of emergencies. From auto accidents on busy interstates to working house fires with potential hazardous materials we train on these types of events and how to protect ourselves from dangers associated with them. One danger that continues to be overlooked is the exposure risks found inside hoarder homes. Often with the accumulation of massive amounts of belongings come the associated risks from exposure to many types of infectious disease and bio-hazards materials. A first responders can be exposed to these dangers when walking into a situation to assist, such as a emergency medical run or assistance call. Many of us have suspected that the houses we have been going into were dangerous, how dangerous may have been severly underestimated. Let’s review some of the potential exposures first responders may face inside the hoarded environment.Air Quality
Airborne contaminants inside a hoarding environment can present dangers not seen by the naked eye. Often when entering these environments first responders do not take in account the unseen dangers. From elevated ammonia levels to aerosolized mold anyone who enters these areas unprotected can be facing danger. These elevated levels can be caused my animal urine, decomposing animals, fecal matter, and mold.
One common risk that can be managed with ventilation is the exposure to ammonia. Ammonia is a irritant to the eyes and upper airway tract at or below the exposure threshold of 50-PPM (Parts Per Million). Without the proper application of ventilation the responder can be exposed to up to 150 PPM of ammonia. This is 3 times more than the limit set by OSHA. Ref.. (The Hoarding of animals Research Consortium) Without accurate gas meters the only detection device we will have in our sense of smell. If you identify a heavy content environment and begin to smell high ammonia levels do not enter without aggressively ventilate the structure or use a SCBA to reduce the risks when high ammonia levels are present.
Misc. Exposures
Without understanding the risks first responders are potentially risking their own personal health and safety when entering the hoarded environment. Here is a list of potential exposures that have been documented inside a hoarded environment.
Human to Human
- Listeria
- Hepatitis A and B
- Scabies
- Pneumonia
- Shingle
Animal to Human
- Tapeworm
- Hanta Virus
- Psittacosis
- Cat Scratch Disease
How many of these diseases are communicable? Without even knowing that we have been exposed we can take them home to our families, my worst fear. If we don’t take the time to protect ourselves from exposures we could potentially place our families at risks.
PPE Discussions.
What types of PPE do you carry? First responders only have a few choices available when selecting respiratory and splash protection. At a MINIMUM we should be using our N-95 mask and turnout gear when entering a hoarded environment. While a n-95 might not protect you from all contaminants it will offer some level of protection. If the levels are extremely elevated a SCBA can be used to enter the environment. Choosing to use a SCBA is the best option that we have available as first responders but does offer some challenges interacting with the occupant, if conscious. We will have more info on that coming, but for this article just realizing that you should be wearing one will be enough.
Protecting yourself from contact with biohazards can be another challenge as the belongings will be stacked so high touching them will be unavoidable. Using gowns, coveralls, tyvex suits, or turnout gear can offer contact protection as you enter. While none of these seem practical, except your turnout gear, they should be considered when entering this dangerous environment. One key point is the potential for patient and/or responder decontamination.
Conclusion:
First responders worldwide have been dealing with hoarding conditions for years. When was the last time you considered that the dangers inside can harm you and your family. Taking the time to identify that hoarding is present, choosing the most appropriate levels of PPE, ventilating the area, and having decontamination available you will increase your safety and reduce the exposure to harmful materials. Would you ever go into a fire unprotected? Hoarding conditions can cause multiple problems for first responders and we have the potential to be “Most Exposed” during an assistance or EMS call. Take the time to identify, adjust, and attack hoarding with the proper level of PPE.
