Automotive Access: Safely Transporting in Wheelchairs
Who is responsible?
A famous story tells of six blind men encountering an elephant for the first time. One man touches the elephant's trunk, another touches the tusk, another the animal's broad side, etc. Each comes away with a different idea of what an elephant is like.
Similarly, the people involved in wheelchair transit — wheelchair manufacturers, securement device manufacturers, automakers, van conversion manufacturers, mobility dealers, clinicians and government officials — may be aware of their own portion of this complex issue, but less familiar with the challenges faced in other segments.
For instance, since wheelchairs are what's being transported, it may seem obvious to hold wheelchair manufacturers at least partly responsible when it comes to safe transit. But is that fair?
Since April 2000, there has been a voluntary ANSI/RESNA standard — commonly called WC-19 — for wheelchairs used as seating in motor vehicles. WC-19, which includes crash-testing, requires the entire mobility system — base, seating and other components — to meet its safety requirements, which can be tricky for custom-built chairs using components from multiple manufacturers. Therefore, many wheelchairs — even some that have achieved WC-19 standards — recommend that users do not remain in the chairs during transport, in part because manufacturers cannot know how the chairs will be secured, in which vehicles, and with which occupants.
So do wheelchair manufacturers — or securement device manufacturers — bear a special responsibility for transit safety?
"Everybody has an equal responsibility for their individual part of it," says Sunrise Medical's Paul Banz. "Through ANSI/RESNA and ISO standards committees, everyone's kind of involved — the auto, transit, securement manufacturers and the dealers that actually install these devices. To me, it goes beyond a competitive issue. It's what's best for the industry and ultimately the people using the products."
Rose Ferreira of Q'Straint, maker of chair and occupant securement systems, agrees. "(For) all manufacturers that deal with transportation, their main focus is transporting people safely and securely," she says. "We think everyone has to share responsibility in making sure passengers are safely transported."
But while responsibility should possibly be shared among all participants, Quantum Rehab's Scott Higley says that hasn't happened on a practical level. "Currently, I think the auto industry (OEMs) has not been involved at all, except for programs where they offer some reimbursement for lift systems and things like that," he says. "It's such a small segment for them to dedicate a lot of resources — it just hasn't happened. So a lot of it has fallen back on the manufacturers of power bases or manual chairs, and also companies such as EZ Lock."
Spirit of Cooperation
The good news is that there is already considerable communication between wheelchair manufacturers and the other players.
"People in the industry — the providers of vans, manufacturers of docking systems and lifts, therapists, DME providers and consumers — have been very interested in talking to me about this subject," says Invacare's Ben Kingery. "Better communication leads to better designs. Invacare has been reaching out to more and more companies in these other segments. The information we are learning is unbelievably important, and I can already see these conversations are going to positively impact the transportation of wheelchairs."
"All our bases that could use an EZ Lock system, we send to EZ Lock, and we depend on their determination on whether or not, from their testing, the chair is EZ Lock capable," Higley explains, adding that Quantum Rehab also works with other securement manufacturers. "Since we now have the definitions on all the tie-down points and where they have to be mounted, we are going back and readjusting and designing new restrainment points, where in the past most manufacturers have called their restrainment points 'unoccupied' restrainment points. That's not (to indicate) that the units haven't been crash tested. There's always so many variables involved in crash testing that I think every manufacturer has (wondered), 'How can we say that in every situation, this is going to be okay?'"
On the retention-device end, Chris Hamilton of EZ Lock, a wheelchair docking system manufacturer, says, "Any wheelchairs that we decide we're going to interface with we'll get a model of that wheelchair. Then we develop an interface bracket for it, then we crash test it. Depending on how it fares during the crash test, then we will release brackets to the public." Hamilton says there's no "official type of relationship" between EZ Lock and the chair manufacturers, but adds, "They are fairly forthcoming with the chairs."
Says Q'Straint's Ferreira, "We have relationships with many manufacturers to help them come up with solutions for their wheelchair securement requirements."
As if the transit picture isn't complex enough, Higley expects the new "high-activity" power chair codes recently released by the Centers for Medicare & Medicaid Services (CMS) to also impact this issue. "(CMS) has kind of pushed the point with manufacturers and the whole industry," he says. "We have to go to all the component manufacturers, (such as) whatever seating you're using. Everybody's going to have to get into the game now. Let's say we sold a Quantum 600 and (the dealer) put a Motion (Concepts) tilt system on it. We need to be able to ensure that the marriage of their seating system and our base is safe. That communication line has to open up in the industry. For us to be successful, we're going to have to share a lot more of our information."
That success may ultimately require uniform standards, as well. "We are talking with manufacturers in these other segments and other industry experts on the subject," says Kingery. " We are committed to crash testing many of our manual and power wheelchair designs to the (WC-19) standard. However, the lack of established standards has been a difficulty faced by all the segments of the industry, and the federal government has chosen to not set any standards in this area."
There was universal agreement on whether chair transport should be an issue at all.
"Absolutely," says Banz. "If you think about the ADA laws, the intent is to give people access to technology. But in reality what ADA is saying is 'How do we help maximize their living?' From that standpoint, we are seeing more consumers wanting to get out."
Sue Johnson of Convaid, manufacturer of WC-19 lightweight, folding manual chairs, many used by children, is so passionate about the transport issue that she gives about 60 presentations per year at school districts, national and state conferences, etc. At a recent gathering, Johnson asked her audience how many of the wheelchairs they worked with would end up being transported in a vehicle at some point. All in the room raised their hands.
She gives these talks, Johnson says, because "we want our products to be used correctly." But she also admits that helping consumers understand safe transit goes beyond a single industry segment or manufacturer. Explains Johnson, "It's a good-will type of thing." — Laurie Watanabe
Is the Future of Auto Access Smart?
CONVERGING: FROM THE DRIVER'S SEAT
The umbrella organization overseeing the promotion of motor vehicle safety is the Department of Transportation's (DOT) National Highway and Traffic Safety Administration (NHTSA). NHTSA carries out safety programs and is responsible for reducing deaths, injuries and economic losses resulting from motor crashes.
But when people in wheelchairs are riding inside a motor vehicle, what entity is ultimately responsible for ensuring their safety? It might just depend on whom you ask.
Michael K. Shipp, assistant director for Rehabilitation Services at the Center for Biomedical Engineering and Rehabilitation Science at Louisiana Tech University doesn't believe one end of the industry should have more responsibility than another. "It's a systematic problem that calls for all to be involved in a 'big picture' manner."
The current Society of Automotive Engineers' Adaptive Devices Standards Committee has been working on tie-down standards for years, according to Shipp. "However, wheelchair manufacturers are not included as members of this group. Certainly everybody recognizes that wheelchair users are riding in vehicles."
According to Norm Simoes, rehabilitation engineer, California Department of Rehabilitation's Mobility Evaluation Program, "Wheelchair manufacturers kept their heads in the sand for years with respect to the issue of wheelchairs being transported in vehicles.
"Until the last few years, they did not even want to know that their wheelchairs were being crash tested by the securement manufacturers. Many wheelchairs were sold with small-print caveats such as 'Not to be used in a motor vehicle.' Fortunately, many wheelchair manufacturers are now at least becoming concerned about how widely their products are secured in vehicles."
When considering the components — or departments — that compose the big picture of wheelchair securement, the issue of responsibility becomes more complex. The primary list includes NHTSA, the Association of Driver Rehabilitation Specialists (ADED), the National Mobility Equipment Dealers Association (NMEDA), automakers, manufacturers of securement devices and van conversions as well as consumers.
Q&A: What Do Consumers Want?
NHTSA, ADED, NMEDA
NHTSA enforces safety performance standards for motor vehicles and motor vehicle equipment; conducts state and local highway safety programs; investigates safety defects; promotes consumer education on motor vehicle safety; and conducts research on driving behavior and traffic safety.
For people with disabilities, NHTSA recommends what it calls "a proven process" to gain freedom on the road. The consumer needs to:
- Evaluate his or her needs.
- Select the right vehicle.
- Choose a qualified dealer to modify the vehicle.
To ensure safety, NHTSA advises consumers to use ADED to find a list of certified driver rehabilitation specialists and NMEDA's quality assurance program (QAP) to find dealers. Driver rehabilitation specialists consult on compatibility and consumer transportation safety issues for people with disabilities. They give advice on modified vehicles and recommend wheelchair lifts and adaptive equipment. QAP is the only program within the adaptive equipment industry governing personal transportation. According to NMEDA, "it binds dealers to guidelines rooted in national safety standards, an in-house crash testing program and proven shop practices that assure the highest level of performance and safety."
QAP includes mandatory adherence to NMEDA's vehicle modification guidelines and on-site inspections by an independent engineering firm.
"The wheelchair must be designed to be used in the transportation mode," says Gene Morton, president of NMEDA. "QAP plays a major role in ensuring that the securement system is installed properly. In addition to the manufacturers' instructions, the NMEDA guidelines outline specific requirements for the installation of securement systems that ensure that best practices are followed."
QAP-accredited dealers are audited for compliance with certain aspects of the ADA, NHTSA's Federal Motor Vehicle Safety Standards and "Make Operative" mandates, according to NMEDA. QAP dealers maintain four types of insurance for liability:
1. Have certified welders on hand if they perform any type of structural modification to the vehicle.
2. Technicians need to be certified in the type of equipment they sell, install and service.
3. Records must be kept on all adaptive work.
4. Undergo annual inspection/audit process by an independent engineering firm to ensure compliance to NMEDA requirements.
According to NHTSA, it is the consumer's responsibility to use accredited services — such as ADED and QAP — and make wise vehicle selection choices, but it is the responsibility of the vehicle modification dealer to make sure the vehicle is properly modified. When it comes to dealers having the bulk of responsibility, many agree.
"The aftermarket modifiers have traditionally closed the gap between what the original equipment manufacturers (OEMs) produce and what consumers need," Simoes says. "Granted, companies such as Toyota have gone a little further to work with companies such as Independent Mobility Systems (IMS). They have made available specialty mobility packages for the Toyota Sienna which have components from parts bins of other Toyota vehicles to make the vehicle easier to modify. Other manufacturers have done this on a more limited basis, but all still tend to keep this buffer, of the aftermarket or second-stage manufacturers between the OEM and the drivers with disabilities."
Automakers, Manufacturers, Consumers
If automakers were to design vehicles to incorporate the securement of wheelchairs, many rehabilitation specialists cite several pros and cons. The pros include greater testing of products and integration of products; reduced cost; and reliability that the wheelchair securement would be as reliable as the rest of the vehicle. The cons include a wheelchair market too broad to be accommodated in the variations in a vehicle's design; consumer demand for the customization of wheelchairs; and a consumer base too segmented for it to be profitable to automakers.
"It has been my experience that while most of us would like to see mobility issues involving vehicles to be solved by the OEMs in most cases, that is unlikely to happen," Simoes says. "The broad range of wheelchairs on the market makes it challenging for automotive manufacturers to come up with a standard or a one-size-fits-all approach when designing vehicles for people with disabilities. OEM vehicles are traditionally designed to fit a user within so many standard deviations from the statistical norm with respect to strength, reach, as well as size. Wheelchair manufacturers, on the other hand, are accustomed to the varieties of disabilities that must be accommodated by their product."
The extensive variations of wheelchairs on the market make it difficult for automakers "to make a product which would meet the needs of enough people to make it worth it to the OEM," Simoes explains. "I have been told in the past that OEMs will not make plans to produce even as an option for a product if the expected market is less than approximately 50,000 units a year — except occasionally for promotional purposes. With the baby boomer market getting older, that increases feasibility for some options, but when it comes to getting wheelchairs into vehicles much more intrusive structural modifications are needed as well as ancillary devices, such as wheelchair securement and properly located safety belts. For these types of adaptations the annual sales volume is not there. In addition, the liability issues appear to be a concern."
Other industry experts have said:
- Anna Zevalalkink, mobility and vocational truck manager for Ford Motor Company, says, "Each manufacturer, be it of wheelchairs, vehicle modifications and completed vehicles, have their own design and development requirements. All OEMs conduct a rigorous design process that locates all vehicle operating controls to accommodate the vast spectrum of the population. The mobility aftermarket is thus positioned to adapt the vehicle to meet each person's unique requirement."
- Ford does not modify vehicles, but provides the aftermarket modifier with drawings and data to assist with the correct seating position and their unique modification. "When a vehicle is being adapted to secure wheelchairs, it requires the coordination of the specific chair and the vehicle," Zevalalkink says. "This may require a new floor, unique mounts on the floor or the chair. Automotive companies do not design wheelchairs, as they are very specified to each person. And thus, the mobility aftermarket is designed to meet the unique needs of the person and their wheelchair."
- Mike Wheelan, national manager of corporate communications at Subaru of America, Inc., says, "While Subaru does not actively work with wheelchair manufacturers or other entities in that industry, Subaru does design our vehicles with low liftover heights at both the trunk opening on sedan models, and the cargo areas on station wagon models. Cargo area floors are flat and very usable, thus facilitating the transport of these types of equipment. Subaru does offer those with physical disabilities assistance through our Mobility at Ease program toward the installation of hand controls or similar."
- Lloyd Updike, national sales manager with IMS, says, "In all the vehicles we build, it's required to have a manual wheelchair retention] system in place. We build (the vehicles) consistently to maintain quality. After that, it's up to the dealer to meet the individual customer's needs. We are a mass retailer on a small scale, if you will. The dealers take out vehicles and manual systems, and they elaborate on that according to customers' specific requirements."
The Final Step
Any person who uses a mobility device should be afforded the same level of safety as anyone else who uses a vehicle for transportation.
"The primary responsibility for the actions of any individual lies, of course, with the individual. Unfortunately, neither society nor any of the manufacturers have stepped up to the plate in educating people with disabilities about what is safe and what is not," Simoes says. "Witness the number of people riding in unsecured wheelchairs, throwing various objects onto the seat of a van, which can become deadly missiles in the event of an accident. Evaluation programs educate consumers, but many do not receive this kind of help."
Renee Tyree, CDRS and regional sales representative at Innovative Mobility, Tempe, Ariz. says, "I believe all people involved in the manufacturing of any of the devices that will be utilized to ensure the safe transportation of an individual who uses a wheelchair should be involved in addition to the wheelchair user. Transportation is a life reality, and each entity should acknowledge this and work with the wheelchair user toward ensuring compatibility of all devices. Writing waivers of liability that wheelchairs are not to be transported in vehicles in an attempt to limit responsibility is not understanding the consumer."
Is the Future of Auto Access Smart?
Is the Future of Auto Access Smart?
Freedom Lift's "smart" automotive access system — a combination of existing seat and lift technology, with robotic sensibilities thrown in — has been wowing mobility dealers since the National Mobility Equipment Dealers Association (NMEDA) show last February in Daytona Beach, Fla. So what's the scoop?
The project — known as the Automated Transport and Retrieval System (ATRS) — is the brainchild of Cook Technologies and Freedom Lift, with Carnegie Mellon University, Lehigh University and the University of Pittsburgh also involved, according to Cook president Tom Panzarella.
Simply put, a wheelchair user ready to disembark from inside a van or similar vehicle would deploy the chair lift, thereby lowering the wheelchair to the ground. The user would then "call" the wheelchair, which would roll up alongside the user. Meanwhile, the user's van seat would have rotated and lowered to enable the user to transfer into the wheelchair.
The user would have also activated doors to open, unlocked the wheelchair docking system, and used a camera/monitor system to make sure there was adequate clearance to operate the lift and summon the chair.
Once summoned, the wheelchair "will robotically move from the dock on the platform, around the van, to the side of where the driver or passenger is egressing the van," Panzarella explains. When the chair is in motion, it will be able to "sense" obstacles — such as a child darting in front of it — and stop to avoid collisions, he says. The system is designed to be modular, so consumers could purchase specific portions if they don't need all of the functions.
So how close is ATRS to reality?
"There are three phases: proof of concept, hardening (field testing) and commercialization," Panzarella says. "Between the hardening and the commercialization phases, there are beta test sites, and that's where the University of Pittsburgh comes in. The robotics and wireless communication, navigation and obstacle avoidance is through both Lehigh University and Carnegie Mellon University." Panzarella indicates that the proof of concept "is going to be demonstrated in several places in June."
Is this the future of automotive access, and if so, what impact would it likely have on the industry, from dealers to manufacturers? Stay tuned!
Q&A: What Do Consumers Want
Q: What will be the next big consumer demand to drive automotive access innovation?
A: Ease of use and flexibility are, and will continue to be, drivers of innovation. Lifts that carry either a power chair or a scooter and adapt to different vehicles should user needs change are examples of what consumers are looking for. Customers in the automotive access industry are just like customers anywhere: They want as many options as possible. — Chad Williams, Harmar Mobility
A: Innovation is driven by manufacturers listening to feedback from both the servicing DME dealer and from the end-user. The ability to be innovative as a manufacturer is being threatened by the fact that the product is being quickly copied and imported from overseas and sold at low margins. As consumers and even some DME dealers are making price the determining factor in purchasing, it discourages the domestic manufacturer (from bringing) new technologies and innovations to the marketplace, as it is costly and time consuming to do so. — Judson Branch, EZ-Access
A: We are seeing consumers today are more aware of mobility products. A trend I think we will see is consumers demanding more and more specific product solutions for their unique mobility challenges. We anticipate that consumers will continue to require new and innovative assistive product solutions that not only meet their mobility challenges, but provide the maximum comfort and style as well. — Mark Roberts, Vantage Mobility International
A: Convenience. Price point — that always figures into the equation. And flexibility — (a product) that can be changed quite easily from vehicle to vehicle. — Greg Moll, Roll-A-Ramp
This article originally appeared in the June 2005 issue of Mobility Management.