Large accessible transit vehicles (LATVs, fixed-route intracity buses), generally considered safe, may not be as safe for wheelchair-seated passengers. Transit provider practices vary regarding use of wheelchair tiedown and occupant restraint systems (WTORSs), while recent research suggests high levels of WTORS disuse and misuse. We sought to better understand wheelchair and wheelchair passenger instabilities related to WTORS disuse and misuse on LATVs. This article presents a retrospective review of 295 video surveillance records of wheelchair passenger trips on LATVs. Wheelchair trips involving disuse and misuse of WTORS were quantified and categorized based on WTORS configurations. Cases of wheelchair and wheelchair passenger instability were categorized based on severity, type, and direction. Three adverse events involving severe wheelchair and/or passenger instability were examined in greater detail. Results showed 20.3% of records involved wheelchair-related adverse events (95% minor instabilities, 5% severe instabilities). Scooters were most likely to be unstable, followed by manual and power wheelchairs. In most instability cases, no tiedowns were used to secure the wheelchair and no lap belt was used to restrain the wheelchair passenger properly. In many instances, the lap belt was misused in an attempt to secure the wheelchair, whereas the shoulder belt was never used.

Proper securement of wheelchairs in motor vehicles is vital to providing wheelchair users an adequate level of safety in a crash. Thus far, wheelchair tiedown and occupant restraint systems (WTORS) loading has mostly been examined under frontal impact conditions. Because of the inherent crash dynamic differences, rear-impact loading of WTORS is expected to differ greatly. In this study, three identical, reinforced, manual, folding, X-braced ANSI/RESNA WC19 wheelchairs were subjected to an International Organization for Standardization-proposed rear-impact crash pulse. WTORS loads (front tiedowns, rear tiedowns, lap belt, and shoulder belt) were measured and compared with frontal impact WTORS loading. Rear impact produced substantially higher loads (up to 7,851 N) in the front tiedowns than frontal impact. The rear tiedowns experienced relatively negligible loading (up to 257 N) in rear impact, while rear-impact dynamics caused the lap belt (maximum load of 1,865 N) to be loaded substantially more than the shoulder belt (maximum load of 68 N). Considering differences in frontal and rear impact WTORS loading is important to proper WTORS design and, thus, protection of wheelchair-seated occupants subjected to rear-impact events.