Anxiety and the Ant Farm
Every fire chief has a story about how his or her department had to respond to a hoarder’s home. Upon first responders’ arrival, hoarders may be embarrassed to allow first responders into their home due to how their condition may be perceived. In turn, firefighters are reluctant to enter an unsafe home.
Deputy Chief Calvin Linke of the Williamsburg County Fire Department knows hoarding affects his community and how the fire service responds to calls at those homes.
“It impacts our access to the victim for medical calls, since we can’t get around the clutter to treat them,” Deputy Chief Linke said. “We have to get them out so EMS can work on them. But it’s not easy because doorways are blocked, and there is usually just one exit.”
For a structure fire call, Deputy Chief Linke says his firefighters have to navigate narrow passages to find the seat of the fire, which could prove nearly impossible. The fire could also smolder for hours because of the fire load, putting a strain on resources.
In other situations, such as fire prevention, a lack of access could deter education about how to respond to a fire. For example, teaching an occupant how to escape from a fire is a longer, more complicated conversation when there are obvious blocked exits and trip hazards, particularly as a result of an underlying disorder such as hoarding. Ultimately, navigating a hoarder’s house during an incident is “like going through an ant farm,” Linke said. “There is only one way around the house and only one way out. We have to tell the occupants of these homes that if we are having trouble coming in to assist you, you will have trouble escaping your house in an emergency.”
Hoarders may find that conversation difficult because their condition is not necessarily intentional. A hoarder generally is suffering from anxiety regarding the keeping and removing of possessions in their home. Researchers studying the condition from Johns Hopkins University School of Medicine estimate between two and five percent of Americans may meet the criteria for being diagnosed as hoarders. Most hoarders are elderly, with the condition becoming worse as the patient ages. While there are varying degrees of hoarding, symptoms worsen over time without treatment.
As the hoarding becomes worse, other parts of the hoarders’ home become unsafe. Tables, hallways, and stairs are landing places for boxes, suitcases and books. Rooms are filled to the ceiling with clothes, newspapers, fast food wrappers or broken appliances. Harsh cleaning or industrial chemicals are left in the reach of children and pets as there is no way to access storage. Bathrooms and kitchens are unusable and unsanitary, leaving occupants struggling to find safe methods to survive.
An Unintended Consequence
Sometimes those unsafe living conditions have deadly consequences. In 2016, 62 fatal residential fires were researched by South Carolina State Fire’s Community Loss Education and Response (CLEAR) team. The team concluded fires are often fatal due to a lack of awareness of the ignition present or the inability of the victim to escape. It was also found that one out of every five, or 20 percent, of those 62 fires had a hoarding component. Victims could become disoriented because of the winding, narrow pathways, battling blockades of belongings since there is no direct path to the door. These victims, exhausted from the heat and smoke, have sometimes been found underneath piles of their belongings. In some situations, the fire cause is undetermined because the fire started in a location which could not be accessed in normal, everyday use. If the occupants were unaware of the fire starting in a room which cannot be seen, the fire may have become too large before the occupant knew to attempt an escape.
Additionally, hoarders engage in riskier behaviors. This includes using improper electrical hookups, unsafe cooking sources, or unsafe ways to extinguish cigarettes. All of these situations were observed in various hoarder homes where a fatal fire occurred last year. The hoarder may not have been the documented fatality, but his or her symptoms and adaptive behaviors fatally affected other occupants of the home.
Addressing the Issue
When fire service members engage with their community, they must be aware of the different demographics and behaviors. The Federal Emergency Management Agency recognizes there are some demographics, which require information providers to consider and change the delivery of the message: non-English speaking residents, those with physical or cognitive disabilities, the elderly population and children.
How do we adjust the way we deliver our safety message so we can best address the needs of hoarders?
The first method is to recognize hoarding is a part of the occupants’ lives and work around it. Installing smoke alarms and teaching the hoarder how to escape during a fire, despite having narrow pathways, will hopefully reduce the chance of the occupant becoming a fire fatality. Explaining how keeping clear exits will help the fire department to come to the occupant’s aid if a medical emergency occurs may encourage occupants to keep such doorways and windows clear. This teaching method is not foolproof, as it does not address the systemic issues of why the person is at greater risk than a non-hoarder.
The second method is encouraging the hoarder and his or her family to consider professional treatment. This could include talking with a counselor for any underlying anxiety and working with a professional organizer to remove the trash and unnecessary belongings. By connecting people to helpful resources, environmental risks can be reduced and resident safety increased.
However, mental health treatment has to be initiated and wanted by the patient. Should a fire department wait for a hoarder’s home to be clean and tidy before installing alarms or sharing educational literature regarding fire drills? If the patient does not complete treatment, or if treatment was unsuccessful, the hoarding may continue. Additionally, this means the safety risks associated with hoarding will also continue. However, the fire department still finds it useful to reduce risk by installing alarms and providing home fire drill plans — regardless of the state of the home.
A Voice in the Conversation
There is no immediate solution for addressing this situation, which affects our civilians and first responders. However, understanding how hoarding affects the fire service during actual incidents is key. To assist with this, South Carolina State Fire is conducting a research project to better understand the relationship and interactions between hoarders and the fire service. Fire departments will detail what symptoms they are seeing in these homes, and how those symptoms specifically impact their duties, regardless of the incident type.
By describing these interactions in more detail, research should reveal the largest home-related issues departments are facing in hoarders’ residences. While State Fire recognizes hoarding is an anxiety disorder, it is important to emphasize how those symptoms are creating unsafe conditions for firefighters. This research will also show the extent of hoarding in our communities and the varying degrees of hoarding symptoms. This research can also help determine best practices for extinguishing fires and rescuing occupants in hoarding environments.
Future projects are planned to facilitate communication between professional organizers, licensed therapists, fire departments and other first responders and hoarders. These conversations should bring to light new ideas for the way we share our safety messages with those who are in dire need of help.
To participate in the hoarding research study, your fire department must respond to calls in South Carolina, report to NFIRS, and respond to residential property calls. If your department would like to participate in this study, please contact State Fire at 803-896-1250, no later than Sept. 1, 2017.