Transfer & Transport Simon Wells MSc DCR (R) Moving & Handling Advisor Kings College Hospital NHS Foundation Trust, London & Queen Victoria Hospital NHS Foundation Trust, Sussex

Aim Transfer – (non-emergency) In/out of vehicles – client, equipment (wheelchair, hoist ) techniques equipment Transport – (routine) guidance Sources of information

Legislation & Regulation • The European Bus Directive 2001/85/EC, Annex VII, Paragraphs 3.8.2.8 and 3.8.2.9. • European Directive 76/115/EEC, Anchorages for motor vehicle safety belts. • European Directive 77/541/EEC, Safety belts and restraint systems of motor vehicles. • UNECE Regulation 14.04, Safety belt anchorages. • UNECE Regulation 16.06, Safety belts and restraint systems. • UNECE Regulation 107.02, Approval of M2 and M3 vehicles, general construction. Annex 8, Paragraphs 3.8.3.8 and 3.8.3.9. • The Public Service Vehicles Accessibility Regulations 2000, SI 1970. • BS ISO 10542 Wheelchair tie-downs and occupant restraint systems: Part 1 - Requirements and test methods for all systems. systems: Part 2 - Four-point strap type tie-down systems. • ISO 10542 Wheelchair tie-downs and occupant restraint systems: Part 3 - Docking type tie-down systems. • BS EN 1789: 2007 Medical vehicles and their equipment, Road Ambulances. • SAE J2249 Wheelchair tie-down and occupant restraint systems for use in motor vehicles. For other global standards, please contact our Engineering team

Legislation & Regulation Wheelchair tie-downs & occupant restraints 'WTORS Min. req - WTORS - ISO 10542 (parts 1-5). All WTORS are required to pass a simulated crash test at 20g/48kph using an 85kg surrogate wheelchair and 75kg ATD occupant. ISO 10542 compliant WTORS satisfy req. - European Whole Vehicle Type Approval for Wheelchair Accessible Vehicles under the Special Purpose Category, The European Bus Directive 2001/85/EC, UNECE Regulation 107 and the UK Public Service Vehicles Accessibility Regulations (PSVAR) 2000. ISO 7176 Part 19 - Wheeled Mobility devices for use as seats in motor vehicles ISO 7176 Part 19 wheelchair manufacturers with min. design performance req.& assoc., test methods for manual & powered wheelchairs intended for use as a forward-facing vehicle seat in a road passenger vehicle. Vehicle Seat fixtures UNECE Regulation 14, or Directive 76/115/EC, as amended by 2005/47/EC. specify seatbelt anchorage load requirements by vehicle category: M1 Vehicles: Vehicles for the carriage of passengers comprising no more than eight seats in addition to the driver. M2 Vehicles: Vehicles for the carriage of passengers comprising more than eight seats in addition to the driver's seat and having a maximum mass not exceeding 5 tonnes. M3 Vehicles: Vehicles used for the carriage of passengers comprising more than eight seats in addition to the driver' seat and having a maximum mass exceeding 5 tonnes Seatbelts design and performance requirements of UNECE Regulation 16 and the Directive 77/541/EC, as amended by Directive 2005/40/EC. Floor & Anchorage Systems requirements of UNECE Regulation 14 & Directive 76/115/EC as amended. .

Transfer & Transport: People & equipment Independent Mobile & requiring assistance Wheelchair users can transfer can not transfer Existing assessment - follow guidance If no assessment ensure it is undertaken & documented to ensure a safe system of transfer for both client & carer

Transfer: in/out of vehicles Options: - Small handling aids (SHA) Swivel Seats Hoists Wheelchair systems Wheelchair accessible vehicle (WAV) Increasing cost

Transfer: In/Out of vehicles: SHA Dependant on assessment and design of car, height of transfer surfaces, size of individual, space, degree of mobility of individual etc Equipment which may assist: – Transfer boards Turn tables Rota stands Slide sheets Transfer bar…..

Small Handling Aids (SHA) No adaptations required for these options Handy bar - acts as a grab bar, lightweight stainless steel bar with soft, non-slip hand grip Non slip handle and simple to use slides into car door latches - can be used on nearly any car door frame Car Caddie Provides an additional hand hold & loops over top part of door/window frame Transfer board Person can slide from seated surface in/out of vehicle seat Soft turntable Helps user swivel their bottom and move their legs into/out from the vehicle ‘slide aid’ – may need to be removed before driving

Swivel Seats Whole seat swivels - Rotate 90º or Rotates coupled with a lifting & lowering function Transfer from wheelchair in vehicle onto swivel seat Transfer from wheelchair to seat outside vehicle

Hoists Lifts person from wheelchair into the vehicle Lifts & stores wheelchair during transport

Hoist

Autochair Lite Wheelchair Lift & Storage System folds, lifts & locks away a manual wheelchair in less than 90 seconds Wheelchair is enclosed during travel Suitable for most manual folding wheelchair with removable footplates & some wheelchairs with fixed plates In emergencies, door can be opened and the wheelchair unloaded manually All operations are from the normal driving position Operation achievable from the drivers’ seat Can be transferred to your next vehicle

Wheelchair Systems Wheelchair seat replaces the vehicle seat User stays in same seat Wheels will need to be stored separately once safely transferred into vehicle (carer safety) If specialist seating required, not be an option

Ex - Milford Person Lift - The Electric Person Hoist Wheelchair Systems Ex - Milford Person Lift - The Electric Person Hoist Hoist designed for lifting people from wheelchair into/out of a vehicle Fits most 4 door cars, all 2 door cars, people carriers & 4x4s SWL – 111 – 148 kg 8kg, has emergency switches & optional manual operation Fitted to the driver's side, passenger's side both front & rear Hoist operation by a carer or disabled person using a small control box attached to a fly lead 

Autochair - Carony Wheelchair System allows the seat in the vehicle to become your wheelchair seat the seat in the vehicle becomes your wheelchair seat, eliminating the need to transfer from one seat to another Carony base unit is then stowed in the boot of the vehicle 3 versions available: ‘transit’ wheelchair - wheelchair user is pushed by a carer ‘user propelled’ - wheelchair user can propels themselves electric wheelchair option

Wheelchair Accessible Vehicles (WAV) Wheelchair or mobility scooter driven onto vehicle Remain in wheelchair as a passenger Option - drive from wheelchair Most expensive option WAV from Motability……. www.ricability.org.uk - guide providing info. on vehicles that allow you to travel in your wheelchair. Contact information reviewed 6 mthly, guidance 2 yrly (Oct 2011)

….About Motability Motability national charity Helps disabled people with their personal mobility Oversee the Motability Scheme which includes the Car Scheme &the Powered Wheelchair & Scooter Scheme Manages the Government’s Specialised Vehicles Fund, specifically to help people who need a heavily adapted vehicles Raises money for own Charitable Grants Programme - provides additional financial help to those people whose allowance does not cover the cost of the mobility solution they need Adaptations are available through Motability to make your driving, or travelling, experience as comfortable as possible. Adaptations can help you drive, stow your wheelchair or scooter, or get in and out of the car www.motability.co.uk

Transport: wheelchair users Self transfer in / out of vehicle Requires assistance to transfer into vehicle Generally safer for person to be transported in the vehicle seat rather than their wheelchair If there is an assessment of how transport should be facilitated – follow recommendations/plan If No assessment – some guidance to assist …..

Transport Wheelchair & occupant restraints Occupant Restraint System – passenger harness Flooring systems Seating systems Accessories (head replacement)

…..Transport: Advice & Guidance MHRA (insert contact info web) www.mhra.gov.uk Community Transport Association UK (www.ctauk.org) Dept. of Transport (www.dft.gov.uk/) Wheelchair manufacturers (leaflets/instructions)

Transport: wheelchair users Direction of travel Code of Practice on the Safety of Passengers in Wheelchairs on buses VSE 87/1 Wheelchair users travel facing forwards, unless provided with a vertical bulkhead against which to travel rear-facing Not advised for wheelchair user to travel rear facing against the back of a vehicle seat (since not vertical) Wheelchair accessible taxis – if integral bulkheads & suitable bulkhead & restraints may offer rear facing facility (as do some accessible low floor buses Use parked/braked position (front castors orientated forwards & brakes on) User restraints fitted Wheelchair tie downs

Transport: Equip. attached to wheelchair assess how attachments would move if a collision bags removed from wheelchair remove trays/tables, communication boards – fit foam block if they remain in position do not remove footrests as may support posture respiratory equipment, firmly secured

Transport: Wheelchair – raised backs/head restraints Leave support in position to prevent whiplash Shoulder straps of the occupant restraint - slotted beneath raised back rather than placed over the top of the raised back; sudden brake straps may break the raised back If raised back of wheelchair prevents shoulder straps from wheelchair occupant restraint being fitted it should be removed & stored If possible replace raised back with a detachable head restraint correctly positioned / secured (screw thread so backward force compresses rather than loosens restraint)

Transport: Narrow wheelchairs For certain models – Not possible to follow manufacturers instructions since clamps have an inwards orientation If this does not allow for secure restraint – use 4 point webbing restraint in preference

Transport: Powered Wheelchairs Powered off Firmly secured Batteries – secured Manual brakes applied If no manual brakes clutch engaged – this may prevent ratchet clamps from proper safe fitting Not to be secured with ratchet clamps – use 4 point webbing to be used and user secured If central mounted joystick – reposition to one side or remove

Transport: Seating inserts Insert secured to wheelchair MHRA – advises postural straps supplied with a seat should be used during travel Special seats will need to be secured following manufacturers instructions, generally with straps additional to & separate from passengers safety restraint system Lightweight cushions do not need to be secured

Transport: Pommels & knee blocks Assess risk of groin injury If possible – remove (but only if users medical advisor approves) If not possible – travel rear facing ensure user wears travel harness & lap strap consider padding around the pommel

Tracking in minibuses Most mini buses have floor tracking - Low profile tracking is recommended for floor tracking Surface mounted tracking for walls to secure folded wheelchairs, other equip. Wheelchair clamps - Widely used & suitable – for manual wheelchairs weighing < 38 kgs Lockable ratchet clamps are preferable, to hook type & more secure Ratchet clamps – fit vertically Adjustable bar- which rests on wheelchair chair frame and onto which lockable wheelchair clamps can be fitted, position bar so cannot damage spokes

Wheelchair restraints Wheelchair 4 point webbing tie downs Suitable - man/powered wheelchairs < 85 kgs (106 kgs for heavy duty types) Attach wheelchair (at set points/manufacture) at/below seat height; 2 at front, 2 at rear Fixed design Restraints mounted on fixed base which fits into floor tracking Floor tracking fitted and in good repair Seat restraint systems which are not track compatible but can be slotted into predetermined access points in vehicle floor and ceiling

Safety Restraints Seat belts – offer protection, law Exemption certificate from GP If exempt must inform Insurance company Wheelchair user posture belts are not passenger safety belts – have No connection to the floor or body of vehicle

Passenger Safety Belts ONLY use as manufacture specifies Vehicles to carry seat belt cutters for use in emergency Must be tight across pelvis fitting inside not outside framework of seat or wheelchair lap belt – must not ‘ride up’ over abdomen (risk of internal injury if collision or user slides out) Shoulder traps fit across collar bone, not neck/throat Safety belts should be in good order & easy to apply Passenger safety lap belt (not wheelchair lap belt) is min. requirement for forward facing travel Single diagonal strap of double straps secure upper body gives additional protection to head 2 Point Safety Belts (most common type) 2 points of attachment to vehicle floor/track system 3 designs: lap belt (are min. req. but little upper body security inertia reel belt (are comfortable with good muscle tone/upper body control fixed harness with 2 shoulder straps (preferable if low muscle tone)

3 - point safety belts 3 - point belt; 2 Attachments - floor, plus to framework of vehicle above height of seated passengers shoulders Preferable to 2 - point safety belts where shoulder straps run over passengers shoulder & directly down to floor 3rd attach takes a single diagonal fixed belt or inertia reel extension but not a harness with straps over both shoulders Very few vehicles are adapted to take 3 point systems Future - Consider for replacement vehicles

Transport: travel in a Mobility scooter on a bus Certain smaller mobility scooter’s are compatible with low-floor buses, if: - your local bus company is running a scooter permit scheme your scooter is a Class 2 type & meets certain size limits bus company has assessed you in safely using your scooter on the bus Permit schemes developed across the UK - Confederation for Passenger Transport (CPT) & in London by Transport for London (TfL). If bus company part of CPT – issue permits which confirm you/your scooter are allowed to travel ricability website - info. on bus companies running the scheme & list of mobility scooters that meet the criteria www.ricability.org.uk/consumer_reports/mobility_reports/mobility_scooters_on_buses

Vehicle Ramps Generally aluminium fixed or telescopic ramps provide safe access even where there are significant height differences wear-free non-skid surface providing grip in wet or dry conditions Light weight & compact Smooth nylon glide adjustment (telescopic) Consider noise if rattle in the vehicle during transport Ideally soft end profiles - no sharp corners Soft rounded carry handles

Seating systems Seating systems can greatly improve a vehicle layout by offering flexible seat configuration. Flexibility easily modified from fully seated to wheelchair accessible Seat Fixtures Fitted to the seat legs to provide an easy way of moving the seat within the vehicle removable seat fixtures, designed for ease of operation and safety single hand operated lockable systems an alternative, the Standard Removable Seat Bolt systems Functions as a non-removable fixing for semi-permanent seat positions. Combined Seat & Wheelchair Restraint Provides either a seat or wheelchair restraint, is easy to move within the vehicle and combines a small footprint as an optimal space saving design. The locking foot operation and adjustable reaction bar ensure the wheelchair is kept securely in place. A modular system for PTS or the Ambulance sector, it enables multiple and quick solutions for the driver as well as security for the passenger

Training Proper training for staff and helpers and carers Transport providers regular risk assessments Some training organisations…..

Training Organisations AJS Training Tel: 0116 277 5242 Email: stanley520@btinternet.com Website: www.ajstraining.com The Community Transport Association Tel: 0161 351 1475 Email: info@ctauk.org Website: www.ctauk.org Specialised Transport Advisory Network Tel: 01642 656320 Email: info@stan-training.co.uk Website: www.stan-training.co.uk Mark's Specialised Transport Tel: 01522 793816 Email: enquiries@marksspecialisedtransport.com Website:www.marksspecialisedtransport.com Nu-Track Ltd Tel: 028 94469550 Email: enquiries@nu-track.co.uk Website: www.nu-track.co.uk Community Transport Training Tel: 01954 253545 Email: info.ctt@btinternet.com website: www.communitytransporttraining.com Phoenix Training Tel: 01745 870456 Email: john@phoenixtraining.co.uk Website: www.phoenixtraining.co.uk Karen Gibson Ltd Tel: 01484 680951 Email: kgibsondts@aol.com Website: www.accessible-transport-training.co.uk  Promobility Tel: + 353 1 8900890 Email: charlie@promobility.ie website: www.promobility.ie Puwertec Ltd Tel: 0845 0590023 Email: info@puwertec.com Website: www.puwertec.com

If you can’t use your own vehicle – Supported transport/travel Advice on Supported Travel is available from your local SPoC (Single Point of Contact) Limited service - priority is given to vulnerable people in isolated & rural areas. You may qualify if you: - Do not have or are unable for medical reasons to travel in your own transport Cannot be driven to your healthcare appointment with friends, neighbours or relatives Are medically unable to use public transport, or this is not practical due to your isolated/rural address It would be detrimental to your immediate health if you were not to attend your appointment on the day in question You have 3 or more appointments in any consecutive 4 week period and do not have access to alternative means of travel due to any of the above If a community voluntary car is provided, normally a nominal mileage charge is made towards this service, check this with your SPoC prior to travelling  If you qualify under the guidelines above please contact your nearest SPoC

Ricability research and information for older and disabled people independent consumer research charity providing free, practical & unbiased reports for older & disabled people www.ricability.org.uk www.ricability.org.uk/consumer_reports/mobility_reports scooters_on_buses getting_in_and_out_of_a_car reports/address list wheelchair_accessible_vehicles

Sources of Information 1 Motability DLF Ricability Queen Elizabeth Foundation Independent Living

Sources of Information 2  Medicines and Healthcare products Regulatory Agency (MHRA) for Technical enquiries -  Wheeled Mobility & Seating Centre, Blackpool    Telephone 01253 596000   MHRA – Other enquiries- Business Services, Hannibal House, Elephant & Castle, London SE1 6TQ. Tel: 0207972 8360. The Community Transport Association (UK) Tel/Fax: 0161 351 1475  /  0161 366 6685 E-Mail: advice@communitytransport.com The Community Transport Association (Wales) Tel: 01286 675555 Department for Transport  Mobility & Inclusion Unit Tel: 0207 944 8300   Fax: 0207 944 6589 CTA – Community Transport Association - www.ctauk.org/advice-and-information/leaflets.aspx