The annual Transporting Students with Disabilities & Pre-Schoolers Conference — this year held in March in Louisville, Ky. — brings together schoolbus drivers, clinicians and other professionals in the transport industry. For the past couple of years, the conference has featured educational sessions involving transporting children in wheelchairs and WC-19, the nickname of the voluntary standard Section 19 ANSI/RESNA WC Volume 1: Wheelchairs used as seats in motor vehicles.
MM chatted with Julie Jackson, group product manager/power mobility for Invacare Corp., after she returned from participating in a rehab panel discussion at the conference. For more information on the conference — the 2008 event will be in Little Rock, Ark., March 7-12 — go to www.eduprogroup.com.
Mobility Management: Who attended and participated in the session you were in?
Julie Jackson: It was mainly schoolbus transporters and a few therapists. From this industry, it was Larry Schneider from the University of Michigan, Dan Lipka from Miller’s, Tom Whelan from Sunrise Medical and myself.
MM: What was your topic?
Jackson: Providing the WC-19 Transit Option: Lessons Learned from Compliance Testing & Expectations for the Future. Between the four of us, we were asked to prepare a 15- to 20-minute presentation individually on this topic.
So it was really interesting, because Larry Schneider presented on WC-19 and what it means for a manufacturer to crash-test. He went through more of the technical information and basically told everyone in the audience that just because you see a chair with transport brackets doesn’t mean it was crash-tested to WC-19.
And then Dan Lipka presented, and he took it from the supplier’s standpoint, which is that in Ohio, for example, you cannot deny a student to be transported. However, there’s nothing that states that anyone has to pay for that transport option. So the school system isn’t required to pay for it. It’s left to the family to pay for it, or it’s left to the supplier to basically eat that cost, because every manufacturer charges for it. So his argument was we don’t have a HCPCS code for it, and we need to figure out a way. If it is so necessary for every kid to be transported, which it is, we have to do it in a responsible manner, which is to give them a transport option.
Then I presented, and for me it was taking a look from the manufacturer’s standpoint — what does it mean for us to crash-test to WC-19, how does it mean we manufacture our product differently, taking into consideration the design and knowing we’re going to have to meet WC-19. Then also at the very end, I said as an industry we have to fight to try to have the Department of Transportation recognize us and approve a standard.
Sunrise also presented, and theirs was similar in taking a look from the (manufacturer’s) standpoint as well.
MM: Making a wheelchair transportable means more than just offering tie-down points, doesn’t it?
Jackson: Exactly. There are so many different things, such as having radiused edges: Any point that comes within 50mm of the strap has to have a 2mm radius. That’s what I think a lot of people don’t understand. They think that all we’re doing is putting a bracket (on the chair), so they don’t always understand why we have to charge for it. But there’s a lot of cost that goes into developing the chair just to meet the WC-19 option. We estimate that our cost is about 10- to 15-percent higher for a chair that is WC-19 tested as opposed to a chair that isn’t. That’s why we have to charge for it. We’re not trying to make money; we’re just trying to cover our costs.
MM: So it’s the entire engineering of a WC-19 product — because there’s so much more to it than just adding tie-down points — that is adding to the entire cost.
Jackson: That’s correct.
MM: Were attendees familiar with this topic?
Jackson: Everybody who’s there is committed to transporting students and doing it safely. So they’re all committed to this topic. As far as how familiar they were with WC-19, I think that was mixed. Some people really knew what it meant to be WC-19 compliant. Others didn’t — they didn’t realize it is an actual crash-test conducted at 30 mph and that in order for the chair to be compliant with WC-19, it has to have a specific lapbelt. They might have thought any seatbelt, any seat positioning strap would qualify. And that’s not true. That actually came up during the panel discussion. Someone asked, “Is a seatbelt that’s attached with Velcro just as safe as a seatbelt that has a metal buckle?” The answer to that was no — the only lapbelt that is approved is a WC-19 compliant lapbelt, and that has the metal buckle.
MM: How familiar were attendees with the children’s clinical needs? Did attendees know, for instance, that some of the children they’re transporting in wheelchairs don’t have a lot of upper-body strength, or that if you swap out the lapbelt, you’re going to change their positioning and many children can’t reposition themselves?
Jackson: They are very familiar clinically with the disabilities that the children have, because they would mention that a lot of the children would have chest positioning straps, that they already have positioning straps to keep them properly positioned in the chair, so how come those straps wouldn’t be sufficient in the case of a crash? And we would have to explain those straps are ONLY positioning straps — they’re only there to keep them in the proper position. They’re not meant to be a restraint in the case of an accident. But attendees were very familiar with the diagnoses and how they need to position the children with those disabilities.
MM: It sounds very encouraging that the conference brought in four rehab specialists — sounds as if the conference managers wanted to build upon the WC-19 discussion that started last year.
Jackson: I would agree. And during the panel discussion, there was an opportunity for members of the audience to ask challenging questions about what they see on a daily basis. An example of a question was “If I’m transporting a student in a chair and I need to have them reclined or they’re in a tilted position for comfort and positioning, what does that mean? Are they still safe?” Larry Schneider was the proper person to answer that, and he referred them to the Web site (www.rercwts.pitt.edu/), where he has a frequently asked questions section, and he does talk about the proper amount of tilt and the proper amount of recline in a seat where it’s still considered to be safe. Once you go past a certain tilt and recline parameter, it’s no longer considered safe.
Another question that came up was “How do you transport a backpack?” Children all have backpacks, so how are they supposed to tie that down? Do you leave it hooked to the chair?
The obvious answer is no, because it could become loose and hit someone. But that’s when someone else in the audience brought up a solution: They said that they tie it down to the floor, just like they do a chair. Another person in the audience said they recommend that the children they transport have two sets of books — one that’s kept at school, and one that’s kept at home — so they never have to transport a backpack. What was nice was that there were members of the audience that could help each other out.
There were over 400 attendees, and there were probably 75 to 100 who attended this particular panel discussion. It was a very good audience.
MM: If you attend this event again, what would you like to discuss, based on what you heard this year?
Jackson: With the crash-testing option we know there are some things that our audience would like us to have. Like for example, they would love to be able to retrofit the option, and we can’t do that. I did touch upon it, but I could tell they weren’t happy with that answer. What happens a lot of times is that they order the chair and either the provider forgot to ask or the family forgot to say they needed the transport option. So they get this brand-new chair in, and we have no way to tie it down. In power, at least, we have no way to retrofit. It goes back to the importance of asking the question — Do you need the transport option? — and reinforcing the importance of putting it on at initial use, because it may be difficult or impossible to add it after the fact.
MM: Because we’re talking about the engineering of the full product?
Jackson: Exactly. It’s not just brackets. In the case of power, it’s a reinforced battery box, it’s different fork stems that are used for the casters… it’s just different components used throughout the product. We would have to take the chair completely apart and rebuild it.
Also, making sure everyone realizes there is no unified standard. Even though we have WC-19, and that’s a great specification and really that’s all we can test to at this point, it’s a voluntary standard. There’s nothing forcing every manufacturer to test to it. And the Department of Transportation has not approved any tie-down system. So we really need to keep pushing that issue.