Ingress/Egress Incidents Involving Wheelchair Users in a Fixed-Route Public Transit Environment

The objectives of this study were to characterize the ingress and egress activities of wheeled mobility device (WhMD) passengers using fixed-route large, accessible transit vehicles (LATVs), and to examine factors associated with incidents occurring on ramps. A retrospective review of public transit video surveillance footage of WhMDseated passengers accessing fixed-route LATVs was conducted. Ingress and egress activities were characterized based on travel conditions and characteristics of the WhMD and LATV ramp. Incidents were identified based on predetermined criteria, and chi-square analysis was performed to identify WhMD and/or ingress/egress characteristics associated with incidents. Video records of 250 WhMD trips were analyzed. A total of 39 incidents occurred during ingress and 12 incidents occurred during egress. Results indicated that the frequency of incidents was significantly greater for scooter users and passengers who ascended the ramp using a rear-facing WhMD orientation. Narrow LATV ramp width was associated with the greatest number of incidents, followed by problems related to LATV door width and steep ramp slope. Introduction Fixed-route, large, accessible transit vehicles (LATVs) provide the opportunity for wheeled mobility device (WhMDs) users to independently participate in everyday Journal of Public Transportation, Vol. 13, No. 4, 2010 42 activities, including traveling to and from employment, shopping, healthcare, and social and recreational activities. However, 20 years after the passage of the Americans With Disabilities Act (ADA), WhMD users still encounter obstacles to safe and accessible use of fixed-route LATVs (Buning et al. 2007; Fitzgerald et al. 2007). In general, LATVs represent a relatively safe mode of travel (Shaw and Gillispie 2003). This is due in large part to overall vehicle mass and the slow speed of LATV travel associated with intercity routes. Despite this relatively safe environment, the U.S. National Highway Transportation Safety Administration (NHTSA) reported that 35 percent of injuries and deaths that occurred between 1990-1995 involving wheelchair users were due to improper or no securement of the wheelchair, with 17 percent of these incidents occurring in LATVs. Additionally, 25 percent of overall injuries or deaths involving wheelchair users were attributed to either lift malfunctions or falling on/off a ramp during ingress/egress (National Highway Traffic Safety Administration 1997). The authors previously conducted a retrospective records review of six years of WhMD-related adverse incident reports maintained by a metropolitan transit agency (Frost and Bertocci 2010). Findings revealed that the majority of adverse incidents occurred when the LATV was stopped during ingress/egress (42.6%). Furthermore, injuries were more likely to result from incident scenarios involving a combination of the WhMD tipping and the passenger falling from the WhMD (61.8%). These incident scenarios were 1.8 times more likely to happen during ingress/egress than while at the securement station (either during transit or when LATV was stopped). Ingress and egress involve many factors that may contribute directly or indirectly to an adverse incident. These factors include the WhMD, the WhMD-seated passenger’s navigational skills, the built environment (e.g., surface terrain, sidewalk height, lamp posts), and adaptive transportation equipment (vehicle ramp). This study sought to provide an in-depth review of video surveillance footage of WhMD ingress and egress activities on LATVs in order to characterize aspects of the ingress and egress process, and to provide a more comprehensive understanding of factors associated with adverse incidents during ingress and egress. Characteristics of the ingress/egress environment, WhMDs, and ingress/egress scenarios are described and quantified, and adverse incidents are summarized and examined to identify factors associated with unsuccessful outcomes. Ingress/Egress Incidents Involving Wheelchair Users 43 Research Methods Approval to conduct this study was obtained from the University of Louisville Institutional Review Board (IRB No. 170.07) Video Recordings Digital video surveillance footage of WhMD activities on LATVs was obtained from a metropolitan transit agency located in the southeastern region of the U.S. during the 21-month period of June 2007 through February 2009. Signs were posted in each camera-equipped LATV notifying passengers that activities within the bus were being monitored and recorded for public safety. During the period of the study, the transit agency operated 57 LATVs that were equipped with the GE® MobileView III Video Surveillance System® (GE Security, Bradenton, FL). This system records digital video images at a rate of 30 frames/second with up to 640x480 pixel resolution. Each video surveillance system consists of 4-5 permanently-mounted video cameras. One camera is directed at the front door to capture all WhMD ingress and egress events. This camera view includes the front door, access ramp, and approximately one-meter distance beyond the LATV door (Figure 1). Figure 1. Output from GE® Security’s WaveReader Software Journal of Public Transportation, Vol. 13, No. 4, 2010 44 Video footage was logged onto a 120 GB digital video recorder (DVR) that recorded a continuous loop for 30 hours. DVRs are interchangeable storage disks that can be removed from the LATV and inserted into a docking station that allows viewing and recording of video and audio footage on a connected computer using GE® WaveReader software. Randomly-selected DVRs were reviewed by the researchers 2–3 times per month throughout the two-year study period. All ingress and egress events involving WhMD-seated passengers were recorded and analyzed using GE® WaveReader viewing software. Data Collection and Analysis Ingress and egress events were recorded per trip or per WhMD-seated passenger. Thus, a video record contained one ingress and one egress event. Ingress and egress events were abstracted and recorded as categorical and continuous data using a FileMaker Pro 8 database (Ver. 2 for Mac OS X). Ingress was defined as starting when the front wheels of the WhMD contacted the LATV ramp, and ending when the rear wheels of the WhMD contacted the vehicle floor and were off the ramp. Egress was defined as starting when the front wheels of the WhMD contacted the LATV ramp and ending when the rear wheels of the WhMD left the ramp and contacted outside surface terrain. All ingress and egress events were characterized based on three categories of data: general travel data, WhMD data, and ingress/egress data. These variables are defined in Table 1. Additionally, the LATV ramp (Lift U® Division, Hogan Manufacturing; Escalon, CA) is mechanically interlocked with the kneeling suspension of the vehicle, preventing ramp deployment without vehicle kneeling. Thus, each ramp deployment indicates that the LATV was kneeled, although the extent of kneeling could not be determined based on video review. A difficulty was defined as either an ingress or egress event involving two or more maneuvering attempts by the WhMD-seated passenger or a minor impact with an interior or exterior LATV component(s) while the WhMD was in contact with the ramp. A minor impact was defined as an impact that did not cause the WhMD to come to a stop. An incident was defined as an event during which the WhMD tipped and/or the passenger fell from the WhMD, or the WhMD and/or passenger had a major impact with an interior or exterior LATV component while the WhMD was in contact with ramp. A major impact was defined as an impact that caused the WhMD to stop moving in its predetermined direction. Ingress/Egress Incidents Involving Wheelchair Users 45 Descriptive statistics were used to present summary information describing general travel data and WhMD and ingress/egress characteristics. Independent samples chi-square analysis was performed to examine difficulties and incidents based on WhMD type, weather condition, whether or not bags/items were carried by the passenger or attached to the WhMD, ramp extension level, surface terrain, and WhMD orientation on the ramp. All statistical analysis was conducted using PASW (formerly SPSS) statistical software (Ver. 17 for Mac OS X). Table 1. Variable Definitions