Safe Transport for Children with Special Health Needs Brian Perkowski, PT , ATP , CRTS February 2 nd , 2016
Safe Transport for Children with Special Health Needs Disclaimer All views and opinions stated in this presentation are solely that of the presenter and are not representative of National Seating and Mobility. National Seating and Mobility nor any former employer of the presenter has endorsed, sponsored or approved any part of this presentation. The presenter does not have any financial interest in any products discussed or displayed throughout this presentation.
Safe Transport for Children with Special Health Needs Presentation Objectives Understand three (3) ANSI/RESNA standards for 1) Wheelchair Transportation Safety in motor vehicles. Identify three (3) types of alternative child passenger 2) restraint systems. Discuss considerations and adaptations for 3) transportation of individuals who are medically fragile. Recognize when to refer to a seating and mobility clinic 4) for transportation related concerns.
Safe Transport for Children with Special Health Needs Why is there concern when transporting Children with Special Health Needs? Lack of body control (i.e. coordination, balance, etc.) – Could be lack of volitional control or due to immobilization Limited selection of safety equipment Limited training for those involved with transporting these individuals A need or goal to provide a level of passenger restraint that is comparable to that which is available to those without special health needs.
Safe Transport for Children with Special Health Needs Purpose of Industry Standards Promote improved product quality and safety Provide improved product information for service providers and end users Facilitate world-wide barrier-free trade (keeps prices in check) Consolidate technical, scientific and clinical knowledge on a world wide scale ANSI – American National Standards Institute ISO – International Standards Organization RESNA - Rehabilitation Engineering & Assistive Technology Society of North America UMTRI – University of Michigan Transportation Research Institute http://wc-transportation-safety.umtri.umich.edu/home
Safe Transport for Children with Special Health Needs The first choice for any individual is to transport while secured onto a vehicle seat Vehicle seats are permanently anchored to vehicle frame Seats are designed without rigid or sharp edges Seats are dynamically tested to withstand crash forces Seat and occupant restraint system (i.e. seat belt) work together to prevent ejection (a leading cause of death) and contact with vehicle interior by helping a user “ride down” the forces of a crash
Safe Transport for Children with Special Health Needs *Whenever possible, a person should transfer out of their wheelchair and onto a vehicle seat during transit. When that is not possible, the following standards should be used to guide decision making.
Safe Transport for Children with Special Health Needs ANSI/RESNA Standards WC 18 (SAEJ2249) – Wheelchair Tiedowns and Occupant Restraint Systems for use in motor vehicles (WTORS) WC 19 – Transit approved wheelchairs WC 20 – Seated Devices for Use in Motor Vehicles
Safe Transport for Children with Special Health Needs Video 1 http://www.convaid.com/school-safety-i-4-l-en.html
Safe Transport for Children with Special Health Needs WC 18 (SAEJ2249) – Wheelchair Tie-down and Occupant Restraint System (WTORS) for use in motor vehicles Use of pelvic and shoulder belts in testing and real world 30 mph dynamic testing parameters – 30mph change in velocity – 20gs – like catching a 3600lb beach ball (same criteria for car seat crash tests) Tiedown straps must latch to receptacle on wheelchair Product must be labeled as to the test it passes Instruction and warnings must be provided to installers and users
Safe Transport for Children with Special Health Needs WC 19 – Wheelchairs – Transit approved WC must provide 4 easily attachable securement points with very specific geometry WC must be successfully crash tested at 30mph when secured with strap-type tiedowns and loaded with an appropriate size anthropomorphic test dummy representing the intended size and mass of the WC user.
Safe Transport for Children with Special Health Needs WC securement point Vehicle anchor points WTORS Poor belt placement Hardened bolts Correct belt placement
Safe Transport for Children with Special Health Needs WC 20 – Seated Devices for Use in Motor Vehicles Seating system defined: seat pan, seat back and attachment hardware; may or may not include postural support devices Forward facing only Surrogate WC is secured with 4-point tie down and an anthropomorphic dummy is restrained with 3-point lap and shoulder belt Tests seating system’s accommodation of occupant restraint belts
Safe Transport for Children with Special Health Needs RideSafe Brochure http://wc-transportation-safety.umtri.umich.edu/ridesafe-brochure
Safe Transport for Children with Special Health Needs Videos 2-13 Video 2 No securement straps Video 3 Only using 2 of 4 securement straps Video 4 Correctly using all 4 securement straps Video 5 No user restraint Video 6 Using only the lap belt (no shoulder belt) Video 7 Using shoulder belt incorrectly – too high – “submarining” Video 8 Properly fitted 3 point belt and 4 point tie down system – WTORS Manual Wheelchair Video 9 Properly fitted 3 point belt and 4 point tie down system – WTORS Power Wheelchair Video 10 Non-transit approved wheelchair and seating Video 11 Postural belts only – NO occupant restraint system Video 12 Never face sideways – always forward facing Video 13 Hard trays and accessories should be removed
Safe Transport for Children with Special Health Needs Other WC securement systems EZ Lock Docking System - from EZ Lock Dock N Lock from Unwin QLK-150 from Q-straint EZ Lock system
Safe Transport for Children with Special Health Needs Alternative Child Passenger Restraints Special Needs Car Seats Safety Vests (Ride Safer) EZ-On Harnesses Car Beds (Hope) Other considerations
Safe Transport for Children with Special Health Needs Special Needs Car Seats Have higher weight limits than traditional car seats Have more positioning accessories Often have a recline option 5 point harness Are large and heavy Difficult to install and re-install on a regular basis
Safe Transport for Children with Special Health Needs Examples of Special Needs Car Seats Columbia IPS Convaid Carrot Columbia Spirit SnugSeat Pilot Britax Traveller Plus Merrit Roosevelt
Safe Transport for Children with Special Health Needs Safety Vests Look less “medical” Can provide full torso contact May provide just enough lateral stability for those kids that can’t sit in a traditional booster Some can be purchased directly from manufacturer or online Others need Rx and LMN from a vendor
Safe Transport for Children with Special Health Needs Safety Vests The The Churchill RideSafer Vest – Chamberlain - Merritt Safetrafficsystem.com - Merritt
Safe Transport for Children with Special Health Needs Safety Harnesses Great for children who can “escape” Modified version available for laying down on back seat when medically necessary Can be difficult for caregiver to don Usually donned before getting in vehicle
Safe Transport for Children with Special Health Needs Safety Harnesses E-Z-On harness – E-Z-On harness – with zipper in back with adjustable front
Safe Transport for Children with Special Health Needs Safety Harnesses – Modified E-Z-On Harness Mod E-Z-On harness Mod E-Z-On harness – – for single leg cast For lying flat Mod E-Z-On harness – For spica cast
Safe Transport for Children with Special Health Needs Car Beds Very rarely used/needed When needed, often difficult to find quickly Usually used for very small infants - 4.5 lbs. but up to 35lbs. Typically part of a loaner closet or program out of larger hospitals
Safe Transport for Children with Special Health Needs Car Beds
Safe Transport for Children with Special Health Needs Other Considerations Rolled towels or The Jefferson – noodles – NEXT to for omphalocele the child, never protection behind – from Merritt Buckle guard Chest clip guard – from Merritt – from Merritt
Safe Transport for Children with Special Health Needs Other Considerations for Individuals who are the Medically Fragile Tilt and/or recline degree Decreased head control Tracheostomies Oxygen tanks and other equipment
Safe Transport for Children with Special Health Needs Tilt/Recline degree * Best Practice says user should ride as upright as possible whether on vehicle seat, in child passenger safety restraint, or in a wheelchair QUESTION: When should we “trump” best practice and allow the client to use gravity to his/her advantage? ANSWER: WHEN BREATHING IS INVOLVED!
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