According to the Centers for Disease Control (CDC), falls are the leading cause of fatal and nonfatal injury among older adults and it is estimated that there are over 37,000 older adults injured annually from falls sustained while entering or exiting a vehicle. While there is not a similar report for persons with intellectual/developmental disabilities, we know that they too encounter safety risks during the transportation process.
For all persons, recognizing safety risks is essential to preventing serious injury.
Entering and Exiting the Vehicle- Reducing the Risk of Falls
- People who require assistance to ambulate should have a personalized plan for safely entering and exiting a vehicle. This includes people who use an assistive device (i.e walker, cane, etc.) or the assistance of another person. An individualized safety plan should include the best approach to supporting the person physically as s/he enters and exits a vehicle, as well as the most appropriate positioning of the person within the vehicle. A formal PT/OT evaluation may be needed to ensure the plan addresses safe transitions related to transport.
- People who utilize wheelchairs should also have a personalized plan for safely entering and exiting a vehicle. This plan should include the procedure for safe operation of the wheelchair lift, the procedure for securing the wheelchair within the vehicle, and the type of safety restraint the person should be wearing during transport. The plan should also include the level of supervision the person requires during transport. This decision should include a review of both medical concerns and positioning needs during transport.
- People who are able to ambulate without assistive devices should be evaluated for their ability to maneuver the environment to enter and exit the vehicle safely. For example, can they manage stairs into and out of a van without assistance? A formal PT/OT evaluation may be needed to evaluate the skills of the person in regard to safety needs during the transportation process.
- For people who are able to enter and exit the vehicle without assistance, staff should position themselves so that they are able to assist in case an person stumbles. This will help to reduce injury from accidental falls.
Safety During Transport- Level of Supervision
- Ensure that staff are appropriately positioned throughout the vehicle during transport. This allows staff to visually assess the occupants during transport and intervene if a person needs assistance.
- Ensure that people are appropriately clothed for the weather. Heat stroke and hypothermia can occur due to temperature fluctuations in vehicles. The vehicle should always have appropriate ventilation running when there are people in the vehicle.
- Agencies should have written policies and procedures regarding transportation services. These should include procedures to ensure all people safely enter and exit vehicles, are appropriately positioned, and properly secured (i.e., vehicle seatbelts and wheelchair safety restraints). For regulations regarding vehicle safety restraints please refer to the federal safety regulations at the National Highway Traffic Safety Administration website (www.nhtsd.gov).
Arriving at Your Destination - Ensuring Safe Arrival of All Occupants
- A mandatory walk through of the vehicle should be done after all people have disembarked to ensure that everyone has exited the vehicle. NO PERSON SHOULD EVER BE LEFT BEHIND IN AN UNATTENDED VEHICLE.
- The temperature in a vehicle can change to dangerous levels within minutes, causing anyone inside serious medical complications.
The federal government has recognized the challenges that older adults and people with disabilities face in finding safe and accessible transportation. Recently, the Federal Transit Authority funded the creation of a new technical assistance center, the National Aging and Disability Transportation Center (NADTC). NADTC will promote the accessibility of safe transportation options for seniors, people with disabilities, caregivers and communities through technical assistance, information and referral, community grants, training, and outreach.
This Health Information Bulletin is not intended as a sole source of information. It serves only as information for a basic understanding of the subject matter.