The most common preventable injuries to wheelchair bound passengers travelling in ambulettes (wheelchair vans) involve falls while entering/exiting the van, being thrown from the wheelchair during a crash, and tip-over/fall incidents while in transit. In this article, physical therapist Dr. Christian Mongrain discusses the standard of care for transporting and securing passengers in wheelchair vans.
Wheelchair Van Safety – Expert Article on Ambulettes
Wheelchair vans, also known as Ambulettes, are vehicles that are specifically equipped to transport passengers who are unable to sit on a manufacturer installed vehicle seat but are medically and functionally stable enough to be transported while seated in a wheelchair. Wheelchair vans typically have a platform lift located at either the passenger side or rear of the vehicle to provide vehicle access for individuals who are unable to climb stairs. These specialized vehicles also have a designated area or areas where the wheelchair(s) can be secured to the floor of the vehicle, thereby enabling the passenger’s personal wheelchair to serve as their seat during transit.
Wheelchair securement involves the use of tiedowns consisting of anchorages installed within the floor of the vehicle and four retractors to connect the wheelchair, two in the front and two in the rear. Drivers are trained to attach the retractors directly to specific locations on a wheelchair frame, and not to moving parts or accessories like leg rests or wheels. The S or J hooks located at the end of the retractor webbing must be attached to solid members of the wheelchair frame. If the hooks cannot be attached to the frame members, webbing loops may be needed to create a securement point. Optimal angle to secure the wheelchair via retractors from anchorages to wheelchair frame is 45 degrees.
There are two types of wheelchair tiedown retractors: Automatic and Semi-Automatic. Automatic retractors add tension to the straps once between the two points of attachment (the floor anchorages and the wheelchair), and semi-automatic retractors require the driver to turn a knob to take up slack and add tension to the retractor after attaching it to the wheelchair. When connected and tensioned properly, the wheelchair tiedown system will secure a wheelchair in the same position during transportation.
Similar to passengers in conventional vehicle seats, individuals travelling via ambulette require both pelvic (lap belt) and upper-torso (shoulder harness) restraints to remain secured within their wheelchair. The location of the wheelchair securement in relation to the origin of the shoulder harness is important to enable the restraint system to maintain the passenger in the wheelchair during travel and in the event of a collision.
To accomplish proper occupant restraint, the driver must properly position the wheelchair forward facing and apply the shoulder harness and lap belt according to standards. Some newer wheelchairs have integrated lap belts that are designed to function as occupant restraints within vehicles. These wheelchairs are clearly labeled “WC19” and still require the use of a vehicle mounted shoulder harness.
When combined with a securement system to anchor the wheelchair to the floor of the wheelchair van, occupant restraints complete the Wheelchair Tiedown Occupant Restraint System (WTORS).
Prior to transporting passengers in the wheelchair van, drivers must complete a pre-trip inspection. This includes ensuring that the equipment necessary to safely transport passengers functions properly, including the wheelchair van lift and the WTORS. To minimize the risk of passenger injury during loading and unloading, the quality of ascent/descent of the lift platform should be assessed as well as proper deployment of the wheel stop. WTORS should be inspected daily to ensure webbing is not fraying, retractors lock, buckles are functional, and the track and hardware are in working condition.
Wheelchair van drivers who work for a transportation company receive a daily schedule known as a manifest. The manifest contains important information including date and time of each transport, passenger origination and destination, passenger equipment, and any specific passenger needs such as a companion to accompany passenger or additional assistance needs. Before loading a passenger into the vehicle it is important that the driver establish the identification and consent of the passenger.
Wheelchair Van Investigations
Ambulette restraint systems cannot prevent injuries in all crash scenarios, but many injuries related to the functioning of the vehicle ramp and wheel stop, wheelchair securement systems, and passenger restraints are preventable. Issues common to wheelchair van investigations include lift platforms that are unleveled, bounce while raising or lowering, or wheel stops that fail to engage. Any of these circumstances should be addressed immediately as they present a dangerous condition particularly for passengers in rolling chairs.
Improper securement of the wheelchair or failure to properly restrain the passenger can result in falls, tip-overs, or belt entanglements during normal vehicle maneuvers. Investigations have shown that the forces generated during acceleration, braking, and turning are sufficient to cause severe injury or death.
The experts at Robson Forensic are qualified to investigate a broad range of issues relevant to wheelchair van incidents, including the condition of the wheelchair, wheelchair securement equipment, passenger restraint systems, ramp and lift equipment, as well as the actions, policies, and procedures of assistive personnel.
For more information, submit an inquiry or contact the author of this article.
Doctor of Physical Therapy & Health Care Administration Expert
Christian Mongrain, PT, DPT, HEM is a physical therapist and former Director of Therapies for several health systems in the Philadelphia region. Dr. Mongrain has recommended mode of transportation for patients when being transferred between facilities and at time of discharge. He has assisted with loading and unloading of patients at outpatient and rehabilitation facilities, and has accompanied rehabilitation patients during wheelchair van transport during community outings. Dr. Mongrain has investigated incidents involving standards of care for passenger loading/unload, wheelchair securement, and passenger restraint in Non-Emergency Medical Transport. He is a voting member of the RESNA Standards Committee for Wheelchairs and Transportation, and is certified in Passenger Assistance Safety and Administration by the Community Transportation Association of America.