’s post will focus on the risks and hazards for Emergency Medical Services (EMS). I am hopeful this information sheds light on why we work so hard to support compulsive hoarders rectify the issues in their home. Sadly, it’s not a matter of if there is a medical emergency, it’s a matter of when.
Let’s Understand a Few Things First
In far too many cases, compulsive hoarders will not call EMS because their fear of ‘discovery’ supersedes their concerns for medical emergencies. Remember this is a mental health issue and one of the many symptoms includes irrational and illogical thoughts processes.
When a call for EMS is placed, it often comes from a friend, family member, or neighbour who heard cries for help from the home or was checking in out off concern for their loved ones’ safety. There have been cases where calls for EMS came hours or days after the medical crisis because the home lacks a functioning phone. I have found upwards of 8-10 different phones and portable phone sets in each residence I supported. Of all the phone handsets, maybe one works and it might even be charged. Don’t even ask about cell phones and chargers: I have long since given up counting the number of those.Many of the calls I receive are from local hospitals identifying that a person was hospitalized following a heart attack, burns or other life-threatening medical issue. If the condition of the residence was not already reported by EMS, the next opportunity for discovery usually arrives during discharge planning from the hospital. If 70%-95% of floor space of a home is packed with items into piles exceeding 4-6 feet in height, there is no physical space to provide the community-based health care supports. I will talk more about the challenges for home healthcare supports in another post. For now, let us get back on track with the hazards present for EMS when the 911 call comes in.
“I need an ambulance so ‘someone’ called EMS…”
Lights and sirens can be heard outside and soon the paramedics will unload the stretcher, the body board, their medical supply bags, and the cardiac monitor/portable defibrillator. Two or three EMS attendants are looking to gain entrance to the residence but the first barrier hits – how do they get in when the doors are blocked and they have 12-18 inches to fit through the only accessible door? The minimum requirements for EMS is no less than three feet of aisle width. That means that the entrance (or egress point for those in emergency response) has to permit a three-foot wide path from the entrance of the residence to all areas of the home. Not sure what this will look like? Take a yard stick in both hands, hold it horizontally, and walk through the home. Hit a bunch of stuff or knock things over? Whatever you tap, knock over, or get stuck on is what needs to move. Think about the width of a stretcher as being the necessary width of a walking path.
Our first step in any call for compulsive hoarding response is to clear the entrance ways, open up a full door way and clear a full path to where the client sleeps. Rarely do we find our clients sleeping in their bedrooms. More likely we will find a form of ‘nerve central’ where the client eats, sleeps and generally exists (term loosely applied here) in their residence. This ‘nerve central’ is typically a 3×4 foot space on a couch with 8-12 inch foot paths to a bathroom and kitchen. In some cases we may not even have foot paths and only smaller piles we can walk over. Pretty sure stretchers don’t have an off-road package so they won’t be able to navigate that situation.
“So I have cleared the three foot path to where I sleep. Now what?”
Perhaps something I took for granted, and likely because I have grown accustomed to working in confined areas with so little light, is the need for EMS to actually see what they are doing. Funny thing! Thank you London Middlesex EMS for pointing this out for me. The Integrated Hoarding Response record for the number of lamps in one room is 11. Each of these lamps had a broken stand or too few legs and was ready to fall over. Furthermore, these lamps were operating with light bulbs that far exceeded the maximum allowable watts for their design. For all of those lamps, the room was still very dim.
Piles and obstacles also block the light EMS requires to see the space they are navigating, hide hazards within the piles, and most importantly the patient they are trying to support. If you have interacted with EMS recently you may have noticed the portable cardiac monitor and defibrillator they carry. Reading a printout from the machine is near impossible with no light. Administering intravenous medication is extremely challenging if Paramedics cannot achieve a clear view of the patients’ arm. Reading a medical alert bracelet, or noticing an unconscious patient is wearing one, is asking a lot in darker spaces. This list likely has many items we could add here but I am hoping the idea is clear at this point.
“What do we need to do about this?”
One of the common signs of compulsive hoarding is year-round closed window coverings. Be it blinds, bed sheets or curtains, all windows are covered nearly 100% of the time. With no natural light and piles continuing to grow, lamps in surplus become a dangerous option in highly congested residences. Our approach in the early phase of supporting compulsive hoarding is to stabilize the lighting sources and reduce the number of broken lamps. For us this means we may repair the base of lamps (or with any luck dispose of them entirely), switch out the light bulbs to the appropriate wattage and ensure the lamps are not sitting on piles of combustible materials. Additionally, we use temporary battery operated light sources that we supply and take with us each day to illuminate darker areas and avoid questionable electrical outlets. This is one of our Harm Reduction strategies as the client is unlikely to permit much more in the early phase. Knowing what EMS requires for lighting we suggest the following: open the blinds, pull back the curtains and let the light shine in. The individual may object for fears of discovery but if EMS has been called it is about to be put out in the open anyway. Let the paramedics do their work and potentially save a person’s life.
“Okay. So I have the aisle width open and my lighting is stable. Now what?”
Admittedly, several clients over the years have hoped we were done after this step but this is not the case. In my conversation with London Middlesex EMS I was advised of the three most common areas paramedics attend to a medical crisis: the bedroom, bathroom and kitchen. This means that opening aisle width in just the sleeping area will not be enough. We will encourage the same expectations as before and open up the aisle widths and rectify the lighting issues in both the kitchen and bathroom.
An additional note here is to pay very close attention to clearing all of the obstructions and obstacles in hallways and an stairways. Ideally there should be no (and I mean none, nada, zip, zilch!) items or clutter on the stairs. Safely being able to ascend or descend the stairs is critical for both the EMS attendants as well as the patient.
“Aisle width and lighting in most common rooms plus the stairways. Got it. Anything else?”
Let us go back to revisit the stretcher and EMS space requirements. With three feet of aisle width, we know a stretcher can fit. A stretcher and two paramedics are going to need a bit more room to maneuver. EMS attendants will require space to place down their medical supply bag, portable cardiac monitor and defibrillator, not to mention they will also require crouching space and lifting space. This will increase the space requirements to 4-5 feet in as many areas as structurally possible. An important consideration for bariatric patients includes the number of EMS attendants that may be required for safe lifting and transport purposes. Safe transport of obese patients may require the support of additional personnel from the fire department to ensure safe lifting. Increasing the number of EMS attendants requires increasing the space to provide necessary medical services.
This is not to say that EMS cannot support a person in more confined areas. However, if the space can be cleared by reducing the congestion and potentially adding precious life-saving minutes, then it is clearly in a clients’ best interest to do so.
Other Hazards for EMS
In medical emergencies, EMS are in the residences for a matter of minutes and may not realize some of the hazards that hide within the piles. I am sure experienced EMS attendants have seen their share of oddities and unique situations but here are a few common findings from Integrated Hoarding Response you may want to be on the lookout for:
- Uncapped syringes tucked in, or laying on, any available open space
- Heavy tools on top of piles, book shelves or wedged between pile layers (chainsaws, saws-all, circular saws, etc.)
- Bed bugs, cockroaches, fleas, mice, rats, raccoons (yes, I did just say raccoons)
- Immediately accessible medications are not always the most recent prescription
- Medications combined in bottles including expired medications
- Sanitary conditions of the residence – human and/or animal feces and urine throughout the residence
- Large volume of rotting, or rotten, food and swarms of fruit flies
- Large pieces of furniture precariously stacked on top of each other – having been in place for years, these pieces are often fully packed and ready to topple inwards
Let’s Wrap This Up
It is important o remember that Compulsive Hoarding is a mental health disorder. Mental health issues require treatment and specialized support in order to reduce symptoms and work towards recovery. Like all mental health issues, quick fixes and band-aid solutions will not remedy the underlying causes and will certainly not prevent re-emergence of symptoms. Treating compulsive hoarding takes time, requires specialized therapeutic services and ongoing support. Not only must we seek to resolve the safety for the client, we must look to ensure the safety of all individuals entering the residence especially EMS. For more information on the mental health services provided by Integrated Hoarding Response Inc., please feel free to contact us and inquire about our service.
My thanks to all of you for taking the time to read this post. Join me next week as we head further into the Hazards of Hoarding and look at the many fire risks we encounter with compulsive hoarding.
Cheers!
Megan
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