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, few people place a high priority on finding a high-quality transport wheelchair for those with mobility challenges. This mentality has devastating consequences. Vehicle safety for the elderly and those with disabilities is a point often overlooked.
Surprisingly for many, 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. Furthermore, there are similar international wheelchair transportation safety voluntary standards from the International Organization for Standardization (ISO).
Are All “Transport Wheelchairs” WC19 Compliant?
Transport wheelchairs should have tie-downs and an occupant restraint system. Although this may be true, just because a wheelchair has these features doesn’t mean that it 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. Because the regulations are only voluntary, compliance is easy to overlook. Without a doubt, it is critical for all industry stakeholders to not be complacent when it comes to the safety of patients, residents, and loved ones.
The Difference Between Child Seat Regulations and Wheelchair Travel Standards
Similarly to the wheelchair transportation standards, all US states and many territories worldwide have legal requirements 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 (NEMT)
Though research is incomplete about the number of people in wheelchairs who are injured in vehicle travel there are some sobering statistics. 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.
Because of 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 wheelchairs. Even if a serious accident doesn’t occur, bad positioning can lead to agitation or discomfort. Eventually, incorrect wheelchair positioning can cause significant pressure injuries or even falls.
The True Cost of Poor Seating Solutions
Since falls are the leading cause of death for seniors older than 65, proper seating solutions should be top priority. In fact, researchers estimate that injuries resulting from nonfatal falls cost the healthcare industry $49.5 billion in 2015 alone.14 In the same fashion, pressure injuries can form during uncomfortable seating on long trips. On account of pressure injuries, the healthcare industry faces $11 billion annually in treatment expenses. Each pressure wound can cost anywhere from $500 to $70,000 to treat — a costly and unnecessary expense.15 Under the circumstances, the most important prevention tactic is comfortable seating solutions.
The Case for Higher Standards in Wheelchair Transportation
Mandatory regulations for wheelchair accessible vehicles, their drivers, and the mobility chairs themselves would not only save facilities money, but also force careless third-party transport companies out of the market. Higher standards would spark greater transparency, therefore giving caregivers more leeway to ensure their residents are properly cared for.
Summing up this sentiment, United States Department of Transportation (USDOT) shared this feedback from a 2017 survey:
“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.”16
Although there are few wheelchair manufacturers who meet these voluntary standards, Broda is proud to be counted among them. If you are looking for an excellent, compliant WC19 transportation wheelchair, then Broda is an excellent choice.
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. In conclusion, we invite you to join Broda in advocating for a change in global mandates to protect the safety of seniors and other wheelchair-dependent populations.
If you would like learn more about wheelchair transportation, then read our Wheelchair Transportation Safety Checklist.
- 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.
- 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.
- University of Michigan Transportation Research Institute. (n.d.). WC10: RF-WPS. WC Transportation Safety.
- 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.
- University of Michigan Transportation Research Institute. (n.d.). WC18: WTORS. WC Transportation Safety.
- 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.
- University of Michigan Transportation Research Institute. (n.d.). WC19: Wheelchairs. WC Transportation Safety.
- International Organization for Standardization. (2008). ISO 7176-19(en) Wheelchairs — Part 19: Wheeled mobility devices for use as seats in motor vehicles
- University of Michigan Transportation Research Institute. (n.d.). WC20: Seating Systems. WC Transportation Safety.
- International Organization for Standardization. (2009). ISO 16840-4:2009(en) Wheelchairs — Part 19: Wheeled mobility devices for use as seats in motor vehicles
- Governor’s Highway Safety Association. (n.d.). Child Passenger Safety. GHSA.
- National Highway Traffic Safety Administration. (n.d.). Car seats and booster seats. NHTSA.
- Association for the Advancement of Automotive Medicine. (n.d.). The Injury Risk to Wheelchair Occupants Using Motor Vehicle Transportation. NCBI.
- American Physical Therapy Association. (2018, March 9). Study: Falls among us adults 65 and older cost $50 billion in 2015. APTA.
- Boyko, T. V., Longaker, M. T., & Yang, G. P. (2018, February 1). Review of the current management of pressure ulcers. Advances in wound care.
- U.S. Department of Transportation Federal Highway Administration. (2017). National Household Travel survey. National Household Travel Survey.