These tips will help you assess your equipment and options for the best results

As the world becomes an increasingly smaller place, the need to reduce, reuse, and recycle—and thereby conserve our environment—grows. For biomedical equipment technicians evaluating options for what to do with equipment that needs to be taken out of service, this concept can be more than tangential. But whether disposition goals are weighted more toward altruism or the bottom line, a methodical process to evaluating your options is key.

“A facility needs to have some sort of decision process to go through to determine what to do with equipment,” says Jim Loeffer, who works in medical equipment procurement for International Aid (Spring Lake, Mich), a nonprofit that coordinates getting the right donated equipment to the right people through numerous organizations that work in more than 170 countries.

The first step in evaluating your alternatives is to assess the equipment’s condition. For equipment still in good working order, there are several steps to tick through in a matrix of options in the decision-making process.

Organizational Needs
A first choice is to look inward. Is there a need within your organization? Although this may seem to apply more to larger health care systems that have multiple hospitals or facilities, uses may exist within smaller organizations as well. For instance, equipment might serve to function as a spare or backup. The equipment might be useful to keep on-site for parts, too. This is especially true if the model has been discontinued or the manufacturer has gone out of business. Additionally, there might be in-house educational and training uses for the equipment in question.

If there are no internal needs, consider the possibility of a trade-in for new equipment. You may not be able to get the value back out of the equipment by trading it in, but at least your vendor is taking the equipment off of your hands, potentially saving the organization substantial shipping and disposal expenses.

Health-service providers also may want to examine hiring a third-party vendor that can come in to manage nonusable assets, because trying to identify buyers and determine the right price may be very time-consuming. Vickie Snyder, biomedical engineering manager at Fairview Southdale Hospital (Edina, Minn), says she spent about 2 weeks working through the right disposal decision for 18 anesthesia machines, looking at selling and trade-ins, ultimately working with a third-party vendor who found a buyer from an overseas organization that needed the units. The transaction resulted in a very small net gain that included free shipping.

Five Easy Steps to Equipment Disposition
• Step One
Evaluate the equipment’s condition:

Poor: There may be an opportunity to recycle parts or materials. If not, discard the equipment appropriately. The job is done!

Good: Several options; begin working through the steps below.

• Step Two
Look for areas within your organization where good equipment might be of use, and transfer it there.

• Step Three
If no internal needs exist, are there opportunities to trade in the equipment for a new model, or to sell it?

If yes, sell or trade it in as best fits the organization’s needs.

• Step Four
If the equipment cannot be sold or traded in, consider its appropriateness for a donation.

If yes, determine the appropriate outlet and donate.

• Step Five
If all avenues have been exhausted, is there any value to parts or materials? If so, recycle. If not, discard equip- ment appropriately. —MF

Generating Revenue
If there is an easily identifiable market and the potential resale value might merit the time required to go this route, selling the equipment may be the preferred alternative. Equipment in good condition may be income for the organization. Snyder says Fairview Southdale is right in the middle of adding new operating rooms. “Let’s say we spend $30,000 on new lighting and can sell the old lighting for $3,000. Then we’ve just been able to offset some of the expense for new equipment.”

Opportunities to sell equipment may exist locally with other physicians or veterinarians. These prospects may come word of mouth through informal networking. And a more formalized large market for preowned equipment exists. The usual suspects—the Internet and the yellow pages—can be a starting point for identifying these vendors, along with your counterparts in other organizations. Even eBay may be the online marketplace for you if your organization’s information technology department does not block access.

Depending on many variables, including what equipment you have, what the current market to buy is, and what nonprofit needs are, donating may end up being the right decision for equipment going off service. Some health organizations may even have policies that encourage disposing of equipment via the donation route.

Snyder says Fairview Southdale has done localized donations, working through the strong ties the hospital has developed with technical and elementary schools in the community. The latter were the recipients of dorm room-size refrigerators that went to the offices of the school nurses. But international matches for donations also arise, such as a recent request from one of the hospital’s physicians who assists overseas and was looking for “more castoffs for Guatemala.”

Be they local, regional, or international, numerous nonprofits need medical equipment as well as biomeds who can help set up the equipment and train users. The World Health Organization (WHO) estimates that in some countries, 80% of medical resources come from donations and foreign aid. When thinking overseas, it is critical to look at the equipment’s appropriateness. The WHO also estimates that in some countries, as much as 70% of donated resources are inappropriate.

“The intentions of a lot of suppliers are good,” says Rick Wood, manager of biomedical services for the four centers that form MidMichigan Health. Wood has seen both sides of the donation equation, having worked for 10 years with nonprofit medical relief where he saw the results of donated equipment firsthand. Unfortunately, Wood adds, “The thinking is that something is better than nothing.” From there, he says, donors try to justify their contribution with some magical thinking. Maybe the equipment’s manual has disappeared, and maybe the equipment is not working “perfectly right,” but somehow, some way, someone will get the machine to work, donors convince themselves.

Overseas Equipment Needs
If your organization’s choice is to donate unwanted equipment, numerous organizations may be interested in what you have. International Aid is one resource for numerous other nongovernmental organizations; and it provides health-related equipment, materials, and services to more than 170 countries out of its Spring Lake, Mich, office. Some of the current needs for its many partners include:
    • surgery lights;
    • portable x-ray machines;
    • diagnostic ultrasounds;
    • electrosurgical generators;
    • anesthesia machines;
    • endoscopy equipment (including cameras);
    • surgery tables;
    • flexible endoscopes;
    • rigid endoscopes;
    • adult critical care ventilators;
    • pediatric ventilators;
    • high-flow operating room suction;
    • portable suction;
    • fluoroscopic C-arms;
    • infant incubators;
    • exam lights;
    • patient monitors;
    • stainless steel instrument tables;
    • PT ultrasounds; and
    • sterilizers (tabletop).

Note: This list is not all-inclusive, and needed items are not listed in order of priority. —MF

Loeffler also emphasizes the importance of making appropriate donations. “Missions can’t use carcasses,” Loeffler says. If a piece of equipment is not good enough for your organization, it is not going to be good enough for a mission.

There are a few key questions to ask and answer before approaching an organization to donate equipment, Loeffler says. These include:

Does the equipment work? If it is not cost-effective for your organization to fix, it is unlikely that a nonprofit will be able to afford to do so.

Are the accessories for the equipment available? If they are not available here, it is unlikely that an overseas organization with few resources will be able to obtain them.

Is there a manual? A complex piece of machinery without directions is just an enigma.

These are questions that need answers, along with the basics of make and model, when talking with a potential recipient of the equipment.

Organizations that handle these items also look at a variety of other factors. Loeffler says appropriateness can mean many things. For instance, will a piece of equipment help one person or 3,000? Will the supplies needed to operate the equipment on an ongoing basis be too expensive? Is the equipment too high maintenance in terms of repairs and user training level? What about voltage? Many countries have different voltage standards. Can the machine be converted?

Loeffler says dialysis machines, for example, are a challenge to keep running. As such, this is equipment that organizations steer away from. Ditto computed tomography and magnetic resonance imaging equipment, which are high maintenance and require service, support, and clean power. Loeffler notes experiences in Vietnam and Ghana where electricity was very inconsistent (in one instance a power variance of 100 volts), which can significantly impact the integrity of the equipment’s operation.

Larry Feenstra, director of the clinical engineering department at Loma Linda University Medical Center (Loma Linda, Calif) echoes the challenges of bringing equipment to countries that labor under dirty power. Feenstra recalls a medic who thoroughly prepared to deliver donated ventilators to Romania. Believing he was all set with spare parts and all the information to hold classes and conduct training, he found there wasn’t the right power to support the ventilators’ operation. It is important to know if what you have is suitable for the environment.

Loeffler says he can help biomeds through the equipment-review process to determine what will work and then arrange for pickup. Just like a hospital or other health service provider has a matrix to work through in determining what to do with a piece of equipment, Loeffler says, “I have a matrix in my head of what is a good, viable piece of equipment for a developing nation.”

Refurbishment, Recycling, Rubbish
Medical equipment refurbishers also can help a biomed determine what the possibilities are for an item that is determined to have value but is no longer needed in a particular setting.

“The first and most important step is to determine whether an item can be repaired and calibrated to meet or exceed manufacturer’s specifications,” says Robert Bean, purchasing director for DRE (Louisville, Ky). Bean’s company handles new and refurbished equipment out of Kentucky, with a large percentage of its refurbished equipment sold in the international marketplace. The company deals with a range of resources, from imaging equipment, lasers, anesthesia machines, ventilators, monitors, surgical tables, and defibrillators to surgical lights.

There usually is some value if the equipment can be brought up to specifications, according to Bean. “Value does not necessarily mean monetary value,” Bean adds. “It could be valuable to a mission organization for repair parts or use overseas. Businesses like ours usually have contacts with enough mission organizations that if it is determined a piece could potentially be used somewhere, we can at least help get it to the correct organization.”

Bean believes there is value in keeping an item in working condition and thus out of someone’s trash. If, however, equipment is no longer in working order, parts of it may be recyclable. Recyclers charge by the pound to take away equipment. They can break down the equipment for destruction and may reclaim materials, such as metals or plastics, or parts. As with any other business under consideration for hire, do the due diligence.

Dotting the “I”s; Crossing the “T”s
Once the useful life of a piece of equipment is over at your organization, be sure you comply with your company’s internal procedures for disposition—whether it be finding a home in your city’s free clinic, donating it to a mission in Afghanistan, or disposing of it at a dump site. For instance, Snyder must complete an “Asset Disposition Form” for all equipment that is retired at Fairview Southdale. She must also have a certificate of destruction for any items that are broken down and track any hazardous waste.

Medical equipment may have materials such as cadmium, lead, and mercury that can be hazardous to health and the environment if not properly managed. The Environmental Protection Agency can offer information on demanufacturing, donating, and recycling.

Also learn any city or county ordinances that may apply to equipment disposition, along with state and federal laws. Among these are the Resource Conservation and Recovery Act—the framework for the management of hazardous and nonhazardous solid waste—and the Safe Medical Device Act. Be aware also of any devices that are tracked by the US Food and Drug Administration, and any Department of Transportation implications for shipping equipment across town or across the country. Be mindful too of any other governmental entities, such as the Occupational Safety and Health Administration or the Nuclear Regulatory Agency, who might have interest in or jurisdiction over particular medical items.

One biomed manager recalled the story of a physician who did volunteer work overseas and liked to use mercury blood-pressure cuffs at a time when most hospitals had discontinued using them. He was discouraged from sending the items overseas, but he did nonetheless. En route to a relief organization, the cuffs broke, resulting in a major cleanup as well as major fines.

Following the advice of experts is a good track to take, as well as knowing who to call when equipment becomes obsolete. Someone with Wood’s experience has developed a large network of approximately 100 organizations. “When we have equipment or supplies we can’t use here, I have a pretty good idea of what might be needed where,” he says.

If this is your first time disposing of equipment, maybe your predecessors left you a good “how-to” with a contacts list. Or, if you have gone through the steps outlined, you will have the start of a database for future dispositions. Either way, continuing to develop and maintain good contacts—be it for seeking to contribute, looking to sell, or another option—is key for the equipment-disposal process to work smoothly.

Maria Fotopoulos is a contributing writer for 24×7.