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December 01, 2008  |   Comments (0)   |   Post a comment

The Dos and Don'ts of Wheelchair Transport Safety


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By Lawrence W. Schneider and Miriam A. Manary

After the Education for All Handicapped Children Act of 1976 became law, it was common practice to transport children in wheelchairs facing sideways in school buses, with the large wheels captured by mechanical rim-pin clamps, with bungee cords attached to the most-available wheelchair components, such as the armrests and footrests, or by other inadequate securement methods.

Seat belts, if provided at all, were often placed around the student’s abdomen instead of low on the pelvis and over the shoulder. In other words, students in wheelchairs were not provided with the same level of crash protection as students seated on the forward-facing, closely spaced, high-back, padded seats required by Federal Motor Vehicle Safety Standard (FMVSS) 222.

In fact, at the time, FMVSS 222 excluded children in wheelchairs from the crashworthiness provisions of the standard, identifying them as students facing 45 degrees or more to the longitudinal axis of the vehicle.

Fortunately, the opportunities for safe transportation for students in wheelchairs have increased significantly over the past two decades. In 1992, FMVSS 222 was modified to include wheelchair-seated students and now requires all wheelchair stations provided by school bus manufacturers to be installed for forward-facing travel and equipped with four-point, strap-type wheelchair tiedown and three-point pelvic/shoulder belt restraint systems that meet static strength requirements.

Most school bus wheelchair stations are now equipped with wheelchair tiedown and occupant restraint systems (WTORS) that comply with SAE J2249, a recommended practice that was completed in 1996 by the Restraint Systems Task Group of the Society of Automotive Engineers’ Adaptive Devices Subcommittee.

In addition, it is now possible for students to travel in wheelchairs that comply with ANSI/RESNA WC19, which means that they have been designed and crash tested for use as seats in motor vehicles. A key feature of WC19- compliant wheelchairs is four accessible attachment points on the wheelchair frame to which tiedown straps can be easily and effectively attached.

Best practices
While changes to FMVSS 222 and increased availability of WTORS and wheelchairs that comply with voluntary industry safety standards provide greater opportunities for wheelchair-seated students to travel more safely to and from school, it is important that school bus operations implement transportation policies and procedures based on basic principles and best practices of transportation safety.

Assuming that the buses are equipped with properly installed WTORS that comply with FMVSS 222 and, ideally, SAE J2249, there are several fundamental DOs and DON’Ts that should be part of every school transportation program involved with the transport of students who use wheelchairs.

DO consider transferring students in wheelchairs to the school bus seats.
It is generally considered safest for students who use wheelchairs to transfer to the vehicle seat when this can be done safely and without compromising special medical and seating needs. However, even when transfer is feasible, it may not always be the safest option in the school bus environment.

For example, if a student is using a WC19-compliant, crash-tested wheelchair that facilitates proper placement of vehicle-anchored seat belts, the student may actually be safer traveling in their wheelchair than sitting on a bus seat that’s not equipped with shoulder and pelvic belt restraints.

For students who transfer to a school bus seat, safety can be enhanced beyond the level provided by compartmentalization through the use of crash-tested harnesses. In addition, postural support vests can help keep smaller children positioned on the bus seat.

DO encourage the purchase and use of WC19 wheelchairs.
As noted earlier, WC19-compliant wheelchairs provide four easily accessible attachment points that greatly facilitate effective wheelchair securement using a four-point, strap-type tiedown. Because these wheelchairs have been successfully crash tested, transportation personnel can have confidence that the wheelchair will support the student and be effectively secured if the vehicle is involved in a crash or rollover. Therefore, school transportation personnel should encourage parents to choose WC19- compliant wheelchairs whenever there is an opportunity to do so.

DON’T deny transportation to students who do not have a WC19 wheelchair.
Although WC19-compliant wheelchairs will make wheelchair securement easier and more reliable, students should not be denied school bus transportation if they don’t have a WC19- compliant wheelchair. Denying transportation to students in wheelchairs will generally result in having them travel to and from school in smaller vehicles that are more likely to be involved in a crash, thereby putting the student at greater risk of injury.

Rather than denying transportation, school transportation personnel should work as a team to identify and permanently mark the best and strongest wheelchair securement points on structural members of the base or seating system. This may require attaching webbing loops sold by most WTORS manufacturers to frame members to create accessible tiedown attachment points. Modifications to plastic trim of powerbase wheelchairs may be necessary to allow access to the most effective securement points.

DO make sure that students in wheelchairs are using crashworthy pelvic and shoulder belt restraints that are properly positioned.
Although effective wheelchair securement is important, it will do little to protect the student in a crash, vehicle rollover or sudden movement if the student isn’t restrained by a properly positioned and relatively snug pelvic belt and diagonal shoulder belt. Most WTORS manufacturers provide detailed instructions and warnings on how to use and position the seat belts, including:

 

  • DON’T route pelvic belts outside the wheelchair side frames and wheels or over wheelchair armrests.
  • DO position the pelvic belt inside of the wheelchair side frame so that the webbing and buckle are in contact with, or very near, the student’s body and with the pelvic belt placed as low across the front of the pelvis as possible.
  • DO angle the pelvic belt up from anchor points behind the wheelchair at 30 degrees or more to the horizontal with the belt placed inside of the wheelchair armrest and side frame.
  • DO position the upper part of the shoulder belt across the middle of the outboard shoulder and connect the shoulder belt to the inboard side of the lap belt (often on the latch plate of the buckle) near the hip of the student while keeping the buckle away from wheelchair components.

    Following these instructions may not be easy, even on many WC19-compliant wheelchairs, because armrests and side frames can interfere with proper positioning of the pelvic belt. In some cases, it may be necessary to thread the ends of the lap belt through openings in or between wheelchair components.

    One WTORS manufacturer facilitates seat belt threading by stiffening the anchorage ends of the pelvic belt so that they can be more easily inserted around the occupant and through wheelchair openings from the front before attaching them to pin-bushing connectors on the tiedown anchorages. To improve seat belt routing and positioning, select a WC19-compliant wheelchair that has been rated A (excellent) or B (good) with regard to accommodating the proper use and positioning of belt restraints.

    DON’T mix components of WTORS from different manufacturers.
    The various components of a WTORS, and especially anchorage track and anchorage components on tiedown assemblies, are carefully designed to function together to form a complete and effective wheelchair securement and occupant restraint system. Although components from different manufacturers may look similar, they may not engage effectively. It is therefore critical that equipment from different manufacturers not be mixed. Doing so can result in improper use and reduced effectiveness of the equipment when needed in a collision or emergency vehicle maneuver.

    DO allow students to use postural supports during transportation.
    There has been much confusion on the use of different types of postural supports in transportation of students in wheelchairs. A summary of the concerns and recommended practices are in a report by the Rehabilitation Engineering Research Center on Wheelchair Transportation Safety (RERCWTS) titled “Guidelines for Use of Secondary Postural Support Devices by Wheelchair Users During Travel in Motor Vehicles” (available at www.rercwts.org/info). A few basic principles should be followed:

     

  • Use of postural supports during travel in motor vehicles should generally be encouraged, particularly if they improve the occupant’s seated posture, since this will also improve the fit and effectiveness of vehicle seat belts.
  • Postural supports should be positioned so that they don’t interfere with the proper fit and function of belt restraints of WTORS.
  • Postural supports should not be relied on for protection during a crash.
  • Anterior head restraints attached to the wheelchair seatback to limit forward head movement should be designed to break away at the minimum force that allows the device to perform its intended function.
  • When head support using a neck support/collar is medically necessary, the softest and lightest material that achieves the needed results should be used.

    DO remove and store wheelchair add-on equipment.
    In the rare event of a school bus collision or rollover, heavy and/or rigid objects that are not adequately secured can become a hazard. Consideration should therefore be given to removing wheelchair add-on items, such as oxygen tanks and trays, and securing them to the vehicle using tiedown straps or other crashworthy storage methods. If these items cannot be removed and stored, add-on items should be attached to the wheelchair by tiedown straps, and dense padding should be placed between hard trays and the student in the wheelchair. Consideration should also be given to replacing hard trays with support surfaces made from dense foam during transportation.

    DO make sure that bus drivers are given detailed training on different types of wheelchairs.
    Much of the challenge to providing effective wheelchair securement and occupant restraint is due to the wide variety of wheelchair makes and models, many of which do not yet comply with WC19 and for which proper placement of seat belts is difficult. One of the keys to successfully meeting this challenge is an active driver training program. Most WTORS manufacturers provide excellent written and video training materials with their equipment and on their Websites. In addition, WTORS manufacturers often host training seminars at conferences and at their company facilities.

    Using these and other materials, such as the Ride Safe Brochure (www.travelsafer.org) and the wheelchair transportation safety education tool box (www.rercwts.org), bus drivers should be trained in the basic principles of transportation safety, including the need for both wheelchair securement and occupant restraint.

    Most importantly, drivers need hands-on instruction on how to achieve effective securement and occupant restraint on different types of WC19-compliant and non-compliant wheelchairs. Permanent marking of team-selected securement points on non-compliant wheelchairs will make it much easier for drivers to properly and consistently secure different wheelchairs.

    Lawrence Schneider is a research professor with the University of Michigan Transportation Research Institute (UMTRI) and director of the RERCWTS. Miriam Manary is a senior research associate with UMTRI.


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