Tech Rescue

Extrication in Wheelchair-Accessible Vehicles

Issue 12 and Volume 8.

There are hundreds of variations of wheelchair-accessible vehicles and other special needs alterations. Some of these vehicles are pre-manufactured, have endured crash tests and include special features, while others are simple retrofits of common makes and models. These vehicles range from small passenger vehicles to large buses.

Training on large vehicles, such as buses or motor coaches, consistently involves some discussion of vehicle alterations; however, little consideration is typically given to alterations of passenger vehicles, which easily blend in with other vehicles on the roadway. This is unfortunate, as these alterations can pose unique hazards during an extrication incident.

Although it would be impossible to cover every type of vehicle alteration within this article, we will address the major categories of wheelchair-accessible vehicles and special needs alterations as well as the associated tactical considerations.

Common Devices
Manual Rotate Lifts: These devices transport a wheelchair, scooter or power-chair into the rear or side of a vehicle and into a truck bed. They have a winch that runs through an arm to raise the chair and a pivoting base to rotate into the vehicle.

Interior & Exterior Platform Lifts: These devices lift a wheelchair, scooter or power-chair from the ground to a stored position. The most common lifts are on the exterior at the rear of vehicles, but some models also retract into the vehicle.

Accessible Seating: These devices pivot and lower from a standard position within the vehicle. They may involve normal doors and openings or specially configured vehicles. The full-size truck pictured on in Photo #1 has both doors welded together and attached to a track system that moves in and out. The driver’s seat lowers to the ground to allow for easy access.

Rear and/or Side-Mounted Folding Ramp: These devices are positioned inside the vehicle passenger compartment and extends outward when deployed.

Floor Ramp System: This deploys and retracts by the use of a drive screw and belt operated by a high-torque electric motor. It offers an obstruction-free interior and doorway for entry/exit for able-bodied passengers.

Tactical Considerations
The presence of vehicle alterations and resulting tactical issues should be quickly communicated to the supervisor. Prior to establishing patient contact and providing medical care, the interior rescuer should attempt to assess hazards and manipulate appropriate vehicle mechanisms on the interior of the vehicle. Conducting certain tasks—unlocking doors, rolling down windows, placing the vehicle in park, etc.—can assist with the extrication process and increase the efficiency of the operation.

Once inside the vehicle, the rescuer may find it difficult to access lock controls and/or door handles, as they may be partially or fully blocked by the devices. Further, many extrication incidents depend on the ability to manipulate seats in order to provide the interior rescuer the necessary space and access, as well as a suitable path of egress.

Most wheelchair-accessible vehicles have multiple seating options. Depending on the vehicle’s make and model options, the disabled person may be able to drive from a chair, sit in the front passenger position or ride in the middle or rear of the vehicle. These seats may be specially manufactured to move in and out of the vehicle, or they may be a power-chair/wheelchair that is locked into position.

Due to space needed to allow these chairs and locking systems to maneuver and lock into position, the interior of the vehicle may be very spacious and accommodating to firefighters. However, considering that many firefighters are likely unfamiliar with these chairs and locking systems, it’s important to closely size up the situation to determine if the seats can be manipulated. If the passenger is conscious and alert, they may provide useful information.

The vehicle may have a suspension option that lowers the vehicle on the ramp side to reduce the approach and entry angle for the power-chair/wheelchair, much like the front of some transit buses. The passenger-side height may be altered by a hydraulic-, electric- or pneumatic-powered system. Because the floor area has to be lowered for clearance, along with decreasing the ramp angle, the vehicles typically have lower trim and cosmetics to mask the alterations. This is one observable clue that the vehicle may be a special needs vehicle. Further, the suspension system, along with the additional trim, may create stabilization concerns. This may increase the time it takes to locate a sufficient “hard point” for stabilization and then to place the cribbing at that point.

The fuel cell is typically mounted toward the rear of vehicle due to the lower and flat floorboard. The fuel cell is visible from the rear and is protected by increased structure in the event of a rear-end collision.

With certain devices, there has to be additional structure and reinforcement in the floorboard of the vehicle. In the case of the floor ramp system, there’s additional track and wiring, the ramp itself, reinforced areas, the motor and movement mechanisms. This problem could be compared to roof operations. Features like luggage racks, sunroofs and hardtops on convertibles should be taken into consideration early in the extrication process.

Additionally, firefighters should be aware that powered ramp systems have a backup in the case of 12-volt failure of the vehicle. This may be in the form of an additional 12-volt battery system with associated switch in the interior or a manual override. In the event the vehicle’s power system has been disabled by firefighters or compromised by the collision, there should still be a means to operate the ramp system as long as it is intact. It could be used to create an access point or a path of egress. Once again, rely on any occupants who may be able to provide valuable information.
If the access point or path of egress point is blocked, most of these systems can be displaced, distorted or cut with the use of tools. With the exception of the structural members, which shouldn’t pose much of a problem for hydraulic tools, the devices are built of fairly light metal.

Summary
Although there are no significant hazards and/or concerns that could completely alter an extrication plan, firefighters should be observant for exterior characteristics of wheelchair-accessibility or other special features, and confirm the presence once access to the interior is established. During size-up of the incident and subsequent tactics, firefighters should evaluate the device, utilize the occupant’s knowledge of the device if possible, and make informed decisions concerning operations. At a minimum, responders may require additional time and flexibility for gaining access, patient care, certain disentanglement tactics and patient removal.

A special thanks to Robin Hernandez and The Mobility Center in Charleston, S.C.