Project P5: Assessing the Impact of WC19 Wheelchairs on the Transportation Safety of Wheelchair-Seated Students

Task Leader: Mary Ellen Buning, PhD, OTR, ATP

Co-investigator: Patricia Karg, MS

Other Participants: Joseph Ruffing (project staff: communications specialist); Pete Baxter (industry: Chair, National Congress on School Transportation (NCST) and Director of School Transportation in Indiana); graduate student; epidemiologist/statistics consultant

Overview

This project addresses the key output of obtaining accurate and objective information regarding the real-world experience of transporting wheelchair-seated students in school buses, and thereby contributes to the RERC WTS intermediate outcome to effect changes in attitudes, policies, and procedures of key stakeholders involved in the transportation of wheelchair-seated students. The primary objective of this research project is to determine the impact of WC19-compliant wheelchairs on the transportation of students using wheelchairs as motor-vehicle seats in school districts throughout the United States.

 WC19-compliant wheelchairs are designed to increase safety and reduce error and time in wheelchair securement. Transportation professionals desire evidence of the impact of WC19-compliant wheelchairs on school transportation safety outcomes. In May 2005, the National Congress on School Transportation (NCST) adopted a resolution (appended below) to survey state directors of student transportation on the extent of WC19 wheelchair use in school districts across the US. The congress wants to determine if injury and liability related to WTORS decrease when WC19 compliant wheelchairs are used. Further, where incidents involving lift-equipped buses transporting students riding in wheelchairs have occurred, they seek data about the performance of WC19-complaint wheelchairs relative to other wheelchairs. This information will inform decisions and may guide pupil transit policy in school transportation districts around the US. Knowledge about unmet needs in transporting students seated in wheelchairs will help to define areas for future product and standards development, and needed changes in policies and regulations. 

The project includes two phases of data collection.  The first phase, taking place in years 3 and 4, will develop and distribute a questionnaire to state directors of pupil transportation. The second phase, occurring in years 4 and 5, will target local school districts and survey a geographically representative sample of school-bus drivers.

This project will produce two wheelchair transportation survey tools - one for state transportation directors and one for school-bus drivers. The data collected will be analyzed and results published in peer-reviewed journals and school transportation publications. The results will also be presented at the 2010 National Congress on School Transportation meeting and other appropriate venues. It will also produce advances in knowledge that can be used to inform the consortium of school transportation organizations and drive the development of transportation policy, training, and public awareness materials.  The data collected will provide evidence of the performance of WC19-compliant wheelchairs, thereby increasing awareness of the importance of these products and any need for modifications to the WC19 standard.

Research Hypotheses

• WC19-compliant wheelchairs increase the ease and frequency of proper wheelchair securement and user restraint than non-WC19 compliant wheelchairs.
• There are fewer travel-related incidents and injuries when students are riding in WC19 compliant wheelchairs than when they are riding in non-WC19 compliant wheelchairs.
• More than ten years after publication of FMVSS 222 and SAE J2249, there are varying degrees of conformity with WTORS usage in school buses.

Study Design

This project will begin in year three (2009) of the RERC.  Project leaders will begin Phase 1 by interviewing NCST personnel to clarify the types and specificity of data reported to state transportation directors, as well as collect samples of available data. This knowledge is essential for developing a questionnaire that state level transportation directors will support and to which they can respond. After reaching consensus on the breadth of the survey, the project research team will develop the survey tool with the oversight of an epidemiologist.  The survey tool will be beta-tested with the leadership team from the NCST before it is distributed to each of the fifty state pupil transportation directors.

Since data desired by the state transportation directors will probably not include the level of detail needed to understand some of the underlying issues, the RERC research team plans to extend the scope of the data collection to obtain data at the level of the local school transportation district specifically, the bus driver. For example, the RERC is interested in knowing about WTORS usage, driver training, implementation of safety practices within local transportation districts, time required for securement of WC19 versus non-WC19 mobility devices, lift operation, and practices on transporting lap trays, communication devices and oxygen tanks.

After reviewing the preliminary data from the survey of state directors, Phase 2 will begin to develop a second survey tool for completion by local district bus drivers. This second phase of the study will provide information about actual practices in transporting students riding in wheelchairs. It is anticipated that this phase will provide more information about day-to-day practices and about driver's issues and concerns. The results should help identify training needs, improvements in equipment usability, and WTORS issues in need of clarification.

In partnership with the NCST, a strategy will be developed to identify a subset of local transportation districts representative of the range of district sizes, school district vs. contract provider approaches, rural vs. urban locations, and six geographic regions of the country. Collecting data from bus drivers who are broadly disbursed might best occur via a website designed for data collection. This site will offer both an online survey and a printable PDF survey that could be mailed or faxed back to the research team.

The project leader and project staff have previously set up and conducted web surveys in two previous wheelchair and transportation studies. The webserver resources and staff's technical expertise allowed integration of participant responses with databases, and monitoring of survey responses during the data collection period.

Addendum to Project P5: Resolution on Wheelchair WC19 Data Collection

Project Update

P5: July 2012 Project Update

Data collection on this study was closed on July 11, 2011. A total of 391 surveys were received. A summer student working with Patricia Karg at the University of Pittsburgh completed data analysis and produced a 10-page report summarizing survey results. These results were presented at the National Association for Pupil Transportation's Annual Summit in Cincinnati on 10/25/2011, and published in an online article in School Bus Fleet titled "Wheelchair use study discussed at NAPT Summit" on 11/7/2011. These data were also shared with the Editor-in-Chief of School Transportation News (STN online), and published in an online article in this trade magazine. The article was titled Wheelchair Securement Study ‘First of Its Kind’, written by STN staff writer Michelle Fisher, and published online 12/7/2011.

The investigators are currently re-examining the data to explore a potential the relationship between “type of training” received by drivers and “accuracy or completeness” results. The final manuscript on this study is in preparation and will be completed and submitted by Fall 2012.

P5: July 2011 Project Update

Activities during the reporting period started off with our 2009 summer engineering intern presenting her web-based study on state school transportation policies at the 2010 RESNA conference. In this presentation she summarized the results of a web-based review of transportation policies. The results are published in the Proceedings of the Annual RESNA Conference, Las Vegas, NV, June 2010.

The results of the State Directors survey were summarized in a paper submitted to the RESNA 2011 conference that was accepted for presentation as a poster presentation. The results are published in the Annual Proceedings of the RESNA Conference which was held in conjunction with the FICCDAT Conference in Toronto, Ontario, CA, June 2011.

The research team had previously developed a State-of-the-Science (SoS) Workshop White Paper on School Transportation of Students Seated in Wheelchairs, which was distributed to stakeholder experts who were invited to participate in the workshop. The workshop was held in conjunction with the Transporting Students with Disabilities and Preschoolers Conference in 2010 in Orlando, FL. We continued work on the white paper after input from attendees of the workshop and submitted the manuscript for publication in the Journal of Pediatric Rehabiliation Medicine (JPRM) as part of a special issue on transportation safety. A second paper on the results of the SoS Workshop has also been written and submitted to JPRM. When published, these articles can be located through Pub Med.

We developed the Phase II web-based survey, which is directed to school-bus drivers and attendants across the U.S. This survey focused on key issues related to driver training, and the prevalence of WC19-compliant wheelchairs and their contribution to the ease of using WTORS and improving safety. In January 2011, the survey was finalized and in February 2011, the University of Louisville IRB granted an exempt protocol approval (11.0051) for an online survey to be directed to school-bus operators (drivers) and attendants (aides). Announcement of the survey made in trade magazines, and electronically through state directors offices, and through a network of school transportation experts in both public and private sectors.  Data collection stopped in June 2011 with 391 responses. Data analysis will begin in June 2011 and a paper will be submitted for publication in the fall of 2011.

P5: July 2010 Project Update

In September 2009, the University of Pittsburgh approved the research protocol as exempt as did the University of Louisville in October. With these IRBs approved we were clear to proceed. The research team began work on a referenced review paper on school transportation for wheelchair-seated students. This paper is to serve as a reference for future peer-reviewed publications from this project. It will also serve to educate pediatric practitioners. The paper outlines the status of regulations, best practices, and key organizations in the field of student transportation. Additionally, our post-doctoral research assistant guided a summer engineering intern who summarized state transportation policies found on the web based upon inclusion of specific metrics in policies on bus specification and driver training. This work became both the substance of a poster presentation and a submitted and accepted paper to the RESNA 2010 Conference.

In October 2009 we began the work of converting our state-director survey into Survey Monkey format. The University of Pittsburgh has a license for full access to this tool so this became an optimal distribution method. The goal for survey distribution was early October 2009. Invitations to participate in the survey were sent out through the list serve of the Board of Directors of the National Association of State Directors for Pupil Transportation (NASDPTS). Despite best efforts and deadline extensions, only 30 surveys (out of the expected 50) were returned. The data were downloaded to Excel and then converted into a FileMaker Pro (FMP) database for study and analysis. Each record was analyzed for missing or ambiguous data. The research team determined essential follow-up questions for each state to capture the data that we found most state directors could provide. The goal is to focus on obtaining complete data on school-bus driver training, application of the National School Transportation Specifications and Procedures, inclusion of information in state policies affecting wheelchair-seated students, knowledge of WC19, and some very basic transportation demographics. Each investigator (Buning, Karg, and Frost) followed up with 10 state directors (total=30) to confirm data or identify another sources of data that were not provided - e.g. special ed mileage. Only a portion of the states completed the second brief, customized questionnaire. However, additional useful information was obtained. We sent the brief questionnaire to the states that had not responded and acquired three more responses for a total of 33.

We are now in the process of cross tabbing the web-based policy analysis completed by the University of Pittsburgh summer intern with the findings of our two efforts at data collection. The goal is to determine if these sources offer missing data or corroborate data provided. The FMP database is being updated to reflect the multiple data sources. The FMP database has shown itself to be an excellent tool for visual analysis of responses showing missing data and discrepancies in data reported.

The research team developed the State-of-the-Science (SoS) Workshop White Paper paper on School Transportation and distributed it to invitees. We have continued work on the referenced review paper and are planning to submit it for publication in a special issues on transportation of the Journal of Pediatric Rehabiliation Medicine (JPRM). This will involve adding the content and results of the SoS Workshop held at the Transporting Students with Disabilities and Preschoolers Conference.

We are now developing the Phase II survey, which is also a web-based survey but directed to school-bus drivers across the U,S. This survey will focus on key issues related to driver training, and the prevalence of WC19 compliant wheelchairs and their contribution to the ease of using WTORS and improving safety. Resources for contacting school-bus drivers were identified through a connection with Ted Finlayson-Schueler at the National Congress on School Transportation (NCST) in Warrensburg, MO. Ted, an industry consultant, has agreed to help up with contacts, blogs, websites, etc.

P5: July 2009 Project Update

This project will now be in two phases.

Phase 1: (years 3 and 4) will develop and distribute a questionnaire to state directors of pupil transportation.

Phase 2: (years 4 and 5) will target local school districts and survey a geographically representative sample of school-bus drivers.
Much of the work to date is background and preparatory in nature. Completed tasks include:

1. A database has been developed that includes all contact for all state directors of pupil transportation. Contact information includes name, position, address, email address, phone, fax and state pupil transportation website information.
   
2. A literature review including: a. mandatory federal motor vehicle safety standards as they apply to school buses and wheelchairs b. voluntary safety standards for wheelchairs and wheelchair tiedowns and occupant restraint systems c. best practice recommendations: i) National School Transportation Specifications and Procedures; ii) American Association of Pediatrics – statements on school transportation; iii) Documents and best practice recommendation from the RERC on Wheelchair Transportation Safety and the University of Michigan Transportation Research Institute. d. Data on pupil transportation for students who remain seated in wheelchairs while traveling on school buses. Including a review of information from stakeholder groups (government organizations, professional organizations, and consumer groups), demographic data, data from the US Department of Education on transporting students with special needs, and costs of transporting students with special needs.
3. A draft manuscript of a review of the literature review is near completion. Pediatrics journal has expressed interest in this topic.
4. A database has been developed that contains an extensive list of potential stakeholders interested in and contributing to safe transportation of students who use wheelchairs on school buses.
5. PI (Buning) and Co-I (Karg) attended the Transporting Students with Disabilities Conference where they had the opportunity to meet and network with pupil transportation professionals. Roseann Schwader and Charlie Hood helped coordinate a focus group with 8 members of the executive committee of the National Association of State Directors of Pupil Transportation Services (NSDPTS). The goal of this focus group was to gather a consensus of the types of information that State Directors typically can provide. Additional conversations occurred with Kathy Furneaux (Pupil Transportation Safety Institute) and Donna Labideau (National Director for First Student transportation service). First Student is a major contractor for school transportation services across the US.
   A draft version of the Phase 1 survey has been fully developed and has been forwarded to the focus group members (item 4) comprised to the NASDPTS board for feedback and comments.
6. IRB submission is proceeding in tandem at the University of Louisville and the University of Pittsburgh for the Phase 1 questionnaire.

P5 Annual Report 2007 (1.9 MB pdf)

Last updated: 07.13.2012