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March 2004 ISS-Instructional Course. Transportation Safety for Wheelchair Occupants. Linda van Roosmalen, PhD Douglas Hobson, PhD Department of Rehabilitation Science and Technology University of Pittsburgh Funding: National Institute on Disability and Rehabilitation Research.

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March 2004

ISS-Instructional Course

Transportation Safety for Wheelchair Occupants

Linda van Roosmalen, PhD

Douglas Hobson, PhD

Department of Rehabilitation Science and Technology

University of Pittsburgh

Funding: National Institute on Disability and Rehabilitation Research


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Application to practice

  • Wheelchair transit and associated risks

  • Methods to prevent occupant injury

  • Safety guidelines and Standards

  • Resources


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Wheelchair Transportation Safety

  • 1.6 million wheelchair users

  • Access to motor-vehicle transportation is the key to functioning in society

  • ADA prohibits discrimination in public transportation services

  • 2001 New Freedom initiative calls for integration of disabled persons into workforce and community - “transportation” critical factor in meeting this priority

  • 82% of wheelchair users indicate difficulty with using public transportation

  • Wheelchair users have 10% higher unemployment rate


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Impact Severity

  • Injury Risk:

    • Proportional to velocity change

    • “Loading = velocity * body weight”

  • Occupant Restraints protect by:

    • Prevent occupant ejection from vehicle

    • Prevent excessive occupant motion

    • Reduce occupant loading

    • Increasing time of energy exposure


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Safety Guidelines

  • Secure the wheelchair

  • Restrain the occupant

  • Remove loose accessories from wheelchair

  • Remove parts that can injure occupant during an impact

    • Lap trays, loose objects, postural supports, communication devices, neck rings


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Sled Impact Testing

Frontal

30mph

20g


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Safety System #1

  • Secure the Wheelchair to the Vehicle


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Wheelchair Securement Systems

  • Four point strap type tie-downs

  • Docking systems

  • Other: wheel-clamps, hybrids

  • Rearward facing compartments (in large buses)


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Strap type tie-down system

  • Advantages

    • Four securement points (improves crash response and stability)

    • Adaptable to most wheelchair types

    • No additional wheelchair hardware required

    • Withstands crash forces

IMMI-Westfield (IN)


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Strap type tie-down system

  • Disadvantages

    • Invasion of personal space

    • Lengthy securement times

    • Requires operator/attendant for securement

    • Tiedowns easily misplaced or soiled

    • Lack of defined wheelchair securement points

    • Requires operator training when securing a variety of wheelchairs




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Docking Systems

  • Advantages

    • Quick securement times

    • Independent securement

    • Eliminates need for human judgment of securement point location

    • Minimizes error

    • Withstands crash forces

EZ-Lock (Baton Rouge, LA)


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Docking Systems

  • Disadvantages

    • Requires add-on hardware

    • Requires adaptations to all wheelchair types

    • Hardware adds weight and length

    • Hardware affects ground clearance

    • Fewer securement points (less stability and control of crash response)



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Wheel Clamps

  • Disadvantages

    • Unable to safely withstand crash forces

    • Not compatible with all wheel types

    • Requires attendant for securement

  • Advantages

    • Fairly quick securement

    • Less invasive


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Passive Restraint:Containment

Wheelchair is positioned rearward facing in the vehicle


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Passive Restraint:Containment

  • Easy to use

  • Quick

  • Non-constraining

  • Independent use

    HOWEVER….

  • For use in ’low-g’ vehicles only

    • More research is needed to evaluate safety during emergency driving situations

(Van Hool, Belgium)


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Safety System #2

  • Restrain the Occupant

    • To vehicle and/or wheelchair

Lap belts mounted to wheelchair frames are generally for positioning purposes and NOT for safety during transit!!!


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Occupant Restraints Reduce Risk of Injury

  • Prevent occupant ejection

  • Increasing time over which the occupant comes to a stop

    • Decreasing deceleration or “G-loads”

    • Higher weight means higher loads!

  • Decrease occupant forward travel

    • Reduce risk of occupant impact with vehicle interior


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Sled Impact Testing without use of Occupant Restraints

Frontal

30mph

20g


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Sled Impact Testingwith proper Occupant Restraints

Frontal

30mph

20g


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3-Point Occupant Restraint

Upper torso belt

(shoulder belt)

Pelvic belt

(lap belt)


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Harness Type Restraint

EZ-On Vest

Gorilla Car Seat

Snug Seat Car Bed

Carrie Bus Seat


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Occupant Restraint Safety

  • Improperly positioned pelvic belt:

    • Abdominal injury due to ‘submarining’

    • Lumbar vertebra injury in frontal crashes

  • Improperly positioned shoulder belt:

    • Excessive head excursions

    • Secondary impact with vehicle surfaces

    • Injuries to vital thoracic cavity organs

Adomeit & Heger, 1975; Leung et al., 1985


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Occupant Restraint Problems

  • Appropriate belt fit related to:

    • Shoulder belt anchor point

    • Pelvic belt anchor point

    • Wheelchair and occupant size

    • Location of wheelchair in securement zone

    • Available clearance for belt placement


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Common Problems

  • Shoulder belt slip off user’s shoulder

    • Due to shallow angle of torso belt

  • Shoulder belt rubs against user’s neck

    • Discomfort,

    • Resistance to using belt

    • Decreased upper torso restraint

  • Anchoring upper torso restraint below shoulder may result in downward loading of torso and spine


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Occupant Restraint “Best Practices”

  • Use both pelvic and shoulder belt to restrain the occupant

  • Lead restraints over bony anatomy

    • Shoulder restraint over the Sternum

    • Pelvic restraint over the (pelvis) Iliac Crests

  • Avoid loading soft tissues (abdomen)

  • Remove belt slack

  • Use a retractor to reduce upper torso belt slack

  • Restraint pre-tensioner reduces belt loading


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Wheel clamps

Sideward facing position


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4-Point Tiedown Systems

Twisted Belts

Belt interferes with tires


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Occupant Restraints& Postural Supports

  • No use of shoulder belts

  • Pelvic belt over armrests


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Ongoing Research

  • Automated Wheelchair Securement

    • Universal docking

  • Customized Occupant Restraints

    • Wheelchair integrated

    • Consumer friendly


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Safety System #3

  • Support the Occupant

    • Wheelchair seating system

    • Wheelchair frame

    • Wheelchair components