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

5.3 Transfer Sides Recommendations

5.3.1 Permitted Obstructions to Transfer Sides for M301 and M302

Description: Transfer side provisions are the same for M301 and M302 and require the transfer surface to be located to provide options to transfer onto the short side and the long side of the surface. The provisions result in the transfer surface being located at a corner of the equipment and the two transfer sides adjoining at the edges of the equipment. The provision will coincide with the seat area design of most examination chairs.

NPRM Proposed Provision: M301.2.3 and M302.2.3 Transfer Sides. The transfer surface shall be located to provide options to transfer from a mobility device onto one short side (depth) and one long side (width) of the surface. Each transfer side shall provide unobstructed access to the transfer surface.
EXCEPTION: Temporary obstructions may exist where they can move out of the way to permit transfer.

NPRM Preamble Discussion: The Access Board is considering whether the final standards should permit equipment parts to extend horizontally 3 inches maximum beyond the edge of the transfer sides provided they do not extend above the top of the transfer surface. This would allow handholds and other features that may facilitate transfer to be located on the transfer sides. The 2010 Standards provide a gap of 3 inches between the edge of a shower seat and the shower compartment entry, and the gap does not appear to interfere with transferring onto and off the shower seat.

The Committee recommends a 3-inch maximum obstruction permitted at transfer sides.

Rationale for the recommendation

Transfer supports provide handholds on adjustable medical equipment to facilitate transfers onto and off the equipment. Some medical equipment types have components that create a gap between the transfer surface and the outer edge of the equipment on the side used for transfer. This standard places a limit on the size of the gap allowed.

To address this, the Committee used the provisions in the 2010 Standards on shower compartment seats. These seats allow a maximum of a 3-inch gap between the edge of a shower seat and the shower compartment entry.

The Committee considered anthropometric data from a research project that examined transfer experience with an adjustable height transfer surface. The two surfaces were placed at the same height and subjects transferred at gaps in increments of 3.5 inches. The result showed that 95% of subjects could transfer when seat and surface are at same height with a 3.5-inch gap. This data helped inform the recommendation since the 3-inch criteria is less than that used in the research and should assure effective transfers for most.

Figure 5.3.1 Permitted 3-Inch Maximum Obstruction at Transfer Side
(SOURCE: U.S. Access Board)

The 3-inch gap would accommodate a variety of supports including ones foldable, collapsible, removable, and articulating. A common example of an obstruction is the side rails on stretchers. Arm rests and footrests are examples of permitted temporary obstructions because they move out of the way of the transfer. The 3-inch maximum gap applies to two sides of medical diagnostic equipment with a rectangular shape, the long length (width) and the short length (depth), where the transfer surface is located.

Special considerations for Stretchers

Each transfer side shall minimize obstructions to the transfer surface. Obstructions shall not be vertically less than 1 inch nor be horizontally more than 3 inches from the edge of the patient support surface to provide unobstructed access to the transfer surface.

This provision incorporates the provisions of IEC 60601-2-52 establishing the maximum vertical obstruction at no less than 1 inch below the top of the transfer surface.

5.3.2 Transfer Sides Recommendations for M301

Description: The transfer side provision requires the transfer surface to be located to provide options to transfer onto the short side and the long side of the surface. The provisions result in the transfer surface being located at a corner of the equipment and the two transfer sides adjoining at the edges of the equipment (e.g., foot of an examination table). Patients who use mobility devices would have the choice to approach parallel to the deep dimension of the transfer surface, parallel to the wide dimension of the transfer surface, or at an angle to the corner of the transfer surface and be able to perform a variety of transfers. Locating the transfer surface at a corner of the equipment and providing unobstructed access to the two transfer sides also would facilitate assisted transfers.

NPRM Proposed Provision: M301.2.3 Transfer Sides. The transfer surface shall be located to provide options to transfer from a mobility device onto one short side (depth) and one long side (width) of the surface. Each transfer side shall provide unobstructed access to the transfer surface.

5.3.2.1 Transfer Sides Recommendation for Stretchers

On stretchers, the transfer surface is oriented along the long dimension of the surface on which patients are in the supine, prone, or side-lying position (see Figure 5.4.1.1).

For stretchers, the Committee recommends the transfer surface be located to provide the ability to transfer from a mobility device onto both long sides of the surface.

Rationale for the recommendation

This recommendation recognizes the configuration and use of stretchers. The configuration of stretchers typically does not allow access to a transfer surface on either end. As a result, with current stretcher design, a patient will access the long side of the transfer surface and the short side will be inaccessible. The location of the transfer side is on the patient right or left roughly midway between the two ends (head and foot). This transfer location places the patient at a desirable location along the length of the stretcher side so that when the transfer is complete, the patient is in the proper location as the backrest articulates.

5.3.2.2 Transfer Sides Recommendation for Imaging Equipment

On imaging equipment, the transfer surface is oriented along the long dimension of the surface on which patients are in the supine, prone, or side-lying position (see Figure 5.2.1.4).

The Committee recommends that imaging equipment provide transfer surfaces on at least one long side of the table.

Rationale for the recommendation

Patients access diagnostic imaging equipment from one of the long sides of the table. Patients would not transfer onto imaging tables from the head or foot end because the patient would need to scoot,” slide, or twist a long distance to get into the proper position for the exam, a difficult if not impossible feat. Recognizing this, imaging equipment provides the transfer surfaces on the short sides of the table. The Committee members recognized the option of transferring from either of the long sides of the equipment is optimum.
Imaging manufacturers noted that many X-ray system tables and all DXA tables with today’s technology have part of the imaging equipment support located on one of the long sides and all patient transfers happen on the opposite side. Many X-ray systems and all DXA systems as currently installed have equipment obstructions on one of the long sides. Industry agreed the best solution is to have transfer access where feasible within the medical equipment design on both long sides.

5.3.3 Transfer Sides Recommendations for M302

Description: Transfer side provisions are the same for M301 and M302 and require the transfer surface to be located to provide options to transfer onto the short side and the long side of the surface. The provisions result in the transfer surface being located at a corner of the equipment and the two transfer sides adjoining at the edges of the equipment. This provision will coincide with the seat area design of most examination chairs.

NPRM Proposed Provision: M302.2.3 Transfer Sides. The transfer surface shall be located to provide options to transfer from a mobility device onto one short side (depth) and one long side (width) of the surface. Each transfer side shall provide unobstructed access to the transfer surface.
EXCEPTION: The provision permits temporary obstructions if they can move out of the way to permit transfer.

5.3.3.1 Transfer Sides Recommendation for Exam Chairs with Fixed Footrests

Some examination chairs have footrests that get in the way of entry from the foot end, such as dental chairs and podiatry chairs.

The Committee recommends exam chairs with a fixed footrest have a transfer surface minimum of a 17 inch depth and a 21 inch width located on both sides of the chair to allow for a left or right transfer.

Rationale for the recommendation

As currently designed, some examination chairs have fixed footrests that facilitate the clinical functions for which the chair is used. The footrests obstruct access to the foot end of the chair. Examples of chairs that fit this category are most dental chairs and podiatry chairs. The current design allows only one long side for transfer, which limits some patient transfers where a patient can use only one side of the body due to paralysis on one side or other such conditions. To address this issue, the recommendation requires chairs with footrest obstructions to allow patient transfers from both sides of the chair. The solution creates the option for either a left or a right transfer. (see Figures 5.3.3.1(a) and 5.3.3.1(b))

Figure 5.3.3.1(a) Podiatry Chair
(SOURCE: Midmark Corporation)

Figure 5.3.3.1(b) Dental Chair
(SOURCE: Midmark Corporation)