Introduction to Hoarding For First Responders Presented by Capt. Andrew Brown Session Objectives Attendees will be able to: Assess/Size Up a Heavy Contents location Establish Safety Priorities in Emergent and Non-Emergency Situations Set Goals for Improvement and Effectively Communicate Needed Change Evaluate Long Term Interventions 1
All case studies, reports and examples used in this presentation are used only to serve as examples of common and possible situations. This presentation is in no way intended to criticize any responder, department, or person (including people with hoarding behaviors). All incident commanders made their decisions based on unique circumstances. Some have provided materials and information to me in order to advance the collective knowledge of our industry. Please honor those who have made the ultimate sacrifice. Respect that they made what they believed to be the best possible decision for the unique situation in which they found themselves and gave of themselves fully for the sake of others. This presentation does not in any way second guess their actions or place blame on anyone. Definitions: Hoarding Disorder: A disorder characterized by 1. Persistent difficulty discarding or parting with possessions regardless of their actual value. 2. A perceived need to save the items and distress associated with discarding them. 3. the accumulation of possessions that congest and clutter active living areas and substantially compromises their intended use. If living areas are uncluttered, it is only because of the interventions of third parties (e.g., family members, cleaners, or the authorities) 4. Clinically significant distress or impairment in social, occupational, or other important areas of functioning (INCLUDING MAINTAINING AN ENVIRONMENT SAFE FOR ONESELF OR OTHERS) 2
Definitions: Responder: Any emergency responder such as police, EMS, fire, sheriff, code enforcement, mental health field crisis unit, or others. Emergency/Emergent: An incident requiring immediate response and mitigation by skilled responders and having the potential for rapid life threatening deterioration Non-Emergent: An interaction that does not require immediate intervention and is not immediately dangerous to life & health. Hoarding Disorder: A mental health disorder requiring diagnosis by qualified medical personnel. Almost no responders are qualified to make this diagnosis. 3
NIOSH Report #F2014-14: A career fire lieutenant was overcome by extreme fire conditions in a 500 sq ft apartment on the 19 th floor of a 21 story residential apartment building. Contributing factors: Clutter conditions blocked ingress Fire originated in bedroom where an extension cord overheated under clutter Thick dense smoke limited visibility Thick dense smoke became fuel for rapid fire progression Lack of water on fire Lack of crew integrity exiting apartment Lack of sprinkler Radios traffic including Maydays not heard by everyone on firegrund Defective elevators The Ladder company (no hoseline) located the apartment of fire, forced and secured the door and waited for the engine company. The Engine company arrived with a charged hoseline and waited at the door while the Ladder company searched for the fire. The Ladder Lt. (victim) reported (via radio) that the apartment was very cluttered. Items are described as stacked high against the walls. The Engine Officer, feeling that the Ladder was taking an unusual amount of time to locate the fire entered the apartment and became tangled in a coatrack. The clutter created a real problem for the [Engine] crew as they advanced straight down the hallway into the apartment. 4
Ladder Lt. NIOSH Report 2013-13 April 2013. A volunteer firefighter died from injuries sustained eight days earlier in a residential structure fire. Contributing Factors: Civilian at risk in the structure Blocked access/egress due to hoarding that added to the fuel load Multiple stairways Uncoordinated response to an emergency scene Portable radios left in the special unit Loss of crew integrity Lack of size-up and situational awareness by initial crew Lack of ventilation 5
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Response to Heavy Contents 1. Is this an emergency? Is there an immediate danger to the occupant, neighbors, or responders? How did I get this call (Why am I here?) What happens if I leave right now? 2. What does the person need? What does the community need? 3. What does my agency require of me? Emergency Response: 1. SAFETY FIRST! 2. Scene size up: WALLACE WAS HOT Weather Area Life Hazard Location Apparatus & Personnel Construction/Collapse Exposures Water Auxiliary Appliances/Units Special Concerns Height Occupancy Time 7
Scene Size Up: Exterior: Look for: Poor exterior maintenance Indoor items stored outside Window treatments permanently closed An engine company was dispatched to this location for a medical response. The property was referred to L&I: Extension cords being used throughout property in place of permanent wiring Building does not appear structurally safe. Most interior ceilings have collapsed onto the floor. Open penetrations in exterior walls at roof line. Exit and interior stairs are mostly obstructed with excessive storage and trash. Only slim corridors of travel are possible through most of dwelling. Occupant of dwelling is an elderly male. The condition of the property is hazardous to both the occupant and potentially any emergency responders. The interior of the property is in extreme disrepair and every room is piled with material and the remnants of the collapsed ceilings. The condition of the interior can possibly be predicted from the exterior 8
In August of 2013, Colleton County Fire Rescue responded to a fire in a single story, stand alone, wood frame, single family dwelling with rear deck Neighbors reported that the home had a single, female occupant and that she was home at the time of the fire. Aggressive attack was made. 9
Members were forced to cut the rear door with the partner saw. The interior was piled four feet high with pathways between rooms 10
Front Overhaul 11
After digging through the property for over two hours, the occupant was located at a friend s house. There were no injuries. Neighbors often insist the occupant is home because the car is present, regardless of whether the car ever moves. Scene size up lessons learned: Presence of a vehicle is not a reliable indicator of presence of the occupant. Interior items stored outside may mean there is no room for them inside Aggressive attack may put members at unnecessary risk 12
High Fire Load (Heavy Contents) Delayed Discovery of Fire Ventilation Controlled Fire Limited Air Entrainment Points Limited Exterior Size Up: No Exterior Indication of Heavy Contents Apartments Is responder access obstructed/limited? Narrow pathways Storage close to entry Odors (may not be possible to assess) Are items stored on the floor (groceries, books, magazines, etc.) Remember, entry to the dwelling is the best image people show of their home. It won t get better. 13
Priorities Life Safety is always the number one priority Is death/severe injury likely if I do not act? What is the risk to responders? Call for additional resources: EMS Call for first responder, SOC, Haz Mat, Animal Control, Etc. Fire Second RIT/FAST Team, SOC, Haz Mat, Animal Control, Etc. Police Call for EMS, Fire, Haz Mat, Animal Control, Etc. Code Inspectors- Call for Fire, EMS, Haz Mat, Animal Control, Etc. Animal Control- Request Police, EMS, Haz Mat, Fire, etc. Contain the Emergency Address immediate risks now. Evacuate the patient (if necessary) Mitigate Haz Mat Rescue animals Follow up to address other challenges An emergency is not the time to effect long term change in a mental health issue. 14
Be prepared to change plans. Contain the Emergency Fire Transition to exterior attack early. Police- It may be safer to convince the occupant to leave rather than force entry to effect arrest. This is essentially a barricade situation. Inspectors- The court process to get a warrant allows time to coordinate with safety agencies such as law enforcement and Haz Mat. Animal Control- Coordinate response with other agencies A wise chief once told me: A building on fire is a building under demolition. Heavy Contents means: Overloaded structure Poor maintenance Potential sudden collapse 15
In 2014, the occupant of this dwelling died when the first floor collapsed under the weight of her possessions. Recovery took two days and involved at least 8 agencies Forced clean outs do not work. No one changes by force alone. Creating Change A person s possessions are how they identify themselves and relate with the world. Taking their possessions inflicts trauma. YOU are a danger to them. 16
Creating Change Listen. What are the occupant s priorities? What are they afraid of? What change is needed? Specific requirements 36 egress path Maximum number of pets Functional sanitation Pest remediation Focus on their safety. Listen some more Partners bring more: Education Resources Ideas Support Creating Change 17
Creating Change Set realistic goals Rome wasn t built in a day and neither was this situation. It will take time to fix it. Start with safety issues. Clear stairs Access to utilities Healthy eating Trip hazards Pet care Smoke alarms Set a timeline for follow up Creating Change Force doesn t work, but some pressure may be helpful. Knowing you are coming back is an incentive to make an effort. Assistance Guidance Support 18
Creating Change Appreciate hard work! October December Evaluation Appreciate any effort made (It was harder than you think) Be clear on where compromise is possible and where it is not. Are goals being met? Where is there a deficiency? What steps need to be taken? Be clear. Be honest. Be fair. 19
Questions? My contact info: Capt. Andrew Brown Philadelphia Fire Department Liaison to Philadelphia Hoarding Task Force Email: andrew.brown@phila.gov Phone: 267 872 1710 PHTF web site: http://www.philadelphiahoarding.org/ Facebook: @PhilaHoarding 20