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Safety of front versus second or third row vehicle conversion for wheelchairs

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Safety of front versus second or third row vehicle conversion for wheelchairs

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Please note:

The research and literature reviews collated by our TAB Research Team are not to be

shared external to the Branch. These are for internal TAB use only and are intended to

assist our advisors with their reasonable and necessary decision-making.

Delegates have access to a wide variety of comprehensive guidance material. If

Delegates require further information on access or planning matters they are to call the

TAPS line for advice.

The Research Team are unable to ensure that the information listed below provides an

accurate & up-to-date snapshot of these matters

Research question: Is it less safe to sit in the front passenger or driver position of a vehicle in a wheelchair, compared to second or third row?

Date: 05/10/2021 Requestor: Sally s22(1)(a)(ii) - irrelevan Endorsed by (EL1 or above): Nicole s22(1)(a)(ii) - irreleva Cleared by: Felicity s22(1)(a)(ii) - irrelev

  1. Contents

Safety of front versus second or third row vehicle conversion for wheelchairs …………………….. 1

  1. Contents ……………………………………………………………………………………………………….. 1

  2. Summary ………………………………………………………………………………………………………. 2

  3. Vehicle transportation safety issues for wheelchair passengers …………………………….. 2

  4. Wheelchair seated passenger safety guidelines in Australia …………………………………. 3

4.1 NSW Guidelines for Modifying Vehicles for People with Disability ………………………. 3

4.2 Australian Transport Safety Guidelines for People with a Disability …………………….. 4

  1. Safety of front row versus back row seats for wheelchair seated passengers ………….. 4

  2. References ……………………………………………………………………………………………………. 6

  3. Version control ……………………………………………………………………………………………….. 7

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  1. Summary

Wheelchair users who are unable to be transferred into car seats require car modifications to be safely transported while seated in their wheelchair. Passengers who are seated in a wheelchair are more likely to be involved in crashes and experience non-crash related injuries than passengers seated in car seats.

The Australian Transport Safety Guidelines for People with a Disability and the NSW Guidelines for Modifying Vehicles for People with Disability outline guidance for vehicle modifications for wheelchair seated passengers based on the Australia/New Zealand requirements for Technical Systems and Aids for People with Disability.

None of these guidelines specifically recommend that the front or back car seats are safer for a wheelchair seated passenger. However, they outline important considerations for deciding where a wheelchair seated passenger should be positioned in a vehicle, such as the amount of head room, the size and model of the wheelchair, the type of vehicle, and the preference of the wheelchair seated passenger.

Research shows that the front passenger seat is safest for those seated in car seats aged over 15 as airbags prevent serious injury for older passengers, however there are no studies specifically investigating the differences in risk of injury between front and rear seated wheelchair passengers. Limited evidence suggests that airbags are beneficial for many adult wheelchair seated vehicle occupants.

Due to the lack of research on the impact of seat position on safety for wheelchair seated passengers, it is most important to focus on ensuring that the vehicle modification complies with the AUS/NZ requirements for Technical Systems and Aids for People with Disability. The position of the wheelchair seated passenger in the vehicle should be in a position where the safety requirements are best met, which may be in either the front or back rows depending on factors such as the model of the wheelchair and vehicle.

  1. Vehicle transportation safety issues for wheelchair passengers

When travelling in a vehicle it is safest to be seated in the original equipment manufacturer’s seat [1]. However, some people with disability who use wheelchairs are unable to transfer into a car seat or are required to remain in their wheelchair for posture support [2]. These passengers enter and travel inside the vehicle while remaining seated in their wheelchair, with the wheelchair secured to the car using a four-point strap tiedown system [3] or a wheelchair docking system [4].

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Vehicle drivers and passengers who remain in their wheelchair are more likely to be involved in crashes than those who transfer to standard vehicle seats [1]. Wheelchair passengers are also more likely to experience non-crash related injuries, particularly in private vehicles [1].

The most common causes of serious or fatal injuries to passengers seated in wheelchairs are improper, incomplete or non-use of seat belt restraints [5], and incorrect wheelchair securement [6]. Improper seat-belt use can be due to wheelchair designs that make positioning the seatbelt properly difficult, or inadequate training of wheelchair user or caregiver on the procedure for properly positioning seatbelts [5]. Wheelchair seated passengers are also at greater risk of serious injury if they are facing sideways or backwards [3].

  1. Wheelchair seated passenger safety guidelines in Australia

4.1 NSW Guidelines for Modifying Vehicles for People with Disability

According to the NSW Guidelines for modifying vehicles for people with disability, a wheelchair occupant must be secured using the vehicle’s original seatbelt, with the frame of the wheelchair restrained separately [7]. The Wheelchair Tie-down and Occupant Restraint System (WTORS) must comply with the Australian/New Zealand guidelines, including:

 OEM seatbelts incorporating pre-tensioners should be retained as part of a vehicle’s supplementary restraint system if the modification allows.

 A lap-only seatbelt should not be fitted where the WTORS is replacing an occupant seat that was previously fitted with a lap-sash seatbelt.

 Adequate space for forward head excursion, that being:

o 950mm when used with a lap-only seatbelt

o 650mm when used with a lap-sash seatbelt.

 The wheelchair’s own postural support shall not be used unless certified as a wheelchair anchored belt restraint.

 Seatbelts and restraints shall be kept clean and coiled within the retractor when not in use.

 Seatbelt and WTORS webbing shall be protected from sharp edges or protrusions.

 A WTORS release mechanism should be within reach of the wheelchair occupant and marked or labelled to assist the user.

 Seatbelts and WTORS should be able to be released using one hand.

The guidelines outline that a wheelchair docking system can also be used to secure the wheelchair inside the vehicle. The docking system must comply with the AUS/NS standards

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and be compatible with the passenger’s wheelchair. A headrest and backrest with enough strength to reduce risk of injury in the event of a crash is also required.

4.2 Australian Transport Safety Guidelines for People with a Disability

The Transport Safety Guidelines for People with a Disability outlines a checklist for key considerations when deciding the type of vehicle modification to suit a wheelchair user’s needs [8]:

 Overall height of the person sitting in the wheelchair, e.g. top of head to ground. Check door opening and height.

 Does the wheelchair need additional room to be restrained (is wheelchair longer/wider than most?).

 Where the passenger would like the wheelchair passenger to be positioned in the vehicle.

 Number of other passengers to travel in the modified vehicle with the wheelchair passenger.

 Positioning of rear compartment seats in relation to the wheelchair position.

 Position of wheelchair passenger in relation to other fittings in the rear compartment e.g. air conditioning vents.

 Door opening height of garage/carport.

 Clear area for wheelchair passenger to enter/exit the vehicle.

 Is rear or side access best for your needs?

  1. Safety of front row versus back row seats for wheelchair seated passengers

Both the NSW and Australian Transport Safety guidelines offer no specific recommendation for whether the front passenger or back row seats are safer for wheelchair seated passengers [7,8]. The only specific recommendation for seating position in these guidelines is that wheelchair seated passengers should face forward. These guidelines outline many considerations when deciding how to modify a car for a wheelchair seated passenger, including the preference of the wheelchair user, the number of passengers travelling in the modified vehicle, the height of the wheelchair user, the car model, and the position of the wheelchair passenger relative to other fittings in the car. These different considerations would likely mean that the safety difference between the front and the back seats would depend on many factors such as the car model, the wheelchair model, and the passengers using the vehicle.

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There is a lack of research on the impact of seat position on safety of wheelchair seated passengers. Most research on vehicle transport safety for wheelchair seated passengers focuses on comparing the effectiveness of different wheelchair restraint systems, different wheelchair models, and the use of seatbelts [5-6, 9-14]. For car seated passengers in cars manufactured after 1996, front seats are safer than back row seats for occupants over 15 years old, and back row seats are safer for passengers 15 years and younger [15]. It is not known if these results are the same for wheelchair seated passengers. The difference in safety between front and back row seats for car seated passengers is due to the deployment of airbags in the front seats, but not back seats, in the event of a crash. Airbags prevent serious injury for older passengers but can cause injury in children [16].

The Australian Transport Safety Guidelines provide no guidance around airbags for wheelchair seated passengers [8]. The NSW guidelines state that an exemption from the NSW Road and Maritime services is required if airbags are deactivated or removed as part of a vehicle modification [7]. There is no research investigating the effectiveness of airbags for wheelchair seated passengers, however there is one study which investigated the effectiveness of airbags for wheelchair seated drivers [17]. This study found that airbags are generally effective at reducing the risk of head and neck injuries for wheelchair seated drivers, however the airbags can cause serious injury if the driver is required to sit very close to the airbag module in order to operate the modified vehicle. It is therefore possible that airbags could be beneficial for adult wheelchair seated passengers if they are not seated too close to the airbag module. It is important to note that this study only investigated frontal impact crashes in one car model and one wheelchair type, so further research is required to confirm if airbags are effective for all wheelchair seated vehicle occupants under different crash conditions [17]. This study also only investigated the effectiveness of airbags on adults in wheelchairs, however it is likely that if airbags cause injury to car seated children aged 15 and under [16], they could also cause injury to wheelchair seated children.

Due to the lack of research on the impact of seat position on safety for wheelchair seated passengers, it is most important to focus on ensuring that the vehicle modification complies with the AUS/NZ requirements for Technical Systems and Aids for People with Disability to ensure that the passenger is safe [7,8]. This includes the correct amount of head room, correct Wheelchair Tie-down and Occupant Restraint System and seatbelt, and ensuring that the wheelchair is facing forward. The position of a wheelchair seated passenger in the vehicle should be where the safety requirements are best met and considers the preference of the passenger. The safest position in the vehicle may be in either the front or back rows depending on factors such as the wheelchair model, vehicle model, and the vehicle passengers [7,8]. The location of airbags and may also be considered when deciding seating position, with some evidence suggesting that airbags can prevent serious injury for wheelchair seated adults [17] but are known to cause injury to car seated children aged 15 and under [16].

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  1. References

  2.  Fitzgerald SG, Songer T, Rotko KA, Karg P. Motor vehicle transportation use and related adverse events

among persons who use wheelchairs. Assistive Technology. 2007 Dec 31;19(4):180-7.

  1. Buning ME, Bertocci G, Schneider LW, Manary M, Karg P, Brown D, Johnson S. RESNA's position on

wheelchairs used as seats in motor vehicles. Assistive technology. 2012 Jun 1;24(2):132-41.

  1.  Schneider LW, Manary MA, Hobson DA, Bertocci GE. Transportation safety standards for wheelchair

users: a review of voluntary standards for improved safety, usability, and independence of wheelchair-seated travelers. Assistive technology. 2008 Dec 31;20(4):222-33.

  1. Hobson DA, van Roosmalen L. Towards the next generation of wheelchair securement—development of

a demonstration UDIG-compatible wheelchair docking device. Assistive Technology. 2007 Dec 31;19(4):210-22.

  1.  Schneider LW, Klinich KD, Moore JL, MacWilliams JB. Using in-depth investigations to identify

transportation safety issues for wheelchair-seated occupants of motor vehicles. Medical engineering & physics. 2010 Apr 1;32(3):237-47.

  1.  Wolf PJ, van Roosmalen L, Bertocci GE. Wheelchair tiedown and occupant restraint system issues in the

real world and the virtual world: Combining qualitative and quantitative research approaches. Assistive Technology. 2007 Dec 31;19(4):188-99.

  1.  Vehicle Standards Information – No.21 Guidelines for modifying vehicles for people with disability

[Internet]. NSW Government Road and Maritime Services, 2019 [cited 2021 Oct 12]. Available from: Vehicle Standards Information – No. 21 (nsw.gov.au)

  1.  Transport Safety Guidelines for People with a Disability [Internet]. Hornsby (AU). Speech Pathologists,

Physiotherapists and Occupational Therapists on Developmental Disability, 2010 [cited 2021 Oct 12]. Available from: Microsoft Word - TranSPOT Yellow Book Rev2.doc (disabilityspot.org.au)

  1. Van Roosmalen L, Ritchie Orton N, Schneider L. Safety, usability, and independence for wheelchair-

seated drivers and front-row passengers of private vehicles: A qualitative research study. Journal of Rehabilitation Research & Development. 2013 Mar 1;50(2).

  1. Fuhrman SI, Karg P, Bertocci G. Characterization of pediatric wheelchair kinematics and wheelchair tiedown and occupant restraint system loading during rear impact. Medical engineering & physics. 2010 Apr 1;32(3):280-6.

  2. Salipur Z, Bertocci G. Wheelchair tiedown and occupant restraint loading associated with adult manual

transit wheelchair in rear impact. Journal of rehabilitation research and development. 2010 Feb 10;47(2):143.

  1. Schneider LW, Manary MA, Hobson DA, Bertocci GE. Transportation safety standards for wheelchair users: a review of voluntary standards for improved safety, usability, and independence of wheelchair-seated travelers. Assistive technology. 2008 Dec 31;20(4):222-33.

  2. Senín AR, Sáez LM, Corral TV. Experimental evaluation of the wheelchair occupant protection under different impact conditions using commercial wheelchairs. International journal of crashworthiness. 2006 May 1;11(5):425-41.

  3. Van Roosmalen L, Karg P, Hobson D, Turkovich M, Porach E. User evaluation of three wheelchair securement systems in large accessible transit vehicles. Journal of Rehabilitation Research & Development. 2011 Oct 1;48(7).

  4. Bilston LE, Du W, Brown J. A matched-cohort analysis of belted front and rear seat occupants in newer

and older model vehicles shows that gains in front occupant safety have outpaced gains for rear seat occupants. Accident Analysis & Prevention. 2010 Nov 1;42(6):1974-7.

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  1. Arbogast KB, Durbin DR, Kallan MJ, Elliott MR, Winston FK. Injury risk to restrained children exposed to deployed first-and second-generation air bags in frontal crashes. Archives of pediatrics & adolescent medicine. 2005 Apr 1;159(4):342-6.

  2. Hu J, Orton N, Manary MA, Boyle K, Schneider LW. Should airbags be deactivated for wheelchair-seated drivers?. Traffic injury prevention. 2020 Oct 12;21(sup1):S37-42.

  3. Version control

Version Amended Brief Description of Change Status Date by

0.1 MBK223 First draft First Draft 12/10/2021

0.2 AHR908 Comments and revisions - 12/10/2021

0.3 MBK223 Interim Revisions Second Draft 12/10/2021

1.0 FFM634 Final revisions Final Version 23/11/2021

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