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

NOTES

^1. Patient Protection and Affordable Care Act, Pub. L. No. 111-148, §4203, 124 Stat. 119 (2010).

^2. See Architectural and Transportation Barriers Compliance Board. Notice of Proposed Rulemaking: Medical Diagnostic Equipment Accessibility Standards, 77 Fed. Reg. 6916, February 9, 2012

^3. Note that height measurement, as defined by the tables and chairs subcommittee, represents the highest point of the transfer surface, inclusive of bolsters, when measuring to the top of uncompressed foam. See the “Measurements of Tables and Chairs” subcommittee report, dated April 5th, 2013.

^4. Medical table install base derived from U.S. medical distribution sales data, as provided by Global Healthcare Exchange (GHX), found at http://www.ghx.com/product-pages/solutions/supplier-solutions/sales-data-analytics.aspx

^5. See M301.2.1 and M302.2.1.

^6. See Architectural and Transportation Barriers Compliance Board. Notice of Proposed Rulemaking: Proposed Accessibility Standards for Medical Diagnostic Equipment. February 8, 2012.

^7. Ibid.

^8. Ibid.

^9. Ibid, citing ANSI/AAMI HE 75, section 16.4.4. ANSI/AAMI HE75 recommends that the height of patient support surfaces "should be easy to adjust (ideally, powered) to suit the needs of health care professionals and patients." ANSI/AAMI HE75 further recommends that the height of patient support surfaces "should be adjustable to a position high enough to accommodate tall health care providers and the range of medical procedures that could occur . . .[and] to a position low enough [19 inches maximum] to allow for the comfort of providers who choose to work in a seated position, to enable patients to keep their feet on the floor while seated, and to accommodate patients who need to transfer laterally between the platform and a chair or wheelchair alongside." 

^10. See Analysis of Seat Heights for Wheeled Mobility Devices at: http://udeworld.com/analysis-of-seat-height-for-wheeled-mobility-devices. The seat heights ranged from 16.3 inches to 23.9 inches for manual wheelchair users; 16.2 inches to 28.9 inches for power wheelchair users; and 18.8 inches to 25.3 inches for scooter users. Seat heights for males were typically higher than for females. Thirty (30) percent of female manual wheelchair users and 6 percent of female power wheelchair users had seat heights equal to or less than 19 inches. All the male manual wheelchair users and 92 percent of the male power wheelchair users had seat heights equal to or less than 25 inches. Thus, transfer surfaces that are adjustable from 17 inches minimum to 25 inches maximum during patient transfer accommodate significantly more patients who use mobility devices.

^11. Although the current accessibility standards and regulations described here reference a fixed height, the MDE advisory committee has recommended adding adjustable height to further enhance accessibility for users whose WMD’s are higher than 19 inches. This includes most power wheelchair and scooter users, as described in the AWM Project. Note that the accessibility standard for pool lifts, 1009.2.4, also specifies adjustability, but with a very different range of motion due to its intended use of lowering a person down into a body of water. 

^12. See Accessible and Usable Buildings and Facilities, ICC/ANSI A117.1-2009. Emphasis of upper dimension of range added.

^13. Ibid.

^14. Ibid.

^15. Ibid. 

^16. Ibid.

^17. Because medical table and chair are typically raised in height for a clinical examination, the transfer supports described in the proposed standards may provide the added benefit of patient security and stabilization.

^18. See Accessible and Usable Buildings and Facilities, ICC/ANSI A117.1-2009.

^19. Medical table install base derived from U.S. medical distribution sales data, as provided by Global Healthcare Exchange (GHX).

^20. Some tables may require installation of a modified top to meet the 19” standard but would not require changing out the installed base.

^21. See Analysis of Seat Heights for Wheeled Mobility Devices at: http://udeworld.com/analysis-of-seat-height-for-wheeled-mobility-devices. The seat heights ranged from 16.3 inches to 23.9 inches for manual wheelchair users; 16.2 inches to 28.9 inches for power wheelchair users; and 18.8 inches to 25.3 inches for scooter users. Seat heights for males were typically higher than for females. Thirty (30) percent of male manual wheelchair users and 6 percent of male power wheelchair users had seat heights equal to or less than 19 inches. All the male manual wheelchair users and 92 percent of the male power wheelchair users had seat heights equal to or less than 25 inches. Thus, transfer surfaces that are adjustable from 17 inches minimum to 25 inches maximum during patient transfer accommodate significantly more patients who use mobility devices.

^22. Available at http://www.wheelchairnet.org/WCN_ProdServ/Docs/PDF/AXbook_Sec4a.pdf.

^23. Ibid.

^24. Available at http://www.ucdenver.edu/academics/colleges/medicalschool/programs/atp/Resources/WheelchairSeating/Pages/WheelchairSeating.aspx

^25. Ibid.

^26. Human Engineering Research Laboratories, University of Pittsburgh, The Impact of Transfer Set-Up on the Performance of Independent Transfers: Final Report. Available at: http://herl.pitt.edu/ab/transfer_assessment_report.pdf (visited May 22, 2013). 

^27. Medical table install base derived from U.S. medical distribution sales data, as provided by Global Healthcare Exchange (GHX), found at http://www.ghx.com/product-pages/solutions/supplier-solutions/sales-data-analytics.aspx

^28. The full meeting minutes, as well as a copy of the presentation delivered, can be found in Appendices A and B to this report.

^29. The example given here describes an examination table, but the complexity and cost would similarly increase for examination chairs, especially those equipped with footplates. See section 4.1.3 of the full committee report for further details.

^30. Examples of such transfers can be viewed here: http://www.youtube.com/watch?v=qivOb_V6IgA 

^31. Full meeting minutes are available at http://www.access-board.gov/guidelines-and-standards/health-care/about-this-rulemaking/background/committee-meetings/minutes-february-26-and-27,-2013