Wheelchair Securements: The Force Is With You

Transportation access and safety for people with disabilities have come a long way over the last 40 years. IDEA is the lifeline for educators and student transporters, alike, when it comes to offering the Least Restrictive Environment in the classroom, in the school bus and on the way to and from both. But what about those students in wheelchairs, for whom the Most Restrictive Environment is the reality they live each and everyday?

Twenty-five years ago, it was Title II of the Americans with Disabilities Act that provided never-before seen access to transportation services while also eliminating architectural barriers and discriminatory practices, especially for non-ambulatory students. Ever since, a generation of students have benefitted as a result of the public literally opening its doors and providing ramps, lifts and elevators.

But there is an alarming and head-scratching discrepancy when it comes to safeguarding the wheelchair bound in school buses. It is rooted in an apparent disconnect between wheelchair manufacturers and school district transporters and therapists.

First, a history lesson

Predating ADA by five years were the first standards for wheelchair transportation safety, developed at the University of Michigan’s Transportation Research Institute, or UMTRI. These efforts led to the American National Standards Institute joining with the Rehabilitation Engineering and Assistive Technology Society of North America (ANSI/RESNA) to write the first guidelines for using wheelchairs as seats in vehicles issued in 1998 and coming fully effective in May 2000. 

For the first time, frontal impact testing of wheelchairs commenced under Section 19 of “RESNA Wheelchair Standards, Volume 1: Wheelchairs and Transportation: Wheelchairs Used as Seats in Motor Vehicles.” That’s quite a mouthful, so the standard was shortened to WC19. Then, in December 2012, ANSI/RESNA updated and revised WC19 as part of RESNA Wheelchair Standards, Volume 4. 

At that time, they added an improved Wheelchair Tiedown Occupant Restraint Systems (WTORS) standard called WC18 (an updated version of the old WTORS standard SAEJ2249).  One of the many improvements in WC18 is that it now requires all WTORS to be tested with a wheelchair anchored lap belt that puts more load on the rear-tiedown system. This is to ensure the WOTRS are compatible with a WC19 wheelchair that must offer the option of a wheelchair-anchored pelvic belt and work with a vehicle anchored shoulder belts to reduce potential injuries and fatalities in frontal crashes, rollovers and side impacts. 

WC19-compliant wheelchairs are subjected to a crash test that simulates a moderate-to-severe frontal crash. Many of the revisions made to WC19 are meant to encourage increased and easier use of a wheelchair-anchored lap belt. All WC19-compliant wheelchairs are required to offer the option of a wheelchair anchored lap belt, said Miriam Manary, a senior engineering research associate at UMTRI and a member of the TSD Conference National Board of Advisors.    

“In an ideal situation, a consumer using a wheelchair with a crashworthy lap belt would then attach a compatible shoulder belt that is anchored to the vehicle to complete the (lap and shoulder belt) system,” she said, adding that about 80 percent of the wheelchairs brought to the UMTRI lab for testing are configured and tested this way.

UMTRI research as well as real-life findings have provided many reasons for requiring the option of a crashworthy wheelchair-anchored belt. First of all, many of the fatalities and injuries to wheelchair-seated occupants in crashes are due to non-use or misuse of the seat-belt system. Manary pointed out that it can be hard to get a good lap-belt fit to a passenger’s bony pelvis when the occupant restraint is completely anchored to the vehicle. Often times, the lap belt has to be threaded around the wheelchair armrests and/or postural support hardware.

Further complicating matters, she said, consumers don’t like their personal space invaded by a transportation provider while applying the belt after they get in the vehicle. Wheelchair users can also feel stigmatized by needing assistance to apply a vehicle-anchored seat belt system or encounter situations where there is no one willing to help apply the belt.  

Simply put, the occupant protection provided by a crashworthy wheelchair anchored belt with a compatible shoulder belt is superior to that of a system that is completely vehicle-anchored, but much confusion remains about its details.

“Many, many, many people mistake the postural lap belt on their wheelchair for a seat belt that can protect them in a crash,” she said. “A WC19-compliant belt with be marked with the new symbol.” 

The problem is that they are seldom if ever reaching the marketplace, as therapists and medical prescribers say that it is nearly impossible to find a wheelchair-anchored lap belt.

The RESNA Committee on Wheelchairs and Transportation (COWHAT) chaired by Manary addressed the concern at its most recent meeting in June. It invited Sue Shutrump, the supervisor of OT/PT services at Trumbull County Educational Services Center in Ohio, to relate to several wheelchair manufacturers in attendance her experience and frustration about not being able to order these lap belts. 

Manary said the manufacturers responded that they indeed offer the option but there is low demand from consumers and prescribers. Shutrump believed that the demand is not there because many therapists, caregivers and school district representatives simply don’t know what to ask for.

“Wheelchair manufacturers are not making it an easier by saying, ‘Oh, we have these,’ but not marketing them or making them readily available to customers,” said Shutrump, a member of the TSD Conference Tenured Faculty. “It takes a great deal of teamwork on the part of the tie-down manufacturers, the therapists that are ordering the chairs, and transporters that are utilizing both to be able to truly have the whole unit crash tested and used properly in conjunction with one another.” 

At the TSD Conference this month, Manary and Shutrump will be part of a panel that will discuss this and other challenges facing student transporters and school therapists during the March 15 OT/PT Forum. 

“If you are a transportation person and just wanted to go out and buy a piece of equipment good luck,” said Shutrump.

Shutrump added that WC19-compliant wheelchairs are easy to spot, as they not only have a label but also four tie down securement brackets. But do they have the optional lap belts? 

“The new revision requires the lap belt anchored to the wheelchair so you can take just the shoulder belt and attach it to the lap belt,” she said. “That’s the part wheelchair manufacturers are not providing. The wheelchair also needs to be crash tested with this new lap belt.”

School Transportation News was unsuccessful in reaching several wheelchair manufacturers for comment, but a review of several price lists for WC19-compliant wheelchairs failed to uncover the optional wheelchair-anchored, lap-belt option.

Chris Yarber, Q’Straint Southeast regional sales manager, is also participating in the OT/PT Forum and said he will have on hand a WC-compliant wheelchair with the crash-tested, wheelchair-anchored lap belt so attendees can see what they need to be ordering. 

While Q’Straint and sister company Sure-Lok don’t manufacture wheelchairs, they are in the business of securing students in wheelchairs and the wheelchairs in transit vehicles. The two are leading the charge in advocating for the new standards and to get the word out about the optional wheelchair-anchored lap belts. 

In the meantime, student transporters and therapists are eagerly awaiting the option, one that Manary added she is hopeful becomes more readily available soon. But the demand must originate from those who want them.

“We know that there are situations where a wheelchair-anchored belt does not work well for people, but it is important to have a choice,” said Manary. “With other safety improvements, the pediatric realm has been the first adopters. If there is any sector that can generate this change, it is the school transportation sector.”

Added Shutrump: “The crux of this whole thing is that transporters need to keep pushing people and working as a group to demand these optional lap belts.”

Last modified onThursday, 03 March 2016 12:27