I always specify that the alarm should sound in a "permanently staffed" area. For example, at a bus station, car park or shopping centre, you cannot guarantee that anyone will be nearby to hear the alarm, or that they will act on it if they do hear it, or that there will be a member of staff around to report the incident to. Therefore the alarm should sound in an office, help desk, reception etc., or failing that, an alert should be sent to a pager.
With regards to the colour of the alarm, I can't see that it would be easily confused with a fire alarm. I don't know of any fire alarm systems with a small trianglular light to indicate the alarm is going off. And if the two alarms sound similar, then I would suggest the fire alarm isn't loud or urgent sounding enough.
Also, as stated previously, if it ain't broke, why fix it? Red is universally recognised as being an emergency alarm - needing assistance in an accessible toilet is an emergency. Any other colour would reduce the urgency of the alarm. I would suggest that the fact that none of us have had this come up as an issue previously would tend to indicate that it isn't actually an issue!
As a side note, I always put the pull cord on the non-transfer side, to reduce the possibility of it being set off accidentally when transferring to/from the toilet. Also, the reset button should be within easy reach from the toilet seat. That way, if it is set off accidentally, it can be cancelled straight away, so you won't get people rushing into the toilet to "help you" while you're using it!
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