Project P2: Assessment and Monitoring of Wheelchair Transportation Activities and Incidents on Public Buses

Task Leader: Gina Bertocci, PhD, PE

Co-investigators: Karen Frost, PhD, MBA

Other Participants: Russ Rakestraw (Director of Safety, TARC), Barry Barker (Executive Director, Transit Authority of River City - TARC), Graduate Student (Mechanical Engineering) and Carol Flannagan, PhD (UMTRI Biostatistician).

Overview

Studies, anecdotal evidence and preliminary data have shown that injuries to wheelchair-seated passengers often occur during normal or emergency driving maneuvers on public transit buses, but a clear and complete understanding of injury causation in the public transportation setting does not exist.  This project will provide an understanding of adverse incidents, injury scenarios and activities (ingress/egress, securement and occupant restraint process, navigating to securement station) on large transit buses involving wheelchair-seated passengers using both a retrospective and innovative prospective approach. This project is possible due to a unique collaboration with the Transit Authority of River City (TARC), which includes unlimited access to their in-bus video surveillance system. Results of this project will provide an objective window into real-world wheelchair-seated passenger experiences on transit buses traveling in a large metropolitan region. 

This project has three interrelated tasks designed to objectively assess and document real-world transportation experiences of wheelchair users, including vehicle ingress/egress, wheelchair securement, occupant restraint, and injury causing scenarios on TARC transit buses.

• Task P2.1: Retrospective Adverse Wheelchair Incident Assessment (task occurs in years 1 & 2)
• Task P2.2: Prospective Monitoring and Assessment of Wheelchair Related Activities (task spans all 5 years)
• Task P2.3: Prospective In-Depth Investigations of Adverse Wheelchair-Related Incidents (task spans all 5 years)

This project contributes to the RERC WTS intermediate outcome to effect changes in attitudes, policies, and procedures of key stakeholders involved in wheelchair transportation safety, as well as the RERC WTS key output to provide accurate and objective knowledge of wheelchair user transportation experiences.

Specifically, project P2 is designed to meet the following objectives for transit on large buses:

• Characterize and assess wheelchair-related activities and procedures used during the transportation process,
• Characterize and assess wheelchair and occupant response during normal and emergency bus driving and during crash events,
• Investigate the circumstances and underlying causes of adverse incidents
• Characterize the extent and frequency of injuries to wheelchair-seated passengers that result from adverse incidents
• Assess the real-world use and performance of wheelchairs, ramps/lifts, and WTORS

Expected Outputs:

• Peer-reviewed publications regarding:
  • adverse incidents involving wheelchair-seated passengers on transit buses
  • causes of injury to wheelchair-seated passengers in public transit buses including identification of operational or equipment problems leading to potentially unsafe conditions
  • prediction of injury risk to wheelchair-seated passengers in public transit buses
• Educational and Training materials - videos describing wheelchair-occupant response during normal driving, emergency driving and crash conditions (if available) under varying wheelchair securement and occupant restraint conditions
• Recommendations for improved safety and usability in wheelchair transportation in transit buses
• Modifications in transit agency policies as warranted to reflect improved wheelchair transportation safety

• Improvements in wheelchair occupant safety on large public buses through a better understanding of real-world transportation procedures, activities, incidents and injury producing scenarios
• Improvements in transit system operational policies involving wheelchair transportation
• Improvements in transit system operator knowledge of wheelchair transportation safety issues through targeted improvements in training

Project Updates

• Project P2.1: July 2011
• Project P2.1: July 2010
• Project P2.1: July 2009
• Project P2.1: July 2008
• Project P2.1: July 2007
  
  
• Project P2.2: July 2012
• Project P2.2: July 2011
• Project P2.2: July 2010
• Project P2.2: July 2009
• Project P2.2: July 2008
• Project P2.2: July 2007
  
  
• Project P2.3: July 2012
• Project P2.3: July 2011
• Project P2.3: July 2010
• Project P2.3: July 2009
• Project P2.3: July 2008
• Project P2.3: July 2007
  
  
• Project P2.4: July 2012
  
  
• P2 Annual Report 2007 (1.5 MB pdf)

Task P2.1: Retrospective Adverse Wheelchair Incident Assessment

This component is a retrospective analysis of TARC transit bus incident reports recorded between 1999-2006.

• Retrospectively characterize all types of adverse incidents involving wheelchair-seated passengers on large transit buses to gain an improved understanding of underlying cause, mechanism and resulting injuries.
• Identify vehicle conditions and wheelchair-related activities that are associated with injury to wheelchair-seated passengers on large transit buses.

Study Design

This component of project P2 is an observational, descriptive study consisting of a retrospective review of prior incident reports involving wheelchair-seated passengers on TARC buses.

P2.1: July 2011 Project Update

This task has been successfully completed. The final sample size was 146 (within 5% of our estimate of 154). All project goals were achieved. Our primary finding is that the majority of incidents occur when the wheelchair passenger is on or in contact with the ramp during ingress or egress. As a result of this finding, we have expanded our examination of ramp-related incidents in Tasks P2.2 and P2.3.

During the past reporting period we published a peer-review manuscript based on our research findings, and presented these findings to TARC.

We have met with TARC on many occasions throughout the year to build a collaborative work environment. The result is a very positive working relationship with TARC and support and enthusiasm for this project throughout the organization. We will continue to invest in this relationship to insure mutually beneficial outcomes.

P2.1: July 2010 Project Update

This task has been successfully completed. The final sample size was 146 (within 5% of our estimate of 154). All project goals were achieved.

Our primary finding is that the majority of incidents occur when the wheelchair passenger is on or in contact with the ramp during ingress or egress. As a result of this finding, we have expanded our examination of ramp-related incidents in Tasks P2.2 and P2.3. During the past reporting period we also published a peer-review manuscript based on our research findings, and presented these findings to TARC.

We have met with TARC on many occasions throughout the year to build a collaborative work environment. The result is a very positive working relationship with TARC and support and enthusiasm for this project throughout the organization. We will continue to invest in this relationship to insure mutually beneficial outcomes

P2.1: July 2009 Project Update

This task is has been successfully completed. Final sample size was 146 (within 5% of our estimate of 154). All project goals were achieved.

Our primary finding was determining that the majority of incidents occur when the wheelchair passenger is on or in contact with the ramp, during ingress or egress. As a result of this finding, we have expanded our examination of ramp-related incidents in subtasks P2.2 and P2.3. During the past reporting period we also published a peer-review manuscript based on our research findings, and presented these findings to TARC.

We have met with TARC on many occasions throughout the year in order to build a collaborative work environment. The result is a very positive working relationship with TARC and support and enthusiasm for this project throughout the organization. We will continue to invest in this relationship to insure mutually beneficial outcomes.

P2.1: July 2008 Project Update

This task ran smoothly and is nearing completion on schedule. The IRB was submitted and approved, and all data was collected, recorded and stored in an electronic database. Preliminary analysis was conducted and presented in poster format at RESNA in June 2007. Dr. Frost is currently analyzing data and leading development of a manuscript for submission to a peer reviewed journal. Additionally, the investigators will prepare a report and presentation for TARC in the fall to summarize the research findings.

Members of the research team are scheduled to participate in TARC’s eight-hour driver training program in order to observe and better understand TARC policies and training approach. We have been invited to provide feedback to TARC regarding any improvements that might be suggested to insure wheelchair rider safety.

P2.1: July 2007 Project Update

This task ran smoothly and is nearing completion on schedule. During this reporting period, the IRB was submitted and approved, and all data was collected, recorded and stored in an electronic database. Preliminary analysis was conducted and presented in poster format at RESNA in June 2007. Dr. Frost is currently analyzing data and leading development of a manuscript for submission to a peer reviewed journal. Drs Bertocci and Frost will add author this manuscript. Additionally, the investigators will prepare a report and presentation for TARC in the fall to summarize the research findings.

Members of the research team are scheduled to participate in TARC’s eight hour driver training program in order to observe and better understand TARC policies and training approach. We have been invited to provide feedback to TARC regarding any improvements that might be suggested to insure wheelchair rider safety.

We have met with TARC on many occasions throughout the year in order to build a collaborative work environment. The result is a very positive working relationship with TARC and support and enthusiasm for this project throughout the organization. We will continue to invest in this relationship to insure mutually beneficial outcomes.

Return to the top

Task P2.2: Prospective Monitoring and Assessment of Wheelchair Related Activities

This component of project P2 consists of prospective monitoring and assessment of wheelchair related activities on TARC public buses equipped with video surveillance systems. Activities of interest include ingress/egress, maneuvering to/from securement stations, wheelchair securement and occupant restraint process, and wheelchair and occupant response during normal and emergency driving. (Adverse incidents will be studied in Task P2.3.)

• Prospectively characterize and assess wheelchair-related activities occurring on large public transit vehicles

This component of the project is a prospective observational descriptive study.

P2.2: July 2012 Project Update

This task has been completed. Dissemination of results has continued. Please see the Publications list for additional information.

P2.2: July 2011 Project Update

Year five activities focused on data analysis, dissemination, and initiation of a doctoral research grant submitted as a follow-on to this work.

Data Analysis:
Wheelchair Securement Practices - Data analysis to describe and examine wheelchair securement practices on a subset of records was completed this year, and two manuscripts were drafted/submitted for peer-review publication. Descriptive analysis of current wheelchair securement practices was followed by in-depth examinations of wheelchair-related incidents/difficulties that occurred at the securement station. Observations revealed excessive wheelchair excursions during 20.3% of wheelchair trips. These observed excursions could lead to compromised safety.

In-depth assessment of adverse events involving wheelchair-seated passengers during travel on LATVs - in-depth assessments of three adverse events that evidenced the greatest wheelchair excursions was completed and incorporated in one of two manuscripts resulting from our analysis of wheelchair securement practices.

Dissemination:
Manuscript Submissions & Preparations. A manuscript providing an overview of wheelchair transportation safety in fixed route & paratransit vehicles was accepted for publication in Assistive Technology. This manuscript was a direct result of our State of the Science workshop on public transit vehicles. A manuscript detailing the case series of adverse events was submitted to JRRD, and we are awaiting reviewer comments. A second manuscript on wheelchair securement practices on LATVs will be submitted July 2011.

Additionally, Dr. Frost presented selected research findings to the Access Board in Nov 2011, in response to their Notice of Proposed Rule Making for the ADA Accessibility Guidelines for Transportation Vehicles, and presented research findings at the American Public Transportation Association's Bus & Paratransit Conference.

A draft manuscript based on our state of the science white paper (wheelchair and scooter transportation safety in fixed-route and demand-responsive paratransit public transit vehicles). This manuscript will be a review paper and we expect to submit this manuscript for publication in June/July.

In summary, during the past year we have worked on completing four peer-reviewed manuscripts for publication based on the research and related activities conducted in this project. One manuscript is in press, two manuscripts are nearing final completion and will be submitted in June/July, and the final manuscript is in process and expected to be finalized and submitted by the end of Sept.

Capacity building: In May, 2010, Zdravko Salipur successfully defended his dissertation proposal titled "Consequences of four-point, strap-type wheelchair tiedown and occupant restraint system practices on wheelchair passenger safety in fixed-route transit."

P2.2: July 2010 Project Update

Year four activities focused on data analysis, dissemination, and completion of a dissertation proposal.

Data Analysis:
Ingress/Egress Activities - Data analysis to describe and examine ingress and egress activities was performed on a subset of 250 records. Cases in which Incidents and difficulties occurred were identified and data from these and other cases without incidents or difficulties were analyzed to determine whether there are statistically significant differences for conditions that result in successful ingress/egress activities and those that result in an incident or difficulty. Our primary findings indicate that: i) difficulties/incidents are three times more likely to occur during ingress versus egress, and ii) the three most common factors contributing to difficulties/incidents are narrow ramp width, smaller vehicle door width, and higher ramp slope.

Wheelchair Securement Practices - Data analysis to describe and examine wheelchair securement practices on a subset of 295 records followed a similar approach to that used for ingress/egress. Descriptive analysis of current wheelchair securement practices was followed by in-depth examinations of wheelchair-related incidents/difficulties that occurred at the securement station. Observations revealed excessive wheelchair excursions during 20.3% of wheelchair trips. These observed excursion could lead to compromised safety. These findings are currently being prepared for publication.

In-depth assessment of adverse events involving wheelchair-seated passengers during travel on LATVs - in-depth assessments of three adverse events that evidenced the greatest wheelchair excursions were performed to identify factors that contribute to episodes of high instability during transit.

Dissemination:
Manuscript Submissions & Preparations. A manuscript on ingress/egress activities was accepted for publication by the Journal of Public Transportation and is currently in press. A second manuscript detailing the case series of adverse events is in draft form, and we expect to finalize this draft and submit this manuscript for publication by the end of June/July. A third manuscript on wheelchair securement practices on LATVs is currently in process. We expect to complete and submit this manuscript for publication in August or September.

A draft manuscript based on our state of the science white paper (wheelchair and scooter transportation safety in fixed-route and demand-responsive paratransit public transit vehicles). This manuscript will be a review paper and we expect to submit this manuscript for publication in June/July.

In summary, during the past year we have worked on completing four peer-reviewed manuscripts for publication based on the research and related activities conducted in this project. One manuscript is in press, two manuscripts are nearing final completion and will be submitted in June/July, and the final manuscript is in process and expected to be finalized and submitted by the end of Sept.

Capacity building: In May, 2010, Zdravko Salipur successfully defended his dissertation proposal titled "Consequences of four-point, strap-type wheelchair tiedown and occupant restraint system practices on wheelchair passenger safety in fixed-route transit."

P2.2: July 2009 Project Update

Year three activities focused on four primary areas: continued data collection, interim data analysis, providing feedback to TARC based on field observations, development of a draft manuscript outline for submission to a peer-review journal and completion of a graduate
engineering master's thesis. Data collection is on schedule, and we now have a data set that is fairly balanced in terms of seasonal observations.

We conducted interim analysis based on 108 observed wheelchair trips. We focused on examining and characterizing wheelchair securement practices. Our primary finding was that the majority of bus drivers did not use the tiedown straps to secure the wheelchair. We
observed that the primary means of wheelchair securement was misuse of the occupant restraint lap belt. Misuse consisted of bus drivers wrapping the lap belt around the wheelchair seatback. These preliminary findings were accepted for a platform presentation at RESNA in June 2009.

We presented our interim findings on wheelchair securement practices to TARC management. This presentation raised TARC management's awareness of improper wheelchair securement practices being used in the field. As a result, the research team held a
"train-the-trainer" course for TARC trainers on wheelchair transportation safety, and TARC has initiated a strategy to improve wheelchair securement practices. TARC continues to seek input from the research team on improving current practices.

We have identified the focus for our first manuscript (wheelchair ingress/egress difficulties and incidents using large accessible transit vehicle ramps) and have completed a draft outline. We are currently analyzing data and anticipate completion of this manuscript in late fall. This manuscript will be submitted to a peer-review journal.

Sheryll Sisson successfully completed her Master's Thesis titled "Investigation of wheelchair ingress/egress activities in large accessible transit vehicles and evaluation of ADA ramp guidelines for improved ramp safety and usability" in April 2009.

P2.2: July 2008 Project Update

During year two of this project we focused on three primary areas: data collection, analysis of interim data, and providing feedback to the Transit Authority of River City (TARC) in Louisville, KY. Currently, we are slightly ahead of schedule on the number of data observations collected. We spent a considerable amount of time refining the database based on actual observations of travel scenarios. This effort has allowed us to better quantify our findings in terms of measurable outcomes. We also completed inter-rater reliability testing with successful results.

Our second focus was on interim analysis of ingress and egress activities. Specifically, we looked at factors that contribute to wheelchair passenger difficulty and factors that influence injury risk during ingress and egress. This work was published in the proceedings of the Rehabilitation Engineering Society of North America, 2008 Annual Conference, titled "Wheelchair Ingress/Egress Activities in Large Accessible Transit Vehicles (LATVs)" and received honorable mention in the student scientific paper competition. Our findings indicate that wheelchair orientation (rear-facing vs. front-facing) used to board the LATV may affect the difficulty of wheelchair maneuverability during ingress/egress. This is an important finding, as many transit agencies recommend rear-facing orientation during boarding. Additionally, an increased ramp angle of incline may also contribute to difficulty during boarding for wheelchair-seated passengers. These findings may help transit providers enhance procedures and identify future training needs for LATV operators who often assist wheelchair-seated passengers during these activities.

During year 2 we met with TARC's Executive Director and Director of Safety to provide an overview of our findings and progress on both P2.1 and P2.2. We provided a powerpoint presentation of our findings from P2.1, and provided a progress summary for P2.2. Summary results from our P2.1 findings were P2.2. We provided a powerpoint presentation of our findings from P2.1, and provided a progress summary for P2.2. Summary results from our P2.1 findings were subsequently incorporated into a presentation given by the Executive Director (Barry Barker) at the American Public Transit Association annual conference in 2007. Additionally, two members of the project team participated in TARC hands-on training sessions for new bus operators focused on wheelchair securement and occupant restraint procedures.

P2.2: July 2007 Project Update

During the past year, we focused on working closely with TARC to finalize video camera, recording and viewing software and equipment, and establishing protocols for collection and storage of data. We have submitted and obtained IRB approval, hired and trained a graduate student and completed development of database field definitions. Database development is currently in progress and on schedule for completion by the end of July.

We experienced a two-month delay in obtaining critical video recording and viewing equipment due to administrative purchasing issues between the University and vendor. This problem was resolved and all necessary equipment has been received. Because obtaining this equipment was a critical path item, this delay was passed on to the installation and test schedule for the final video surveillance protocol. We used this time to refine database field definitions, data collection and video viewing protocols.

TARC agreed to install the video cameras into existing buses at no charge. This cost savings allowed us to purchase all 17 cameras in year 1, rather than spreading the purchase and installation across 2 years. Installation and testing of the video surveillance protocol is expected to be complete by the end of July. Having all 17 cameras installed in year 1 will allow the research team to observe more data, sooner than expected. This benefit will offset the initial two-month delay.

Data collection for this project is running approximately two months behind schedule

Return to the top

Task P2.3: Prospective In-Depth Investigations of Adverse Wheelchair-Related Incidents

This component consists of in-depth investigations of wheelchair related adverse incidents occurring on TARC transit buses.

• Prospectively investigate wheelchair related incidents occurring on large public transit buses
• Identify activities, vehicle conditions and factors leading to injuries in wheelchair seated passengers
• Identify deficiencies in operational procedures and/or wheelchair and adaptive equipment designs leading to adverse incidents and injuries

Null Hypothesis: There are no differences in wheelchair-seated passengers injury outcome across various transit bus conditions (non-moving; moving non-crash; crash).

This component of project P2 is a prospective, observational descriptive study.

1P2.3: July 2012 Project Update

This task has been completed. Dissemination of results has continued. Please see the Publications list for additional information.

1P2.3: July 2011 Project Update

During this reporting period,two additional bus drivers were interviewed regarding wheelchair-related incidents that occurred on their buses. Interview results are consistent with previous driver interview findings, and reinforced our need to re-focus our research activities on understanding the ergonomic issues related to wheelchair securement using four-point, strap-type tiedowns that are installed in almost all wheelchair stations of public transportation vehicles (see 2010 report).

We completed all aspects of our 'spin-off' pilot study, which was incorporated into a Master's thesis in industrial engineering. A conference abstract summarizing these results is currently in preparation.

Note: The following questions regarding this study reflect our progress on the 'spin-off' pilot study.

P2.3: July 2010 Project Update

During this reporting period 10 bus drivers were interviewed regarding wheelchair-related incidents that occurred on their bus. Interviews results further reinforced the previous finding that the wheelchair securement using the four-point, strap-type tiedown system poses a significant ergonomic challenge for bus drivers. Based on this information, we re-focused our research activities on understanding the ergonomic issues related to wheelchair securement using four-point, strap-type tiedowns that are installed in almost all wheelchair station of public transportation vehicles.

First, we obtained IRB approval to conduct a pilot study. The objectives of the pilot study were to assess existing and potential work-related injury risk factors that bus drivers are exposed to during the wheelchair securement process, and to provide recommendations for improving bus-driver safety during this task. These objectives were met by conducting video taped assessments of bus drivers while performing the wheelchair tiedown process, and surveying a subset of bus drivers about musculoskeletal problems and injuries they have experienced. We are currently conducting preliminary analysis of these data.

P2.3: July 2009 Project Update

We interviewed 42 bus drivers regarding wheelchair-related incidents that occurred on their bus. These interviews have been integral in providing the researchers with a more in-depth understanding of the multitude of factors that can contribute to wheelchair-related
incidents. One of the major findings thus far is that the wheelchair securement process poses a significant ergonomic challenge for bus drivers. Issues of visibility, reach and space affect drivers' ability to properly secure wheelchairs and scooters, which in turn has lead to improper and unsafe securement practices. Factors such as bus driver age, weight and fitness level also influence driver practices. This finding has resulted in the development of a pilot study to investigate ergonomic issues during the wheelchair securement process. We have teamed with ergonomics experts at the University of Louisville and are in the process of obtaining IRB approval to launch this project. This project is being designated P2.4. We are also in communication with a transit agency in Eugene, OR that is working to address these issues as well, and we hope to facilitate an environment of knowledge sharing between these two transit agencies.

Legal concerns precluded our ability to interview wheelchair-seated passengers involved in incidents. In lieu of interviewing wheelchair-seated passengers involved in incidents, TARC has allowed us to review closed claim files. These are legal files for which a monetary settlement was agreed to between TARC and a plaintiff. Although these files do not provide the level of detail we originally anticipated obtaining, these files contain information about damage to assistive technology and/or personal injuries.

P2.3: July 2008 Project Update

At the beginning of year two we received IRB approval for the study protocol. We also completed all data collection sheets (subject & bus operator interviews) and the initial version of the database. Based on our previous database experience on P2.2, we anticipate further refinements to the database once we begin to conduct investigations and enter data. We also worked closely with TARC to refine a recruitment strategy and, after encountering several delays, initiated subject recruitment.

P2.3: July 2007 Project Update

The IRB is in process and expected to be submitted the first week of July. IRB approval is anticipated by the end of July, allowing us to begin incident investigations beginning in August. The prospective incident investigation database will build on the video monitoring database, and is scheduled for completion during the 4th quarter of year 1.

Return to the top

Task P2.4: Wheelchair Activities in Paratransit Vehicles

P2.4: July 2012 Project Update

A total of 154 wheelchair trip observations have been completed to date. Information from 135 video records have been entered into the project database, and 19 video records are in the queue for review and data abstracting. Data collection ranges between 30-40 wheelchair observations per month, and we are on target to achieve or exceed our data collection goals.

We recently completed preliminary analysis based on 112 observations. We did not observe any egregious WTORS practices, nor did we observe any major or injurious incidents. We did observe a number of minor difficulties which are summarized in our preliminary findings below:

Wheelchair distribution - The majority of wheelchairs observed were power wheelchairs (53%), followed by manual wheelchairs (43%), scooters (3%) and transport wheelchairs (1%). General wheelchair configuration information was also recorded. Configuration information refers to any wheelchair setup affecting the wheelchair’ overall space ‘footprint’ as well as its maneuverability and/or the operator’s ability to secure the device, such as an elevated footrest. To date, 13 passengers seated in wheelchairs have used elevated footrests during transit, and one wheelchair was outfitted with a single footrest.

Wheelchair orientation on lift - Most passengers in wheelchairs used a forward-facing orientation on the lift (i.e., they were facing toward the vehicle during ingress and faced toward the sidewalk/street during egress). During egress, 97% of wheelchair passengers entered the lift facing outward, or away from the vehicle. However during ingress this percentage dropped to 35%. Differences in wheelchair orientation on the lift during ingress were examined based on whether the vehicle operator or the wheelchair passenger maneuvered the wheelchair onto the lift. Wheelchair passengers were more likely to position themselves in a forward-facing orientation when maneuvering their wheelchair (71% of the time), than were vehicles operators. Vehicle operators positioned wheelchair passengers in a forward-facing orientation 51% of the time.

WTORS Practices - Use of all four tiedowns was observed in all but 2 cases. In one of these cases, the wheelchair passenger called out to the driver during transit to alert him that the front tiedowns had not been applied. The driver pulled the vehicle over and applied the front tiedowns. The transit agency permits wheelchair passengers to decline use of the shoulder belt during transit, as the manufacturer’s vehicle seats are not equipped with shoulder belts. Seven wheelchair passengers transferred from their wheelchair to a vehicle seat, and thus are not included in the data. Lap belt usage was observed during the majority of wheelchair trips (92%). Shoulder belts were used to restrain passengers 34% of the time. The most frequently observed use of the shoulder belt (64%) was routing the belt behind the wheelchair seat back or between the passenger and wheelchair seat back. Note that the shoulder belt cannot be de-coupled from the lap/shoulder belt assembly. Therefore, it appears that, if a decision is made not to use the shoulder belt, it is routed behind the passenger or wheelchair to avoid use.

Time to complete ingress and egress - Time to complete the boarding and alighting process in a demand-responsive environment is generally considered to average between 4-5 minutes per passenger. For purposes of this project, we defined time of process for ingress as beginning when the first wheels cross the outboard roll stop, and ending when the vehicle operator completes the wheelchair securement and occupant restraint process. During ingress, time to deploy the lift is not included, as the lift is typically deployed immediately upon arrival at the facility, and time delays may be incurred waiting for the wheelchair passenger to travel to the vehicle. Time of process for egress begins when the vehicle operator initiates release of the wheelchair securement straps or occupant restraint belts, and ends when the rear wheels cross the outboard roll stop. Egress includes time to deploy the lift in some cases because some operators release the wheelchair securement and occupant belts then leave the vehicle to deploy the lift while the wheelchair passenger maneuvers to the lift. Preliminary observations show that both ingress and egress processes, as defined above, fall below the 4-5 minute timeframe. On average, the ingress process took 3.9 minutes to complete (range=1.9-8.2 mins), while the egress process took 2.9 minutes (range=0.4-4.9 mins).

Difficulties During Ingress and Egress - We identified difficulties involving lift components and usage in 26 of 112 wheelchair trips. All difficulties appeared to be minor. Difficulties during ingress involved the following lift components/factors: outboard roll stop, platform side plates, wheelchair passenger ability to maneuver, and an other category. Difficulties during egress involved the following lift components/factors: inner roll stop, outboard roll stop, platform side plates, and wheelchair passenger ability to maneuver. Note that several difficulties involved more than one contributing factor. Difficulties are summarized below according to whether they occurred during ingress or egress.

Ingress Difficulties - Both wheelchair passengers and vehicle operators experienced difficulties aligning the wheelchair within the platform side plates and maneuvering the wheelchair across the outboard roll stop. In cases involving platform side plates, one wheelchair passenger propelled a wheel over a platform side plate while maneuvering onto the lift in a rear-facing orientation. Another wheelchair passenger had difficulty propelling over the outboard roll stop and then positioning his wheelchair within the platform side plates as a result of inadequate maneuvering space between the lift and curb. Limited space required the passenger to make a sharp turn onto the lift, resulting in difficulty crossing the roll stop and an impact with the platform side plate. In the remaining two cases involving platform side plates, two operators each pushed a manual wheelchair into a platform side plate while trying to position wheelchairs on the lift; stopping the boarding process and requiring re-alignment of the wheelchair passenger. Four of the 6 outboard roll-stop difficulties appeared due, in part, to ramp deployment location. In these cases, the wheelchair passenger was required to make a sharp-to-moderate turn onto the lift. Uneven surface terrain beyond the lift contributed to two outboard roll stop difficulties.

Egress difficulties - Difficulties involving the inner roll stop comprised the majority of egress difficulties. Each difficulty involved the roll stop hitting a component of the wheelchair, automatically stopping the lift. In each case, the wheelchair had to be moved forward by either the operator or the wheelchair passenger before the lift would descend. Three outboard roll stop difficulties were also observed. One difficulty resulted from the lift being deployed on a cross-slope (slanted surface), requiring the operator to manually lower the outboard roll stop in order for the wheelchair passenger to exit the lift. In another case, the outboard roll stop did not deploy for an unknown reason. The operator manually raised and re-lowered the lift (while occupied) in order to successfully deploy the outboard roll stop. The third outboard roll stop difficulty was related to a wheelchair passenger’s ability to maneuver their wheelchair.

These very preliminary findings indicate that for this transit agency, wheelchair-related difficulties result from the human actions & behaviors of the paratransit operator. These issues can be mitigated by providing an improved understanding of operator actions in terms of parking location (so that wheelchair passengers do not have to propel over the rollstop at a severe angle) and proper placement of occupant restraint belts. We will continue to collect data on our own to examine/explore further issues related to adaptive equipment. This finding is somewhat consistent with what we know as professionals who have testified as expert witnesses in wheelchair-related legal cases involving paratransit accidents and injuries. These legal cases frequently (but not always) boil down to inadequate operator training. Our review of transit agency operator training manuals and programs during legal case reviews reveals that operator training programs are typically focused on informing operators of WHAT they need to do (i.e. attach 4 tiedowns to the wheelchair here, here, here and here), but do not include WHY they need to do it. Adding a WHY component may go a long way to improving operator behaviors. One way to do this is to incorporate research-based crash test videos in training programs, or a similar visual component that drives home the message of what can happen if the shoulder and lap belt are not properly positioned.

We will continue to collect data beyond the end of this project to further assess issues regarding adaptive equipment, and to share these findings with stakeholders to further identify policy implications of these findings. We will also discuss the operator training implications of these findings. The transit agency has received a copy of this preliminary report.

Last updated: 07.13.2012