Specific Guidance 2.1: Medical Tables
Overview
This specific guidance addresses medical tables, which were identified in the RERC-AMI's national consumer survey (Winters et al., 2007) and through focus groups (Story et al., 2005) as key pieces of equipment causing access barriers to healthcare services. This guidance applies to all types of medical tables, including those used for a wide variety of examinations and procedures.
The specific guidance provided here is based on existing legislation (Americans with Disabilities Act Accessibility Guidelines, ADAAG) and expertise and experience of RERC-AMI staff.
2.1.1 The height of the table should be adjustable.
Discussion: The table should adjust in height to suit the needs and preferences of patients with different needs and preferences, as well as the needs of medical professionals of different heights and as appropriate for specific procedures.
The preferred minimum height is 17 inches (ADAAG), although this is not currently available for all types of medical tables. The 17-inch height makes it possible for some wheelchair users to transfer themselves onto the table from the wheelchair, and for some people of short stature to use the table independently.
However, wheelchair users and some ambulatory people may prefer to have the table at a higher height (e.g., 19 or 20 inches) when getting off the table. It is easier for wheelchair users to transfer themselves off a table that is higher than the seat of the wheelchair (so they are working with gravity rather than against it), and it is easier for individuals with weaker quadracep (thigh) muscles to stand up from a higher seat (Demura & Yamada, 2007).
2.1.2 The weight lifting capacity of height-adjustable tables should be at least 300 lb.
Discussion: A 300-lb. capacity to lift patients while they are on the table will accommodate at least 99% of the U.S. population.
In 2003-2004, the CDC’s National Health and Nutrition Examination Surveys (NHANES) found that 32.2% of Americans age 20 and older (31.1% of men and 33.2% of women) were obese (BMI ≥ 30.0). For a 6-foot-tall person, this would be a weight of more than 221 lbs. In addition, 2% of Americans were morbidly obese (BMI ≥ 40.0). For a 6-foot-tall person, this would be a weight of more than 295 lbs. (NCHS, 2006). Medical facilities should be prepared, however, to accommodate people who weigh much more than 300 pounds, possibly with a bariatric gurney or platform.
2.1.3 Controls for table adjustments (e.g., height, back angle) should be located appropriately for the application.
Discussion: For some table uses, it is appropriate to allow patients to adjust the table themselves to suit their personal needs and preferences. For other uses, only medical personnel should adjust the equipment. For example, when patients may be left alone on the table for some period of time, it would be desirable for them to be able to adjust the table so they could shift their body positions, particularly to avoid pressure sores.
2.1.4 Any pad or cushion on the patient support surface of the table should be firmly attached or secured in place.
Discussion: The table’s padding or cushion should be firmly secured in place so as not to endanger the stability of patients while transferring onto and off the equipment or while repositioning themselves. When the pad is not secured, patients are put at risk of losing their balance and falling.
2.1.5 The stiffness of the table padding or cushion should be appropriate to the application.
Discussion: Softer surfaces are more comfortable and appropriate for tables on which patients must remain for a substantial period of time; however, they can more more difficult to transfer on and off, especially for wheelchair users and others who perform lateral transfers. In contrast, firmer surfaces are less comfortable but can be easier to transfer onto and may be appropriate for applications in which patients remain on the surface for only a short duration. More research is needed to investigate the optimal characteristics of transfer surfaces.
2.1.6 The table should have handholds to improve patient safety and enhance independence while getting on or off the equipment.
Discussion: Handholds on tables may be side rails, arm rests, grab bars, vertical poles, or other elements that provide a secure grip for patients while maneuvering their bodies relative to the table. Patients may use handholds while getting on or off the equipment, or while repositioning themselves while on it. Research is ongoing in this area.
2.1.7 The table should have side rails available. The side rails should drop down or be removable so they will not obstruct patient transfer or hinder professional diagnosis or treatment.
Discussion: Side rails enhance patient comfort, safety and security while on the table or while repostioning themselves. However, they may need to move out of the way when patients are getting on and off, depending on individual patient needs and preferences. They may also need to be removed to increase healthcare professionals’ physical access to the patient. The table should provide a place to store the side rails in or on the table (e.g., in a side recess or in a drawer on one end or hanging on a wall nearby) so they will be readily available when needed.
2.1.8 The table cushion should be wide enough to allow the patient to manuever safely and comfortably into any body position that may be needed or desired (e.g., lie on one side, roll over, shift pressure points).
Discussion: The maximum current standard exam table width is 28 inches, but wider widths would make it easier for patients to position or reposition their bodies on the table. For medical facilities that serve bariatric (obese) patients, wider tables would be prefereable.
2.1.9 Tables used for examinations or procedures for which stirrups are required should accommodate leg supports (e.g., knee crutches) either instead of or in addition to stirrups.
Discussion: Some patients, especially individuals with lower extremity paralysis, cannot keep their feet in stirrups, and supports for the leg (e.g. knee crutches which cradle the back of the knee) are needed. The leg supports or knee crutches should be padded for patient comfort.
The leg supports should be adjustable and lockable. Some patients have asymmetric bodies or have limited ranges of motion or prefer different body positions, and this feature would enable them to assume and maintain a variety of positions and to change positions.
2.1.10 The base of the table should not extend past the edge of the patient support surface or cushion.
Discussion: A base that extends past the edge of the table may prevent patients who use wheelchairs from maneuvering close prior to transferring, which may make the process less safe. The edge of any flat plate where the table base meets the floor should be beveled or sloped so it will not be a tripping hazard or rolling obstruction. More research is needed to understand the base clearance needs of wheelchair users, including the needs of people who transfer laterally and those who transfer forward.
2.1.11The table should provide clearance for lift equipment.
Discussion: The base of the table may be narrow enough for portable lift equipment to straddle the end of the device, or it may have clear space underneath the body of the table to accommodate the legs of portable lift equipment. The table should have a clear path of travel for overhead lift equipment, if applicable.
Training
2.1.12 For ambulatory patients, height-adjustable tables should be set to the height of the patient’s mid-thigh for getting on and off.
Discussion: People with weak quadracep (thigh) muscles find it easier to sit down and sit up from a seat that is taller than a typical chair (17-19 inches) (Demura & Yamada, 2007).
2.1.13 Positioning aids should be offered to patients.
Discussion: A variety of auxiliary support devices should be offered to support and stabilize patients to maintain comfortably specific positions of their bodies, arms, legs, head, or other body parts, as needed. The auxiliary devices may be foam wedges, shaped cushions, pillows, and/or straps (e.g., woven material with velcro closures).
References
Demura, S. & Yamada, T. (2007) Height of chair seat and movement characteristics in sit-to-stand by young and elderly adults. Percept Mot Skills, 104(1):21-31.
National Center for Health Statistics (2006). Prevalence of overweight and obesity among adults: United States, 2003-2004. Hyattsville, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention.
Story, M.F., (2005). Focus groups on accessibility of medical instrumentation. In Proc. RESNA 2005 Ann Conf. 2005: Atlanta, GA.
Winters, J.M.W., et al. (2007). Results of a national survey on accessibility of medical instrumentation for consumers. In Medical Instrumentation: Accessibility and Usability Considerations, J.M. Winters and M.F. Story, Eds. Boca Raton: CRC Press, 13-28.