A big concern of providers is access for wheelchairs. Mobile vans can be accessible but are not usually compliant with the Americans with Disabilities Act (AwDA); AwDA requirements were developed with fixed facilities in mind. This is not to say that vehicles are not capable of serving those in wheelchairs; just keep in mind there are factors that prevent AwDA compliance. With the size limitations inside a mobile vehicle, many of the requirements are impossible to adhere to (for example, 48 inches of clear floor space around any fixed object, in all directions is impossible when the inside width of the largest vehicles is a total of 96 inches.) Door frames need to be 30 inches to accommodate standard size wheelchairs. Designate one of the operatories as accessible. Storage of wheelchairs is also an issue; encourage use of folding ones.
Wheelchair lifts are available in two configurations. An interior storage type utilizes a 2 foot by 4 foot space on the interior of the vehicle--this is usually in the operatory area to minimize patient travel though the vehicle. The under-floor storage lift stores outside in a compartment under the access door, taking virtually no interior floor space, and thus better suited for most programs. Unless the van specifically services persons with special needs, the lift (whether mounted inside or outside), will be used very little in most cases. Because of this, most programs make the investment to place the lift outside rather than lose the interior space. An exterior mounted lift is about $5,000 more than an interior one
Because wheelchair lifts are expensive, some programs have found it more cost-effective to eliminate lifts from their plans and transport these patients to a fixed clinic or use a portable or mobile-portable hybrid system that treats the patient in-situ. Small children with physical impairments can be carried into the van.
With floors that typically rise 4 feet above the street, using a ramp instead of a lift has many drawbacks. A ramp with a 4/12 pitch means that for every foot of ramp, the ramp changes height by 4 inches. This is very steep, especially when the ramp doesn't have safety rails on each side. Another consideration is the actual length of the ramp and where to store it on the vehicle. Even if you had a ramp customized to break down into sections, you would still have two very heavy 36-inch wide and possibly 8-foot long aluminum ramps to lift, secure for use, and store for transit.