Healthcare Design - April 2017 - 49

AIA-AAH

ON THE MOVE

Mobile medical units aren't covered by
traditional codes and regulations, but that may
be about to change
By Skip Gregory and Deborah Smith

M

OBILE/TRANSPORTABLE MEDICAL units are used
throughout the U.S. to provide easy, and sometimes free, access to medical and dental services,
including screenings, diagnostic imaging, minor
procedures, and non-emergency services. These
units can be used to bring care to underserved areas or to temporarily house services during construction projects at a host medical facility.
While the medical services offered to patients in these units are often the same as those offered in permanent building structures, these
mobile environments aren't regulated by building and fire codes that
require owners to maintain buildings and equipment within designated parameters. The Facility Guidelines Institute's (FGI) Guidelines for
Design and Construction of Hospitals and Outpatient Facilities is one
such design standard adopted by authorities having jurisdiction (AHJ),
but unless a mobile/transportable unit is part of a state-licensed medical facility, the guidelines generally aren't
applied. Previous editions of the guidelines
outlined some design requirements for moIF MINIMAL DESIGN
bile units, but they didn't provide the patient
REQUIREMENTS
safeguards necessary for when interventional
ARE NECESSARY TO
therapies are provided inside these units that
they do when the same procedures are done
COMPLETE A SAFE
inside a regulated medical facility.
MEDICAL PROCEDURE
To remedy this, members of FGI's Health
Guidelines Revision Committee (HGRC) deINSIDE A BUILDING,
cided to revise the chapter for mobile/transTHEN WHY SHOULDN'T
portable units during the 2018 revision cycle.
THE SAME APPLY TO A
The primary goal of these changes is to ensure
patient safety for all medical services providMOBILE UNIT?
ed in this setting and to assign responsibility
for assuring these requirements are met. The
American Institute of Architects Academy of Architecture for Health
(AIA-AAH) has three representatives on the 2018 HGRC who offered
input on this topic throughout the comment period. All revisions to this
chapter have been completed and will now be voted on for final approval by the HGRC. The following is an overview of some of the major revisions to the mobile/transportable medical unit chapter.

C R E AT I N G C O N S I S T E N C Y

Similar to other code committees, the HGRC is
moving away from patient safety design standards based on the setting where medical services are provided and toward the idea of basing
these standards on the types of services provided.
The idea is that if minimal design requirements
are necessary to complete a safe medical procedure inside a building, then why shouldn't the
same design standards apply to a mobile/transportable unit? The task group didn't agree with
older editions of the guidelines that mitigated
requirements for mobile/transportable units
due to the small size of the unit or its limited occupancy and instead wanted to find a way to scale
reasonable requirements based on the services
provided.
Fortunately, another guidelines task group had
developed a classification of room types based on
the procedures performed in the rooms and the
acuity of the patient. The task group adapted this
classification system to designate three different
classes for mobile/transportable units based on
increasing levels of medical intervention. Class
1 medical units are for services such as diagnostic radiography, fluoroscopy, mammography, CT
scan, ultrasound, MRI, and other imaging modalities. Class 2 units can be used for diagnostic and
therapeutic coronary, neurological, or peripheral
angiography procedures and endoscopic procedures. Class 3 units provide locations for invasive
procedures when the patient requires physiological monitoring and active life support.
Some variations to the design standards for
Class 1 and Class 2 medical procedures, such as
minimum clearances around the procedure table
or between equipment, may be permitted if the
owner completes a safety risk assessment regarding the acuity of the patients and the intensity of the medical procedures being provided and
has the assessment and any alternative arrangements reviewed and approved by the AHJ.
Certain requirements were also outlined for
each class, such as ventilation or electrical design. For example, Class 1 units that require
positive or negative ventilated areas must meet
ASHRAE 170, and all areas of Class 2 and Class 3
units must meet all of ASHRAE 170 ventilation
and filtration requirements. Also, some required
supporting spaces, such as clean and soiled utility rooms, storage rooms, and holding areas, are
permitted to be provided in a host facility if the
support areas are readily accessible to the mobile/transportable unit. If not, then they must
be supplied within the unit, otherwise medical
services cannot be provided from the unit.
 
APRIL 2017

49
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