Ems Response to Hoarding: Locating the Victim

Posted on November 2, 2013 by Rpennington

One type of call that Fire, EMS, and Law Enforcement often respond to is the

Ems response to Hoarding

“check the well being” of a occupant that has not made contact with family in a certain amount of time. Being called to check the well being of a person inside hoarding conditions can turn into a major incident it the responders enter ill prepared. Let’s take a look inside the hoarding environment to offer some insight for first responders tasked with going inside them looking for people that have not been communicating with their friends, family, or others.

Ensuring Occupancy

Before we go inside the hoarding environment, exposing ourselves to different dangers, we should take steps to determine if the person is still living there. Often, in hoarding conditions an occupant can fill their home until it is no longer inhabitable and just move out, that simple. If the home has become so full the occupant will often disconnect the utilities, whether their choice or the building inspectors choice, and move to a different location.

If the call comes in to check on an occupant and you arrive to find a potential Heavy Content Environment we should take some steps to find out if the home is still occupied.

  • Have dispatch forward contact information to on scene responders for questioning
  • Question neighbors
  • Inspect utility meters
  • Perform a 380 degree size up
  • Look for access points (often NOT the front or back door)

Locating the Victim

Once the determination has been made that a person could be inside the hoarding it’s time

Hoarding

Hoarding

to go looking for them. Understanding that hoarding can take over a home and prohibit occupants from sleeping in bedrooms or sitting in living room can help lead you to their locations. If you understand this complication we may start searching for occupants in different locations.

Example: Searching for an occupant after dark, we may start our search in the living room instead of the bedroom.

The best way of making access to trapped occupants will be to find their primary entrance points. If the home has filled the space around “normal” access points, such as doorways, they will often enter through windows or other means. Finding these entrances will be the best place to start looking for a missing person.

Using the only access points will lead you to the “goat paths” throughout the home. These pathways can lead directly to the occupant. Warning: using these pathways EMS providers should start a search pattern when looking for occupants and try to keep the belongings in place. Keeping the debris from falling can be a difficult task as the pathways can be so narrow.

One way of making your travel through the pathways less destructive is to leave your bags outside the environment until the patient has been discovered. Without our bags across our shoulders it will reduce or profile and keep from knocking the stacks over. First responders should carry a small bag or the basic CPR mask just in case of impending need of CPR or rescue breathing. Keeping the bags outside the building will also reduce the need for decontaminating them as well.

EMS providers should use a coordinated search pattern to find the victims, much like firefighters would. Collapsed belongings could easily hide patients. Utilizing a primary and secondary search can help offer the occupant a larger chance of survival

Primary: Traveling the pathways looking for occupants quickly and efficiently. The primary search should be a quick and organized search.

Secondary: Secondary searches should be a slower search where individual piles of collapsed belongings that seem out of place or different should be inspected for occupants.

Review

Hoarding can present many challenges to first responders in all three divisions. Before entering a hoarded environment you should ensure the potential for occupancy and use an accurate size up to locate the victim. Finding people that are missing inside the massive amounts of belongings can turn a “routine” check the well being call into a technical rescue inside a Haz-Mat situation.

Start preparing for the call you will receive, not might receive. Hoarding is found in everyone’s district and it is an area that we need to review. Use this quick article for some thought stirring discussion and review your department’s policies on entering private residence on check the well being calls.

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Hoarder Fire Live Fire Test

Posted on October 26, 2013 by Rpennington

Here is a sample of the Live Hoarder Fire evolution from Frontier Fire Company…..

 

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Challenging Hoarder Fire Situation from California

Posted on October 17, 2013 by Rpennington

From News10.net

Continue reading →

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Hoarding Assessment for First Responders

Posted on October 14, 2013 by Rpennington

Dealing with the challenges presented by compulsive hoarding disorder is assessing how IMG_1008bad the conditions are. When families reach out for help with a family member the mental health professionals start the treatment process with an assessment of how severe the hoarding conditions are. There are different hoarding assessment scales available to use when assessing the severity. As first responders we need an common scale to use when hoarding conditions are discovered. Using common terminology to describe the severity and danger will allow the dangers communicated effectively, accurately, and evenly.

Keep the assessment simple and straight forward is key during this process. For that reason we recommend using the Institute for Challenging Disorganizations scale that rates all conditions on a 1-5 level. Using this scale will allow the discovering agency to give a slight problem a one and the most severe a level 5.

As first responders this scale can be adjusted for the dangers we face. This rating scale should be used by all first responders, utility workers, and anyone tasked with entering the environment to answer an emergency or service call.

Fire Service Hoarding Scale

Level 1: The start

• Most of the homes that we see fires in seem to be at least a level 1 home.

• With Level 1 you will not encounter large amounts of materials but may find normal clutter with some apparent signs of insects or rodents.

• At a level 1 all doors, windows, and hallways will be accessible.

Level 2: Build Phase

• In a Level 2 hoarder home the amount of overall clutter has begun to appear.

• This is the point where you would consider the amount of belongings to be over and above a “Normal Level”.

• Trash cans over flowing, one or more exits may be blocked, and housekeeping is at a minimal level.

• At level 2 the piles of belongings may be at or above waste level.

• Windows are starting to be unusable as the piles continue to get larger.

 

Level 3: Big Problems Begin

• The amount of belongings has taken control of the house and making the rooms unusable for the occupants.

• At Level 3, the amount of clutter becomes a serious hazard for firefighters.

• The “Goat Paths” become the only access to the small areas of usable space.

• At Level 3, the clutter may be visible from the exterior.

• Noticing the windows and the level of belongings being above the lower sill, if not covered completely will be a prime cue or clue that a hoarder condition is present.

• In a Level 3, the stairwells are mostly blocked with belongings.

• Most Level 3 homes pathways are open to all rooms they are just narrowed down to a path.

Level 4: Beginning of the end

• The beginning of the end of the useable areas of the hoarder home starts in level 4.

• With most of the rooms at an “unusable” hoarded level the living space is reduced to small pockets of living area among 1 or 2 rooms.

• The piles of belongings will be at ceiling level and all but most entrances will be inaccessible.

• All windows will be covered, while the hoarder begins to find more ways of storing more belongings in these small spaces.

• Attic spaces will be full; all cabinets will be full, even under the floor spaces may be used to amass the huge amounts of belongings a level 4 will collect.

 

Level 5: Uninhabitable

• Unable to enter!

• There is obvious structural damage to the home, broken walls, no utility service.

• All rooms including the kitchen and bathrooms are unusable; the occupant is unable to stay in the residence.

 

This scale should be used in a pre-planning phase of operations. It allows a common terminology and assessment scale to be shared between first responders. Stay tuned for more assessment processes to share the discovery of Heavy Contents with all first responders.

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Hoarding Firefighting: Lesson from a Live Fire Experience

Posted on October 9, 2013 by Rpennington

When firefighters enter a burning building many different factors come into play. One huge factor that can affect the outcome of the operation is the presence of increased amounts of belongings, caused by a person afflicted with compulsive hoarding disorder. As their collection of stuff accumulates the danger in hoarding firefighting increases.

Firefighter Enter Hoarding

Firefighter Enter Hoarding

Over the past two years of reaching out to fire departments from around the world some common challenges kept coming up. Inability to hit the seat of the fire, shielding from the heat , and difficulties in escape were top of the list. This past weekend the chamber of hoarders had a unique opportunity to enter a “live fire” environment to experience these variables.

With the assistance of the Frontier Fire Company in Wheatfield New York a hoarding environment was set up and multiple scenarios were run. The results were a confirmation of all the research collected. Each variable was looked at individually and together with great success. It truly served as a reminder that hoarding changes our operations and if we are unwilling to adjust our operation it may not be successful.

Shielding from the Heat

With many safety measures in place the fire rotations started with a firefighter between the stacks of belongings with a thermal imager. What we learned was a confirmation and an amazing result. While the other instructors took a beating from the heat in front of and behind the stacks of stuff the inside firefighters documented floor temperatures of 125 degrees with thermal imagining, shielded from the heat.

Documenting these temperatures was an unofficial, non- scientific example of the true dangers of the hoarding environment. No monitors, measuring equipment, or recording devices were in place, just a group of firefighters with thermal imaging cameras watching something amazing. The hoard shielded the firefighter from the heat. It restricted the heat and pushed it past and around. These results proved a multiple amount of points.

  • Hoarding can give interior firefighters a false sense of environment
  • Shielding can allow firefighters to push further inside without experiencing the normal heat levels
  • Stacks of stuff can trap firefighters
  • Victims can have more survivable thermal temperatures when insulated with hoarding.

With the recent research on flow paths coming to light the need to adjust them for hoarding firefighting was revealed inside the burn room in New York this past weekend. It reconfirmed the dangers of the insulation provided by the interior conditions. This insulation can hide the hidden heat and dangers until it’s too late. Most firefighters advance into burning buildings using their senses to determine how far and deep they are to go. In hoarding conditions they may keep pushing unaware of the hidden dangers waiting for them. Dangers that could present themselves in the form of rollover, flashover, or backdraft, trapping the firefighters because they don’t have secondary means of egress.

Hoarding Firefighting

Hoarding Firefighting

Conclusion

Confirmation that the shielding is real was not a surprising result. This weekend just reconfirmed what we have been learning from survival stories from around the world. Hoarding conditions can act as an insulator keeping high temperatures away from the victim or firefighter in the middle. We need to educate firefighters to be aware that this shielding can lead to poor judgment to just how far we should push.

Identify, adjust, and attack when Hoarding is discovered!!!!!!!

FDIC Flow Path Video.

 

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Hoarding Fire Safety for Family Members

Posted on October 1, 2013 by Rpennington

Since attacking the problem of emergency responses in Hoarding Conditions, from the perspective of first responders, the questions from the family members of people who are suffering from Compulsive Hoarding Disorder keep coming in. How can I help my family member? How do I make their home safer are a small examples of the questions that are commonly asked.

Hoarding Fire Safety Should include a Escape Plan

Answering these questions is complex and has no one simple answer, but there are some steps to help protect your loved one from the dangers of fires in hoarding conditions. While these simple steps may not eliminate the risks to them it can improve the chances of survival if a fire were to happen. Since starting the research into hoarding fire safety many common causes have been identified. Sharing these common causes will help family members protect their loved ones until they can be treated by the mental health professionals.

 

Cooking Fires

Cooking fires are commonly seen in the fire service today. Hoarding conditions complicate these types of fires because the clutter has accumulated to the edge of the heating source. When the belongings are allowed to invade the space adjacent to the stove the potential for cooking fires goes up. If you add ordinary combustibles to a heat source the resulting fire can spread fast and trap the occupant who is in the kitchen.

Hoarding Fire Safety In the Kitchen.

Fire proofing your family member’s kitchen may be a huge undertaking, especially if the hoarding level is at or above waist level. Compulsive hoarding disorder prohibits the occupant from distinguishing between things that have great or little value. If you were to try and move their “treasured” valuables you will be met with passionate resistance. Being understanding and compassionate in your response will keep the family member at ease as you try to explain the risk for fire.

Approaching them with some tradeoffs will allow them to move their belongings away from the heating source, thus reducing the risk for a cooking fire. Example: “Can we take the belongings from the counter and move them over to the table, away from the stove.” If the family members understand how the thought process works they will focus on a positive solution to this problem.

This approach may be met with resistance and take time to explain the risks of cooking fire inside their environment. Persistence with this process will be needed and the kitchen may need to be revisited multiple times as the family member replaces the belongings that have been moved.

Electrical Fires

Another leading cause of fires inside hoarding conditions are electrical fires. Having stacks of belongings closely placed near electrical outlets increase the risks of fire from a sparking electrical outlet. Much like the cooking fires the ordinary combustibles, newspapers and like materials, can make a fire more likely and increase the burn rate trapping occupants.

Moving the stacks of belongings away from the outlets is a simple solution to this problem. Approaching the family member with the example of electrical outlet malfunction and explain that you are not asking to throw anything away, just move it away from the outlet will ease the pain felt when approached with the thought of losing their “treasures”. Explaining the process of “moving” not “removing” the items can reduce their anxiety.

Hoarding Fire Safey

A blaring similarity, in electrical fires, seen in the hoarding environment, is caused by extension cords. They are commonly stacked one on top of the other as electric outlets become unusable. If an electric outlet becomes non-functioning the occupant often just runs an extension cord from a functioning one increasing the chance of overloading one outlet. When you enter the family members home you should take time to investigate the status (usable or not) of all the outlets in the home. This access can be difficult as the access to them can be blocked with the hoard. Use the pathways established by the occupant to access the points available first before trying to go through the stacks.

Escape Plan

Much like the education given to elementary students in fire prevention month family members afflicted with compulsive hoarding disorder should be exposed to the exit their home plan. Fires today are known to double every thirty seconds, offering less time for occupants to escape. Taking the time to explain this danger to your family members will help offer some simple solutions, while starting the treatment plan.

Taking the time to explain this danger and evaluate the presence of multiple exits paths is paramount for their safety. Example: “If a fire were to happen in the current condition blocking this only exit, you will burn to death” While this sounds somewhat extreme it may be necessary to bring home the dangers presented by not having multiple exit points in their home.

Ask your family member “What is your plan in the event of a fire and this pathway is blocked?”

 

Smoke detectors

By far the most important part of the visit should be the instillation of smoke detectors in EVERY room. When hoarding conditions are present available airflow for smoke can be restricted. This restriction can delay the time needed for a standard smoke detector to be alerted. Delayed alerting can lead to less time for escape of an occupant. Expecting this delay should lead family members to install more smoke detectors, one in each room. Mounting them on the ceiling in the center of the room is a best option, if the stacks of stuff allow. If not the closest proximity to the center ceiling will allow for the most coverage.

Hoarding Fire Safety Conclusion

Dealing with loved ones that are dealing with compulsive hoarding disorder can be an emotion filled challenge that takes years. Keeping a positive, reassuring approach that always keeps in mind the complexity of Compulsive Hoarding Disorder can lead to a successful safety intervention. While this is not a cure it is an intervention that could save your loved ones life. Make sure to reach out to your local fire departments, hoarding tasks forces, mental health professionals, and health officials for resources to help in your journey.

 

Additional Links:

http://www.hoarders.org/f-c.html

http://childrenofhoarders.com/wordpress/

http://hoardingdisorderinstitute.com/

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Often Ignored Hoarding Dangers

Posted on September 30, 2013 by Rpennington

How much risk are you willing to take? While attending the 2013 Ohio Fire and EMS expo in Columbus Ohio last week it seemed clear that first responders don’t fully understand Hoarding Dangers and how they can affect safety. Having the opportunity to travel and meet the brave men and women who serve as first responders is a HUGE honor. In this past week’s travel is where this lack of understanding became crystal clear in these conversations.It’s like clockwork that when someone hears that I am studying responses in Hoarding Conditions they immediately start into a story of a response. These stories always involve the words “lucky” and/or “fortunately” something happened or it could have been bad. As an educator these words are like fingernails on a chalkboard.

Hoarding Dangers: Glassware Image from http://hoardingwoes.wordpress.com/2012/09/30/hoarding-the-glassware/

I would like to share two conversations that came from Ohio. Sharing these conversations is not a judgmental or an effort to “bash” anyone, but rather an attempt for everyone to learn from their experience.

Hoarding Danger in Piles:

The most troubling story was, by far, the firefighter who described a fire where they had to crawl over piles and piles of belongings to fight the fire. They described hoarding at a level 3 and went on to explain that the interior firefighters had to crawl over multiple stacks of belongings to access the fire, which sounded rather small.

The conversation described the difficulties of traversing the stacks and how “lucky” they were to make the fire room and have a successful firefight. With the hair standing up on the back of my neck I began to question them and after some time the “I never thought of that’s came”. Often we all don’t think of a certain danger until someone exposes us to it. Their response is common when dealing with hoarding conditions. Without being judgmental we should all be exposed to the danger possessed by the stacks of stuff.

Let’s review some of the factors and why firefighters should not crawl over stacks of stuff and exactly how dangerous it is.

  • Stability of the Piles
  • What are the Stacks Comprised of (magazines, books, Glassware)
  • Collapse Risk
  • Entrapment dangers (wires, yarn, extension cords)
  • Weight of the firefighter
  • Need for rapid escape
  • Height of Stacks (putting firefighter closer to the ceiling and hotter temps)

Each of the above danger can place a firefighter in a life or death situation at a moment’s notice. Mix one with another and a recipe for disaster is on the horizon.

Example: Firefighters making an interior push choose to crawl over a stack of glassware. The weight of each firefighter plus gear added to the instability of the stacks causes a collapse of the stack downward then adding a side collapse covering the firefighters with sharp glass.

You can see the dangers in the above example. Not knowing what is in the piles of belongings should be the number one reason why we should NOT crawl over stacks of belongings. Adding the weight of a firefighter to an unstable situation can lead to a mayday. Do the occupants crawl over the stacks or walk around them?

Occupants use the pathways to access the usable space inside the house and so should we. Using the “goat paths” for interior access is the safest way to gain interior access without collapsing piles of belongings on beneath the firefighters. Think about walking to the stage of a theater, would you crawl over the rows of seats or use the isle to access the stage.

It was a Clean Hoarder House:

Another hoarding story from this trip was a assistance call where they described a Clean Hoarder Environment. This mindset is troubling because of the hidden dangers that may not be seen because of the accumulation of belongings.

How clean can it be. Hoarding Dangers

While the environment may look “clean” from the view point of a responder, do we truly know what lies beneath the hoard. Without access to walls, rooms, and the inability to see the floor do we truly know what’s underneath the stacks of stuff. The answer is NO.

 

Stacks of belongings in the home can hide dangers for first responders. Rodents, insects, mold, and animal excrement’s can all be dangerous to responders and all can be hiding beneath stacks of stuff that appear to be clean. Without the ability to clean and maintain a home, due to the hoarding, the occupant may never truly have the ability to clean, sanitize, or remove problem areas. This accumulation can be dangerous for them and us.

If you find a hoarding condition that must be entered we MUST assume the worse situation possible and choose to wear our PPE properly. Assuming that the hoarding area is “clean” is an assumption that can lead to Bio Hazard exposure. Once discovered we should take the appropriate precautions and choose to wear ALL of our PPE to make sure we don’t care these dangers home to our families.

 

Review:

Emergencies in hoarding conditions should be identified, adjusted for, and then attacked with different approaches by all first responders. Crawling over debris and not choosing to wear proper PPE are just two dangers that could cause injury or death. Make the choice to avoid them both when, not if, you are called to enter the hording environment.

 

 

Posted in Compulsive Hoarding Disorder, Hoarder Fires, Hoarding, Hoarding Fire, Hoarding FIrefighting, Uncategorized | Tagged , , , , , , , , , , | Leave a comment