Recommendations on Standards for the Design of Medical Diagnostic Equipment for Adults with Disabilities, Advisory Committee Final Report

4.2 Stretchers

Stretchers are ubiquitous throughout inpatient, outpatient surgery, and other health care settings. They are best known as transport devices for patients in supine, prone, or side-lying positions. However, as noted in Section 3.1, patients often undergo diagnostic evaluations while positioned supine, prone, or side-lying on a stretcher. This occurs especially in emergency departments. It is also common for patients to be transported within hospitals or other facilities for diagnostic procedures and to remain on the stretcher while the test is performed. The MDE Advisory Committee therefore included stretchers among MDE requiring consideration in setting accessibility standards.

Given their multipurpose usages, stretchers have various features that affect recommendations about their accessibility standards. Two features are especially important. First, to serve these multiple purposes, the current configuration of stretchers must accommodate the vertical height needs of numerous components, including (Figure 3.1): the basic elements of wheels, brakes, and steering systems; the green oxygen cylinders necessary to support patients on ventilators or who require supplemental oxygen; and assorted monitors and therapeutic devices, such as intravenous poles, infusion pumps, and Foley catheter bags. As currently designed, oxygen cylinders are typically transported in a horizontal position below the patient bed surface, consuming critical vertical height. Another component is the 6" high lift clearance window that forces foot operated controls up. With these essential features competing for the same vertical space, current stretchers cannot lower to the desired minimum height of 17" to 19" (see Sections 5 and 6). While current stretchers are height adjustable, they have a low deck of 20” to 23” without the surface (i.e., mattress) and would therefore not meet accessible minimum height standards.

The second feature is the patient support surface (mattress), which is currently purchased separately from the stretcher deck. The standard of care is to have a pressure-relieving surface on the stretcher to help prevent pressure ulcers. These patient support surfaces may range from 4” to 5” in thickness; these inches add to the vertical height of a stretcher when measuring from the floor to the top of the surface in its uncompressed state.

The Stretchers Subcommittee and full Advisory Committee discussed possibilities for stretcher redesign, emphasizing that current designs should not preclude future innovation. With respect to lowering stretchers, members discussed at least three ways to further reduce height: (1) allow the frame to lower into the lift clearance area when the stretcher is being used for an independent transfer; once the patient is on the mattress, the stretcher frame could be raised, permitting the stretcher to move normally; (2) use another type of oxygen cylinder or make the oxygen cylinder movable to allow the frame to lower to 17”; or (3) use a gel mattress that is not as thick as conventional mattresses.

Figure 4.2

Configuration of Features in Current Stretcher Design

(SOURCE: Hill-Rom, Inc.)

MDE Advisory Committee members also discussed the possibility of developing different types of stretchers for different purposes. For example, stretchers used primarily in outpatient surgery centers for elective operations with patients who are not acutely ill might not require the oxygen cylinders or other equipment features that contribute to the vertical height of current stretchers. However, representatives from health care delivery systems argued that having different types of stretchers with different capabilities could reduce the efficiency of busy clinical settings. Research and development could allow future stretcher technologies to accommodate low-height accessibility standards (Section 5.1.3). But with today’s stretcher design, meeting those standards is infeasible given current requirements for multipurpose stretcher functions within health care delivery settings.