Safe Wheelchair Transportation in Pediatrics

Safe Wheelchair
Transportation in Pediatrics
05/15/2014
NuMotion Clinical Education,
Convaid University
Objectives
Describe the key components of a
WC-19 WOTRS system
 Select appropriate transportable
equipment based on client’s needs
 Describe 3 possible hazards when
using a wheelchair for transport
 Describe 3 options in wheelchair
transportation

Introduction
When traveling in a motor
vehicle, it is generally safest
to transfer to a vehicle seat
 Use the vehicle seatbelt
system or a child safety seat
that complies with Federal
Safety Standards
 Store and secure the
wheelchair in vehicle

Introduction

If transferring is NOT possible:
 Secure the wheelchair to the
vehicle floor (forward facing)
 Use all 4 crash-tested wheelchair
securement straps
 Use crash-tested 3-point seatbelts
to secure the wheelchair rider to
the wheelchair
 If a 3-point seat belt is not
available, a 2-point belt would be
the minimum
Starting with the Right
Equipment



It is best to use a wheelchair
that has been designed and
crash-tested for use as a seat in
a motor vehicle
Crash-tested wheelchairs
comply with ANSI/RESNA WC19
standards and/or ISO 7176/19
(International)
How do you know a wheelchair
has been designed for transport
and crash tested?
How do you know a wheelchair
has been designed and crash
tested?
ANSI/RESNA WC19 is a
voluntary standard
developed by
transportation safety and
rehabilitation experts
 Wheelchairs that comply
with the design and
performance standards
are labeled

The Right Equipment
A WC19 compliant
wheelchair has 4 clearly
labeled and crash tested
securement points
 The securement points is
where hook fittings on tie
down straps are easily
attached

The Right Equipment
The Wheelchair Tiedown and
Occupant Restraint System
(WTORS)
 Use a complete WTORS system
 Secure the wheelchair to the
vehicle
 Secure the wheelchair occupant
with a properly designed and
tested seatbelt system
The Right Equipment WTORS
A complete WTORS system consists of:
 2 front wheelchair securement
straps
 2 rear wheelchair securement
straps
 2 vehicle tracks or 4 anchor points
for the straps
 And a 3-point occupant restraint
belt for the wheelchair occupant’s
torse and pelvis
The Right Equipment WTORS



A WTORS system requires
someone other than the
wheelchair rider to secure and
release the wheelchair
A WTORS system can secure al
types of WC19 and non-WC19
wheelchairs
Always position the wheelchair
and the rider in a forward-facing
configuration.
The Right Equipment


Some of the common manufacturers of
WTORS are:
 Q’Straint
 Sure-Lok
 Orthosafe
Always use crash tested straps for the
wheelchair and occupant that comply with
SAE J2249
 Read labels and/or product descriptions
Overall goal of WC19
The overall goal of WC19 and SAE
J2249 is to provide the wheelchair user
with the opportunity and the option to
use equipment (i.e., a wheelchair seat,
a wheelchair, a wheelchair securement
system, and an occupant restraint)
that is comparable in design and
performance to seats and restraint
systems available to able-bodied
travelers in motor vehicles.
What is ISO 7176/19?



ISO is the International Organization for
Standardization
The ISO 7176/19 was developed by
the Working Group 6 of ISO TC73 SC1, in
conjunction with the ANSI/RESNA WC19
working group
The ISO standard is similar in scope to the
WC19 standards, in that both require that the
wheelchair provide four securement points for
securement using a four-point, strap-type
tiedown that comply with the same structural
geometry specifications.
Difference between
WC19 and ISO 7176/19



ISO 7176-19 currently only applies to
adult wheelchairs for which testing is
conducted using a 168-lb
anthropomorphic test device (ATD)
WC19 also applies to Pediatric
Wheelchairs
ISO 7176-19 does not place any
limitations on wheelchair size, mass, or
configuration regarding seating posture
Difference between
WC19 and ISO 7176/19
2 exceptions between WC19 and ISO 7176/19:
 WC19 allows the wheelchair securement
points to be spaced laterally closer
together, and
 WC19 allows 450 mm of rearward head
excursion for the midsize male adult ATD
during rebound, whereas 7176-19 allows
only 400 mm or rearward head excursion.
WC19 and ISO 7176/19
A wheelchair that complies fully
with WC19 also complies with ISO
7176-19
 However, a wheelchair that
complies with ISO 7176-19 may
not comply with WC19

Securing the Occupant
VERY IMPORTANT
Must provide for effective
restraint of the wheelchair
passenger
 Use crash-tested pelvic and
shoulder belts
 Proper placement of the
restraint belts is KEY to their
effectiveness

Securing the Occupant




The torso belt should cross
diagonally across the middle of the
chest
It should connect near the hip of the
wheelchair rider
Top anchor of the shoulder belt
should connect to the vehicle above
and behind the top of the shoulder
All restraint belts should be in
contact with the occupant’s body
Securing the Occupant
Postural support belts (pelvic
positioning belts) are NOT strong
enough to withstand crash forces
 Anterior Trunk Supports are NOT
occupant restraint devices. They are
postural support devices and will
NOT withstand crash forces
 Always use properly labeled crashtested restraint belts and harnesses.

Other KEY Points in
WC19



The wheelchair backrest (seat to
back angle) must be at an angle
of 30 degrees or less
Tilt angle should be as close to
parallel to the ground as possible
If more recline or tilt is needed,
the shoulder belt anchor point
MUST be moved rearward to
maintain contact with the rider’s
shoulder and chest
Other Key Points in
WC19




Maximize clear space around the
wheelchair
Remove hard trays and any other
hard accessory.
Consider the use of Foam trays
during transit if they must be
used for upper extremity
positioning
Check the WTORS equipment
regularly
Wheelchair Seating
Standards. WC-20


Surrogate Wheelchair
Addresses “complete seating
systems” that includes a seat, a
back support, and attachment
hardware
Provides a means to evaluate the
frontal-impact crashworthiness of
seating systems independent of
production wheelchair frames by
installing the seating system on a
surrogate wheelchair frame
Wheelchair Seating
Standards. WC-20


Evaluates a seating-system’s accommodation
of vehicle anchored lap/shoulder-belt
restraints of seating systems as in WC19 for
complete wheelchairs with:
 one rating for the ease of achieving proper
belt positioning,
 second rating for the degree to which
proper belt positioning is achieved.
Must achieve an “acceptable” or better rating
for each and no “zero” score for any belt-fit
criteria
Safety in
Transportation
Safety and Hazards in
wheelchair transportation
Safety in Transportation


Wheelchair MUST be secured in
Forward-facing configuration!
There are other options for
wheelchair securement
 If other than a WTORS (4-point
tiedown and 3 point occupant
restraint) is used, verify that the
chair has been crash-tested
safely with that device
Safety in Transportation
Alternative Wheelchair securement
Docking Devices – Not WC19
 Clamp-type securement devices

• NOT recommended
• They have NOT been effective in frontal
crash testing
2 different “docking” devices
“Clamp-Type” device
NOT Recommended
Safety in Transportation

If you do not have a WC19
wheelchair:
 Attach straps to welded junctions
on the wheelchair or other
structural areas of the frame
 DO NOT attach straps to
adjustable, moving or removable
parts
 NO Armrest, NO Footrests, NO
WHEELS!
Safety in Transportation

When transporting users with life
support equipment, the following is
recommended:
 Oxygen tanks MUST be removed
from the chair and safely secured
 Ventilators and other heavy
equipment SHOULD be removed
and safely secured to the vehicle
 Life support equipment holders
SHOULD be removed and safely
secured
Safety In Transportation



WC19 standards require chair and
occupant restraint at 30 MPH and 20 G’s
at the moment of impact
Energy Forces increase with the “Square
of the Velocity”, i.e. at 30 MPH the forces
are more than double than a 20 MPH
(900 is more than double than 400)
A 10 lb object becomes 200 lbs traveling
forward at 30 MPG at the moment of
impact! (20 G’s)
Durability Testing
Dynamic Crash Test
Live Test, 30 MPH, 20G at impact
Crash Test – Slow Motion
Cruiser Successful Crash Test
Crash Test – Improper
Equipment
Two-Drum Test
Test: 480,000 cycles
Drop Test
Test: 6,666 drops
Transportation in
Pediatrics
Key considerations
Transportation and
Pediatrics



Children with Special Needs have as
much a need to travel to school, social
events, family events, and other events
as able children for their social skills and
psychological development
Given their medical requirements, they
need to be transported more often than
able kids to attend their medical needs
These children need to be transported in
a safe manner when a transfer to the
vehicle seat or car seat is not possible
Transportation and
Pediatrics
School systems are responsible for
ensuring that children with special needs
are safely transported on all forms of
federally approved transportation
provided by the school system.
Transportation in
Pediatrics
Families with special needs children
need to be able to attend family
functions, doctor appointments,
activities of daily life and transport
their child in a safe manner.
Funding
Challenges
Challenges in WC19 wheelchair
options and suggested
documentation
Funding WC19
Wheelchairs



The “transit option” on WC19 compliant
wheelchairs is considered an “upgrade” or
“add on” to the basic manual or power
wheelchair.
Wheelchair transportation safety standards are
still voluntary industry standards rather than
Federal or State regulations
The Food and Drug Administration have not
yet recognized the importance of
incorporating these industry standards into
mandated design criteria
Funding WC19
Wheelchairs


Additionally, the coding body of the
Centers for Medicare and Medicaid
Services (CMS) does not require it and
does not consider it a “medical
necessity”
Payment for transit options on
wheelchair must be requested on a
case-by-case basis
Recommended
Justification
The safest place for anyone traveling in a motor vehicle is in the
crash-tested vehicle seat and using the approved occupant
restraint system. However:
 Due to weakness, in-coordination, (name the functional
reason) this client is unable to independently initiate and
safely complete a transfer from his/her wheelchair to the
crash tested automobile, school bus or public transportation
vehicle seat (identify the type of transit system).
 The transit system (identify the transit system) used by the
client refuses to take responsibility for the transfer of the
client from their wheelchair to a vehicle seat. They require
that the client travel using their wheelchair as a seat in a
motor vehicle.
 The transit system (identify the transit system) used by the
client mandates the use of a crash tested or WC19 compliant
wheelchair
Recommended
Justification


Transportation in the larger community is important for this
client because they:
 Must travel to and from work on a daily basis. They spend
about XX min/day in this high-risk activity.
Must travel to and from school on a daily basis. They spend
about XX min/day in this high-risk activity.


Are active in the community and must be able to travel in
all types of vehicles including public transportation. They
spend about XX hours/week in this high-risk activity.
Must frequently travel to medical and therapy
appointments in the community and travel using paratransit/public transit/wheelchair adapted van. He/She
spends about XX hours/month in this high-risk activity
Additional Facts


The US Department of Transportation
estimates that a typical auto driver will have
a near accident 1 to 2 times per month and
all drivers will be in a collision of some type
every 6 years on average.
The National Safety Council (NSC) reports
there are more than 12 million motor vehicle
accidents annually. If the population of the
US is approx 300 million and approx 2
million use wheelchairs (2000, NIDRR) this
translates to approx 1% of the population or
12,000 accidents per year!
Additional Facts
The $200.00 (average retail of the
transit option) is small in comparison
to the cost of even one emergency
room visit. The transit option may
prevent serious injury and potential
worsening of the level of impairment
with all of its related costs.
Alternate Sources for
Funding
If funding for the “Transit Option” has been
declined by Medicare, Medicaid or Third
Party Insurance, some options are:
 School District Transportation Dept
 Local Charity Organizations
 Lions Club International
 Group Bake Sales
 Family and Friends fund raising
assistance
WTORS Manufacturer
References



Q’Straint
800 987-9987
www.qstraint.com
Sure-Lok
866 787-3565
www.sure-lok.com
OrthoSafe Systems
609 587-9444
www.njcost.com/ortho_safe.htm
References




Wheelchair Transportation Safety Standards,
update 6/2011, Larry Schneider. U.M.T.R.I.
Rehabilitation Engineering Research Center on
Wheelchair Transportation Safety in partnership
with the RESNA Subcommittee on Wheelchairs
and Transportation website at
http://www.rercwts.pitt.edu/WC19.html
Rehabilitation Engineering Research Center at
http://www.rercapt.org/
United States Department of Transportation at
http://www.dot.gov/accessibility
References
The RERC on Wheelchair
Transportation Safety:
http://www.rercwts.org/
 Able Data
http://www.abledata.com/ableda
ta.cfm?pageid=113573&top=160
40&ksectionid=19326

Attendance and CEU’s

Convaid and RESNA are pleased
to provide 0.1 Continuing
Education Units (CEU’s) for
registered attendance and
successful completion of this
educational progam.
Presenter:
Eli Anselmi
Product & Education Specialist
Questions: [email protected]
CONTACT INFORMATION
For more information please visit our website
at:
Speaker Contact:
Eli Anselmi
Convaid
[email protected] | 406.581.1503
Numotion
Clinical Education
800-500-9150
Course transcripts and additional copies of certificates of completion are available
upon written request: 5501 Wilshire Blvd NE Ste C ABQ, NM 87113
1.800.500.9150.
888-Convaid ● www.convaid.com
Convaidwheelchairs
Convaid
2830 California Street, Torrance, CA 90503 USA