Transportation Safety Laws for Wheelchairs vs. Car Seats: The Dangerous Double Standard

When it comes to transportation safety, there’s a dangerous double standard that is leaving one of our most vulnerable populations at risk: the elderly. While no one would disagree that car seat safety is vitally important for children’s wellbeing, much less thought is put into finding a proper, transportation-certified wheelchair for those with mobility challenges. This mentality has devastating consequences.

Vehicle passengers riding in wheelchairs are 45 times more likely to be injured in a crash than a typical passenger.1 Furthermore, there is a disturbing lack of legislation in place to protect wheelchair users during transit. A 2004 study identified the concern that there are several federal regulations (FMVSS 201, 207, 208) protect occupants seated in vehicle seats but, there are no federally mandated regulations that address wheelchairs used as seats in vehicles.2 There are, however a set of standards in place for a wheelchair to be considered safe for vehicle travel.

Existing Standards for Wheelchair Travel Safety (WTS)

The Wheelchair Transportation Standards for North America are voluntary standards that are monitored by the University of Michigan Transportation Research Institute. (UMTRI). These standards are the guiding principles that encourage mobility device manufacturers to include crash protection in their chairs and devices.

In 2000, the American National Standards Institute (ANSI) approved No. WC19: “Wheelchairs Used as Seats in Motor Vehicles,” making the guidelines the voluntary national standard in the United States. Internationally, there are similar wheelchair transportation safety voluntary standards from the International Organization for Standardization (ISO).

Rearward-Facing Passenger Spaces: U.S. Standard: WC10, International Standard, ISO 10865-1
Wheelchair Tiedown and Occupant Restraint Systems: U.S. Standard: WC18, International Standard: ISO 10542-1
Wheelchairs: U.S. Standard: WC19, International Standard: ISO 7176-19.14
Seating Systems: U.S. Standard: WC20, International Standard: ISO 16840-4

Are All “Transport Wheelchairs” WC19 Compliant?

Just because a wheelchair has tiedowns and an occupant restraint system doesn’t mean that the wheelchair is WC19 compliant. Most NEMT providers, caregivers, accreditation agencies, or even government facility surveyors don’t know how to determine which products and services are properly certified or not. The voluntary nature of the regulations makes compliance easy to overlook. It is critical for all industry stakeholders to not be complacent when it comes to something that could compromise the safety of patients, residents, and loved ones.

The Difference Between Child Seat Regulations and Wheelchair Travel Standards

These equipment guidelines are similar to the legal requirements that all states and territories have about the safety and security of child seats in motor vehicles.11 Unlike child seat regulations, however, the adult wheelchair equipment standards are voluntary and do not account for consistent, proper use.

Wheelchair transport equipment standards are a step in the right direction, but there is still a lack of accessible guidance on the proper use, securement, and positioning of wheelchairs in a vehicle. While the National Highway Traffic Safety Administration (NTHSA) has extensive information about the proper choice of car seats and booster seats for dependent children,12 there is little to no guidance for those who depend on wheelchairs for non-emergency medical transportation (NEMT).

Injury Risks in Non-Emergency Medical Transportation

Not every elderly or disabled person has an NEMT experience that results in a severe injury, and research is incomplete about the number of people who are injured. Among the injuries found in preliminary reports, however, 35% were attributed to improperly secured wheelchairs.13 Because the WTS standards are neither readily available nor mandatory, caregivers and transporters have little education, inconsistent rules to follow, and few incentives to avoid cutting corners for the sake of convenience.

Poor standardization and communication — combined with pressure to serve an increased number of patients every year — caregivers and transportation providers are sometimes tempted to save time by neglecting to correctly secure or position transport chairs and their dependent users. Even if a serious accident doesn’t occur, bad positioning can lead to agitation or discomfort. At its worst, incorrect wheelchair positioning can cause significant pressure injuries or even falls.

The True Cost of Poor Seating Solutions

These risks are of paramount concern for long-term and complex care because falls are the leading cause of death for seniors older than 65, and researchers estimate that injuries resulting from nonfatal falls cost the healthcare industry $49.5 billion in 2015 alone.14 Pressure injuries and ulcers from uncomfortable seating on long trips can also plague seniors who depend on DME mobility equipment, accounting for about $11 billion annually in expenses. Each pressure wound can cost anywhere from $500 to $70,000 to treat — a costly and unnecessary expense.15

The Case for Higher Standards in Wheelchair Transportation

Having mandated regulations for wheelchair accessible vehicles, their drivers, and the mobility chairs themselves would not only save facilities money, but it would also force careless third-party transport companies out of the market. Higher standards would spark greater transparency, giving caregivers more leeway to ensure their residents are cared for regardless of the situation.

The United States Department of Transportation (USDOT) underscores this in feedback from 2017: “The survey results and the input received…indicated a desire by some of the stakeholders for the establishment of mandatory rather than voluntary standards for wheeled mobility devices…There are a few wheelchair manufacturers who manufacture their products to meet these standards, but there are many that are distributed in the U.S. that do not meet any of the voluntary standards.” SOURCE: U.S. Department of Transportation, Federal Highway Administration, 2017 National Household Travel Survey.16

Our Call to Action

While healthcare providers and regulators have strict requirements for new parents to have a certified and properly installed vehicle for their child to even leave the hospital, our elderly and disabled family members have no formal regulations to protect them when they leave a healthcare facility in a wheelchair. Join us in advocating for a change in global mandates to protect the safety of seniors and other wheelchair-dependent populations.

To learn more about advocating for your rights in wheelchair transportation,
read Broda’s Wheelchair Transportation Safety Checklist

References

  1. Buning, M. E., Bertocci, G., Schneider, L. W., Manary, M., Karg, P., Brown, D., & Johnson, S. (2012). RESNA’s position on wheelchairs used as seats in motor vehicles. Assistive technology: the official journal of RESNA, 24(2), 132–141.
  2. Songer, Thomas J et al. (2004) The injury risk to wheelchair occupants using motor vehicle transportation. Annual proceedings. Association for the Advancement of Automotive Medicine vol. 48 pp. 115-29.
  3. University of Michigan Transportation Research Institute. (n.d.). WC10: RF-WPS. WC Transportation Safety. Retrieved October 14, 2021, from http://wc-transportation-safety.umtri.umich.edu/wts-standards/wc10-rf-wps.
  4. International Organization for Standardization. (2012). ISO 10865-1:2012(en) Wheelchair containment and occupant retention systems for accessible transport vehicles designed for use by both sitting and standing passengers — Part 1: Systems for rearward-facing wheelchair-seated passengers. ISO. Retrieved October 14, 2021, from https://www.iso.org/obp/ui/#iso:std:iso:10865:-1:ed-1:v1:en.
  5. University of Michigan Transportation Research Institute. (n.d.). WC18: WTORS. WC Transportation Safety. Retrieved October 14, 2021, from http://wc-transportation-safety.umtri.umich.edu/wts-standards/wc18-wtors.
  6. International Organization for Standardization. (2012). ISO 10542-1:2012(en) Technical systems and aids for disabled or handicapped persons — Wheelchair tiedown and occupant-restraint systems — Part 1: Requirements and test methods for all systems. ISO. Retrieved October 14, 2021, from https://www.iso.org/obp/ui/#iso:std:iso:10542:-1:ed-2:v1:en.
  7. University of Michigan Transportation Research Institute. (n.d.). WC19: Wheelchairs. WC Transportation Safety. Retrieved October 14, 2021, from http://wc-transportation-safety.umtri.umich.edu/wts-standards/wc19-wheelchairs.
  8. International Organization for Standardization. (2008). ISO 7176-19(en) Wheelchairs — Part 19: Wheeled mobility devices for use as seats in motor vehicles Retrieved October 14, 2021, from https://www.iso.org/obp/ui/#iso:std:iso:7176:-19:ed-2:v1:en
  9. University of Michigan Transportation Research Institute. (n.d.). WC20: Seating Systems. WC Transportation Safety. Retrieved October 14, 2021, from http://wc-transportation-safety.umtri.umich.edu./wtsstandards/wc20-seating-systems.
  10. International Organization for Standardization. (2009). ISO 16840-4:2009(en) Wheelchairs — Part 19: Wheeled mobility devices for use as seats in motor vehicles Retrieved October 14, 2021, from https://www.iso.org/obp/ui/#iso:std:iso:16840:-4:ed-1:v1:en
  11. Governor’s Highway Safety Association. (n.d.). Child Passenger Safety. GHSA. Retrieved October 14, 2021, from https://www.ghsa.org/state-laws/issues/child%20passenger%20safety.
  12. National Highway Traffic Safety Administration. (n.d.). Car seats and booster seats. NHTSA. Retrieved October 14, 2021, from https://www.nhtsa.gov/equipment/car-seats-and-booster-seats.
  13. Association for the Advancement of Automotive Medicine. (n.d.). The Injury Risk to Wheelchair Occupants Using Motor Vehicle Transportation. NCBI. Retrieved October 14, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3217423.
  14. American Physical Therapy Association. (2018, March 9). Study: Falls among us adults 65 and older cost $50 billion in 2015. APTA. Retrieved October 14, 2021, from https://www.apta.org/news/2018/03/09/study-falls-among-us-adults-65-and-older-cost-$50-billion-in-2015.
  15. Boyko, T. V., Longaker, M. T., & Yang, G. P. (2018, February 1). Review of the current management of pressure ulcers. Advances in wound care. Retrieved October 14, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5792240.
  16. U.S. Department of Transportation Federal Highway Administration. (2017). National Household Travel survey. National Household Travel Survey. Retrieved October 14, 2021, from https://nhts.ornl.gov/.
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