Safe Transport for Children with Special Health Needs Brian - - PowerPoint PPT Presentation

Safe Transport for Children with Special Health Needs

Brian Perkowski, PT , ATP , CRTS February 2nd, 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

• r 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

1)

Understand three (3) ANSI/RESNA standards for Wheelchair Transportation Safety in motor vehicles.

2)

Identify three (3) types of alternative child passenger restraint systems.

3)

Discuss considerations and adaptations for transportation of individuals who are medically fragile.

4)

Recognize when to refer to a seating and mobility clinic 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

• n 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

http://www.convaid.com/school-safety-i-4-l-en.html

Video 1

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 Hardened bolts Vehicle anchor points WTORS Correct belt placement Poor 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 Columbia Spirit Convaid Carrot Merrit Roosevelt Britax Traveller Plus SnugSeat Pilot

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

• r online

 Others need Rx and LMN from a vendor

Safe Transport for Children with Special Health Needs

Safety Vests

RideSafer Vest – Safetrafficsystem.com The Churchill

• Merritt

The Chamberlain

• 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 – with zipper in back E-Z-On harness – with adjustable front

Safe Transport for Children with Special Health Needs

Safety Harnesses – Modified E-Z-On Harness

Mod E-Z-On harness – for single leg cast Mod E-Z-On harness – 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

The Jefferson – for omphalocele protection – from Merritt Buckle guard – from Merritt Chest clip guard – from Merritt Rolled towels or noodles – NEXT to the child, never behind

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!

Safe Transport for Children with Special Health Needs

Tilt degree

 30 degree tilt to the horizontal is acceptable when riding

in a wheelchair used as a seat in a moving vehicle or when in a child passenger safety restraint that has the approved capability of reclining.

 Considerations must be made when using a lap shoulder

• belt. Shoulder belt must be lowered on

the side wall of vehicle (and in some cases moved rearwards) in order to contact the shoulder and collarbone at the appropriate position.

Safe Transport for Children with Special Health Needs

Decreased Head Control

If 30 degrees tilt is not achievable (or more is needed), a soft collar should be considered. Hard collars should never be used and the collar should never be permanently mounted to a wheelchair or other travel equipment.

Danmar Hensinger Danmar Swirl

Safe Transport for Children with Special Health Needs

Tracheostomies

 Should never be a barrier to transportation  A team approach may be needed to determine the

best transportation solution

 Most often, a combination of tilt/recline is needed

for safe transport with a tracheostomy

 Tracheostomy and all tubing should be clear and

not blocked by passenger restraint

 All necessary equipment should be secured to the

wheelchair or under vehicle seats - Equipment should not be loose on the floor

Safe Transport for Children with Special Health Needs

Oxygen tanks and other equipment

 If user is in wheelchair, there are few “transit

approved” Oxygen tank holders. Since BREATHING trumps best practice, if Oxygen is required during transit, team may agree that wheelchair will have an Oxygen tank holder.

 An Oxygen tank should never be placed under a

• wheelchair. If tank holder is not available, tank

should be secured to the vehicle during transit.

 Suction, Pulse oximetry, and other machines should

be stowed and secured without exception.

Safe Transport for Children with Special Health Needs

Understanding a Seating and Mobility Clinic

 Equipment obtainment is typically is a lengthy process – if

equipment is needed right away, consider a local loaner closet.

• Many pediatric hospitals have loaner programs.
• Expect 2-4 months for acquisition of equipment.

 Most clinics work with a Complex Durable Medical

Equipment/Complex Rehab vendor to submit to insurance for the recommended and medically necessary items.

• Typically have many different types/brands of equipment
• Client can see, feel and actually trial devices
• May even be an in-home trial period or multiple visits to trial
• A referral to the clinic is highly recommended for individuals

who are medically fragile

Safe Transport for Children with Special Health Needs

When to Refer to a Seating and Mobility Clinic

 Special needs car seats are often over-prescribed.

Do your research! There are commercially available car seats with 5 point harness systems to accommodate larger weight limits (up to 65 pounds).

 Tricycles / jogging strollers are not typically covered by

insurance and do not need a referral to a seating and mobility clinic. These can often be spec’d out by a therapist in the

• utpatient setting or purchased directly from the

manufacturer working closely with parent and the child’s measurements.

Safe Transport for Children with Special Health Needs

When to Refer to a Seating and Mobility Clinic

 Understand that referral to a seating and mobility clinic is

not an “end-all”. There is no obligation to move forward with any piece of equipment that is presented.

 At a minimum, it may expose the team to other

equipment options available.

 Education is a step in the right direction.

Safe Transport for Children with Special Health Needs

Closing Comments

 The Safe Transport of Children with Special Health Needs

is an ongoing and ever-evolving topic.

 It is best approached by a team of individuals from many

aspects of the child’s daily life.

 Following Best Practices with the available equipment on

the market, while using common sense will ultimately result in the best outcome.

 The best outcome is that the child is able to ride in a

motor vehicle more safely than he or she would have without intervention.

To obtain a certificate of attendance, please email your name and credentials to:

Certificates@iprc.info

Safe Transport for Children with Special Health Needs

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Presenter Contact Information

Brian Perkowski

bperkowski@nsm-seating.com

Safe Transport for Children with Special Health Needs

Questions / Comments?

Safe Transport for Children with Special Health Needs

References

UMTRI - http://wc-transportation-safety.umtri.umich.edu/home Crash Test Video compilation https://www.youtube.com/watch?v=8ZLHeTeGyWw Convaid – www.convaid.com SnugSeat – www.r82.com Merrit Manufacturing – www.eztether.com Columbia Medical – www.columbiamedical.com RideSafer – www.safetrafficsystem.com/vol5/products Danmar – www.danmarproducts.com EZ On Harness – www.ezonpro.com