# Ambulatory Health Care Facility



## EPrice (Feb 24, 2010)

Ok, it seems pretty certain that Utah will be adopting the 2009 IBC for enforcement beginning July 1st, so its time for me to get serious about understanding the changes.  I'm trying to get a good handle on what types of health care facilities would be considered to be Ambulatory Health Care Facilities.  In particular, what determines when an individual is rendered incapable of self-preservation.  Any input is welcome. I would be particularly grateful for references that would help nail this down.

Does the typical use of nitrous oxide render an individual incapable of self-preservation, and would this make a dentist office that uses nitrous oxide an Ambulatory Health Care Facility?  What if they use injections to produce a deeper state of sedation than achieved with nitrous oxide?


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## cda (Feb 24, 2010)

Re: Ambulatory Health Care Facility

You sure you want to open that can of worms???

You will find it is more " you make the call""

Are you able to include local ademendments????

viewtopic.php?f=1&t=1074&hilit=ambulatory

viewtopic.php?f=1&t=1046&hilit=health

http://www4.iccsafe.org/cgi-bin/ultimat ... 795#000000

http://www4.iccsafe.org/cgi-bin/ultimat ... 114#000000

http://www4.iccsafe.org/cgi-bin/ultimat ... 419#000000


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## Big Mac (Feb 24, 2010)

Re: Ambulatory Health Care Facility

This is a provision ripe for abuse and mis-interpretation.  It looks like this provision was placed in the code because people didn't want to deal with "Stand Alone Emergency Departments" as was specified in the previous code editions.

Check Table 1604.5 of the 2006 IBC and whatever Table is the equivalent of that in the 2009IBC.  It is no longer classiifed as a Category IV structure in the 2009 Code.


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## Coug Dad (Feb 24, 2010)

Re: Ambulatory Health Care Facility

The new ambulatory care provisions somewhat parallel those in NFPA 101, The Life Safety Code, which is used for the  licensing  of the facilities.  ICC would love to crack the monolopy NFPA has with CMS and the Joint Commission.  However, they need to address other uses to match the scoping of NFPA 101.


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## chris kennedy (Feb 24, 2010)

Re: Ambulatory Health Care Facility

Want an electrician's point of view?  Okay.  This is from NECHB 2008 (an NFPA document):



> Ambulatory Health Care Occupancy. A building or portion thereof used to provide services or treatment simultaneously to four or more patients that provides, on an outpatient basis, one or more of the following:   (1) 	Treatment for patients that renders the *patients incapable of taking action for self-preservation under emergency conditions without assistance of others.*
> 
> (2) 	Anesthesia that renders the *patients incapable of taking action for self-preservation under emergency conditions without the assistance of others.*


This is the commentary following 517.2:



> Ambulatory health care occupancies, such as outpatient surgery centers, freestanding emergency medical centers, and hemodialysis units, are subject to the requirements of Part II and 517.45. This definition was revised for the 2008 Code to correlate with the definition of the same term in NFPA 99, Standard for Health Care Facilities. The Code now recognizes that some emergency or urgent care may be performed at ambulatory health care occupancies.


Seems pretty self-explanatory to me.


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## Dr. J (Feb 24, 2010)

Re: Ambulatory Health Care Facility

The main difference between the 09 IBC and NFPA 101 definitions of Ambulatory Health Care  Facility is that the IBC does not have a minimum number.  NFPA 101 requires 4 or more to become an AHCF (as quoted by Chris K).

It is actually pretty straight forward (and was before as well).  The only tough part will be getting the owner to fess up as to the extent of sedation performed.  Nitrous on the plans is a good hint that people will be incapable of self preservation, but not a cinch.  They could be using portable bottles, and a needle will not show up on the submitted plans.  A standard dentist (not oral surgeon) can use just enough nitrous to calm nerve and still allow people to get up and leave by themselves.  Your state health agency most likely licenses a Dr. or practice for specific levels of sedation.  If licensed for a non-self-preservation level, then it would be valid to require that office to meet the requirements for a AHCF.

I find this a good addition to the code.  Until the '09 version, a full-out Ambulatory Surgery Center, doing fairly major surgery could have an unlimited amount of ORs, an unlimited amount of people completely zonked out, but as long as they are kicked out within 23.99 hours, could still be in an unsprinklered, non-separated, non-alarmed B occupancy by pure IBC.  Of course, most ASCs are also reimbursed by CMS and therefore had to meet NFPA 101 as well.  I will not see too much difference in design, since all the ASCs I have designed had to meet NFPA 101 anyway.  The owners who will be complaining will be the ones who never had to deal with CMS and NFPA 101 before.


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## Dr. J (Feb 24, 2010)

Re: Ambulatory Health Care Facility

One subtle point.  The facility has to be doing the "rendering incapable" for it to be an AHCF.  An unconscious patient brought in for treatment is not rendered incapable by the facility.  An urgent care clinic is probably not an AHCF, unless it has a Trauma Room.  Again - check with the state health licensing agency - are they licensed to knock people out or not?


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## EPrice (Feb 25, 2010)

Re: Ambulatory Health Care Facility

Thanks to all who have responded.  Yes, it will be a judgment call on a case by case basis.  The thing that I am struggling with the most is knowing when/if nitrous oxide use renders the patients incapable of self preservation.  Dr. J's mention of state licensing is a good lead.  I'll have to check that out.

Although the IBC doesn't require "4 or more" to become an Ambulatory Health Care Facility, it does bring that number up when actually applying the regulations in 903.2.2, but not in 907.2.2.

To make things more interesting, in adopting the 2009 IBC, Utah will be adding a requirement for occupancy separation of Ambulatory Health Care Facilities from all other occupancies and tenants in the building.

Thanks again to those who have responded.


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## globe trekker (Feb 25, 2010)

Re: Ambulatory Health Care Facility

EPrice,

As Dr. J mentioned, it's the level of sedation that is the critical point of design.   Ask for something in

wrting from the owner / DP [ that comes from your state medical licensing board  ].    Put the

obligation of ' actual  use '  of the faciltiy on the owner to provide you with enough information for

you to be able to accurately review the design of the facility.     Not much ambiguity after that!


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