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Safe Travels, Part 2: Transporting Your Child with Special Needs on the School Bus

Question: 

Should children who use wheelchairs or special needs strollers be transferred into a car seat when riding in a wheelchair-accessible school bus?

This is the second article in a four-part series, focusing on safe transportation of individuals with disabilities, from infancy through adulthood.  The first article, Transporting Your Child with Special Needs in the Family Vehicle, can be found here.

Nathan is about to start Kindergarten and the school bus will be transporting him to and from school.    Can car seats or booster seats be used on school buses?  He was recently fitted for a customized manual wheelchair with NHTSA-approved tie-downs. Should he ride the school bus in his wheelchair once it arrives?

 

 
Answer: 

The American Academy of Pediatrics states that, if possible, students should be transferred from wheelchairs, strollers, or other seating devices to standard school bus seats equipped with properly installed child safety restraint systems (CSRS) for travel.  

Any child who can assist with transfer or be “reasonably” moved from a wheelchair, stroller, or special seating device to the original manufacturer’s forward-facing vehicle seat equipped with dynamically tested occupant restraints or be “reasonably” moved to a child car seat complying with FMVS 213 requirement should be so transferred for transportation to and from school. The unoccupied wheelchair also should be secured adequately in the vehicle to prevent it from becoming a dangerous projectile in the event of a sudden stop or crash. (link)

Nathan, age five, has low muscle tone, global developmental delays, and receives most of his nutrition through his G tube.   He is very small for his age (weight 30lbs, length 36in.) He uses a rear-facing Britax Marathon convertible car seat at home.   Nathan’s family uses two vehicles, which have each had a Britax Marathon car seat professionally installed in the rear-facing position.  According to recommendations from the American Academy of Pediatrics as well as The National Highway Traffic Safety Administration, Nathan should ride in a rear-facing car seat, professionally installed or inspected in each family vehicle, until he meets the maximum weight limit for his present convertible car seat, which is  40lbs.  Despite NHTSA recommendations, it may be necessary to transport Nathan in a forward-facing Child Safety Restraint System (CSRS) to accommodate the distance between bus seats, the presence or absence of seat belts, and the ability to retrofit anchors for the car seat’s tether system.  (link)

Proper Use of Child Safety Restraint Systems on School Buses

 Child Safety Restraint Systems must be installed correctly in order to provide maximum protection for the student.   This brochure illustrates some of the common mistakes made when installing and using child safety restraint systems in school buses, and provides information on how to properly use child safety restraint systems in school buses.  The NHTSA also provides detailed training videos for anyone responsible for choosing and installing CSRS.

 

Child Safety Restraint Systems used for school bus transportation

Most students who require the use of Child Safety Restraint Systems (CSRS) meet one or more of the following criteria:

·         Children age 5 or younger, such as preschool or kindergarten students.  Some Early Intervention/Birth to Three programs also provide transportation for infants and toddlers eligible for developmental services.

·         Students who weigh less than 50lbs, but more than the upper limit on a standard convertible car seat.  These students are safest when seated and restrained in a 5-point booster seat.  At this size, the child is at high risk of “submarining,” during a sudden stop or collision, meaning that the child’s body slips out of the standard 3-point automobile seat belt by sliding under the lap belt and continuing to move forward into the back of the passenger seat.  The child passenger often sustains catastrophic spinal and abdominal injuries.

·          Students with special medical, physical, developmental, or behavioral needs *NOTE: The purpose of CSRS is to provide physical support, positioning, and to ensure the safety of the student and other passengers.  Safety restraint devices should never be used as a disciplinary measure.  Restraint and Seclusion laws for each state can be found here.

·         The student’s need for special transportation needs must be documented in the Individualized Transportation Plan, which is a subsection of the student’s IEP.  The student’s special transportation needs must be addressed at the student’s annual IEP meeting.  If the student requires CSRS, 1:1 supervision for medical and/or behavioral conditions, or any other unusual accommodations, it is strongly recommended that they receive a CSRS-specific Assistive Technology assessment every three years. 

The CSRS most commonly used to secure students are described below:

·         EZ-on Vest for School Buses:  EZ-On vests are NHTSA-approved devices designed to safely restrain children weighing 30lbs or more while they are passengers on a school bus.  EZ-On vests for use in private vehicles are also available.

·          Additional EZ-On products  

·         5-point harness system for school buses with or without lap belts

·         Standard forward-facing car seat (Photos demonstrating correct and incorrect use of standard forward-facing car seats can be found here.

·         Car seats specifically designed for passengers with disabilities who are unable to utilize commercially-available vehicle restraint systems (Detailed descriptions of special needs seating and positioning for use during transportation, along with possible sources of financial assistance, will be discussed in detail in the third article of this three-part series.)

The Georgia Department of Education has produced an informative and easy-to-read document outlining the types of CSRS that can be used on buses.  The information provided is applicable for school buses and passengers in all states.   Federal laws pertaining to transportation rights for children with special needs can be found here.

The NHTSA has provided additional information regarding the proper use of CSRS, which can be found here.

Wheelchair or CSRS?

The American Academy of Pediatrics states that, if possible, students should be transferred from wheelchairs, strollers, or other seating devices to standard school bus seats equipped with properly-installed child safety restraint systems (CSRS) for travel.  

Any child who can assist with transfer or be “reasonably” moved from a wheelchair, stroller, or special seating device to the original manufacturer’s forward-facing vehicle seat equipped with dynamically tested occupant restraints or be “reasonably” moved to a child car seat complying with FMVS 213 requirement should be so transferred for transportation to and from school. The unoccupied wheelchair also should be secured adequately in the vehicle to prevent it from becoming a dangerous projectile in the event of a sudden stop or crash. (link)

If a student’s medical and educational team decide that the child should remain in his or her wheelchair while being transported between home and school, there are several factors that contribute to the student’s safety during the trip:

The Student Him/Herself

·         Unable to transfer student from wheelchair to CSRS without the use of a mechanical lift

·         Student is connected to any medical devices stored within or onto the wheelchair, such as oxygen, enteral or parenteral feeding tubes, or a ventilator.  (If the child has a 1:1 licensed nurse in attendance, the child may be transferred in and out of the wheelchair at the nurse’s discretion.)

·         Student has anatomical differences, such as curvature of the spine, that require customized seating

The Wheelchair or Mobility Device

Wheelchairs or other mobility devices should have factory-installed, tie-down anchors, in compliance with ANCI/RESNA WC19;  RESNA’s official position is that wheelchairs prescribed for individuals with the inability to transfer and which will serve as passenger seats in motor vehicles should:

(1) Demonstrate that they can be effectively secured and provide effective occupant support under the same frontal impact conditions used to test occupant-restraint systems and seats in passenger cars, and child safety seats used by children,

(2) Facilitate the proper placement of vehicle-anchored belt restraints, and

 (3) Have design features that reduce user error in securing the wheelchair by four point, strap-type tie downs. (link)