School Bus Emergencies Part 2: HANDICAPPED TRANSPORT
RESCUE
Photo by Ron Moore
On April 5, 1983, a two-ton flat-bed truck, loaded with one farm plow and towing another, was traveling southbound on a two-lane highway near Holmesville, NY. A 40-passenger school bus with 20 adults onboard was following the flatbed truck at a distance of about 100 feet. As both vehicles entered a sweeping right curve, the towed plow suddenly separated from its hitch and veered left into the opposing northbound traffic lane. A northbound tractor trailer used as an auto transporter struck the plow, rupturing the tractor’s left front tire. As a result, the driver lost control of the vehicle, and the vehicle veered left across the highway center line and collided head-on with the bus.
RONALD E. MOORE, a firefighter in the Henrietta, NY, Fire District, is a Pennsylvania and New York State certified instructor in vehicle rescue. Mr. Moore also is employed as a senior fire training technician with the New York State Office of Fire Prevention and Control.
The tractor’s overhead car-carrier ramp assembly penetrated inside and along most of the driver’s side of the bus, ripping open windows and displacing the bus sidewall area inward and to the rear, 6 to 18 inches away from its original position.
The front of the bus was pushed inward and the front axle assembly separated from the vehicle. Its front roof structure buckled down into the passenger section near the initial impact area. The bus driver and four passengers seated along the impact side died as a result of the extremely high collision forces. The fatally injured victims suffered multiple penetrating and crushing type injuries. The driver of the car-carrier and nine of the bus passengers were hospitalized. Six other bus passengers were treated and released. The driver of the flatbed truck was uninjured.
The details of this tragic incident were taken from a National Transportation Safety Board highway accident report. What the report didn’t mention was that 18 of the 20 people in the bus were handicapped. Important to this case study is how the bus performed relative to the handicapped onboard and how the rescue process was influenced.
Incidents involving handicapped persons present unique rescue challenges to emergency service personnel—and ones that personnel should be prepared for.
Beyond the external, physical damage to the bus, rescue personnel must take a closer look at the operability of the bus’s exits. In the Holmesville incident, only the wheelchair ramp door of the bus was totally operable. The front bi-fold type door was deformed and essentially inoperable. The rear door, marked as an emergency exit, was useless during the rescue because the rear of the bus had lodged against a tree.
Extrication of bus occupants through the emergency exit windows was hampered by the type of window units on the vehicle. As is typical of buses, the top-hinged windows are heavy, obstructing access through the window opening. These windows have no hold-open devices to keep them in the open position.
The wheelchair ramp door was labeled as an emergency exit on the outside of the bus only. The door itself could not be opened from inside. A civilian was able to release the ramp door from outside and lower the wheelchair ramp from its stowed position to its horizontal position. Some victims were removed through this opening.
Performance of the transit-type seats is also important to this case study. Many seats were moved into the aisle, some as much as 12 inches, blocking the already narrow aisle.
Six seats broke or separated at the floor mounts or wall brackets. Several seat frame assemblies separated or partially separated. Many cushions or seatbacks came loose.
Emergency medical and fire/ rescue personnel told of the uniqueness of dealing with the handicapped. Although many victims remained unusually calm and orderly, some made communication and patient injury survey an extremely hard task.
Photo by Ron Moore
The approximately 100 emergency medical and fire/rescue personnel operating at this incident were commended for their professional efforts in handling this most difficult incident. Their skills were put to the test, and their efforts were exemplary.
All emergency service personnel will be challenged by handicapped transportation vehicles involved in incidents. Whether it’s a fire or accident situation, the demands on the skills of the rescue personnel will be intense.
Surveys of handicapped vehicles of all types can and should be included as company-level training sessions because of the vehicles’ unique designs necessary to serve the special groups of passengers. Looking in, on, under, and around these special vehicles must be done as a means of training for and preplanning of these incidents. Anticipating rescue and medical procedures before an incident occurs is the best way to equip emergency personnel with valuable background information, information that must be known prior to the emergency.
Practical tours of the vehicles and non-destructive activities such as victim immobilization and extrication via windows can allow EMS and fire / rescue personnel the opportunity to see for themselves what problems and demands may lie in store for them at an actual incident.
THE VEHICLE
As mentioned in the article “School Bus Emergencies” (FIRE ENGINEERING, August 1984), there are four types of school buses. Type A and Type B school bus vehicles are typically the small van-conversion type units with a gross weight of approximately 10,000 pounds. These vehicles are very popular for the transport of the handicapped passengers. Also included as Type B are the mini-bus vehicles, those school buses that look similar to a modular type ambulance.
Type C and Type D school bus vehicles (accounting for 90% of all school bus vehicles in use in the United States) are the larger, conventional size units.
School buses are not the only vehicles in which emergency crews may encounter handicapped occupants. Due to the many governmental agencies and private organizations involved in the care and welfare of the handicapped, a wide variety of vehicle types are used for transport.
The vehicles may range from the full-size school bus or school bustype vehicle to the smaller sixwheel bus. Smaller size vehicles also include the mini-bus style and the van or van-conversion type unit. Worthy of note is the possible transporting of handicapped persons in station wagons and/or suburban style automobiles.
EQUIPMENT
Although the vehicles can and will differ in appearance, there are some vehicle features and equipment similarities that can be discussed. Buses, both large and small, are generally not required to display markings on their exteriors to indicate that a special client group uses the vehicles.
The National Transportation Safety Board, in an April 1984 report, made the following recommendations to the New York State Department of Transportation as a result of an investigation of the motor vehicle accident discussed earlier: “Install placards on the front, rear, and sides of mass transportation vehicles which routinely carry mentally and physically handicapped persons to alert motorists and rescue personnel to the fact that the bus passengers may have mobility and other impairments and may need special assistance in evacuating the vehicle in an emergency situation.”
The recommendation was given a Class II, Priority Action classification.
In lieu of any required markings or placards on the exterior of the vehicle, there are still other clues for the first arriving fire or rescue officer to observe. These indications may or may not be present in all situations:
Exterior passenger-carrying capacity markings
Markings may be found on the passenger side of the vehicle if handicapped persons are being transported by school bus. These markings, generally located along the passenger side of the vehicle to the rear of an exit door or exit way, indicate the total passenger load of adults by a number and the letter “A.” The total child carrying capacity is denoted by a number and the letter “C.” If handicapped persons are routinely transported, the wheelchair occupant carrying capacity may be indicated with a number and the letters “WC” or the handicapped insignia commonly used to indicate handicapped parking areas at stores and shopping centers.
Entry and egress doors
The physical appearance of the vehicle may give yet another visual clue as to the nature of its client group. If physically disabled passengers are to be transported and are confined to wheelchairs, the presence of an enlarged exterior door will be readily apparent to rescue personnel. The door must have sufficient height and width for the passage of both a wheelchair and a seated person, thus accounting for its enlarged size.
Photos by Ron Moore
These handicapped exit doors are generally located on the passenger side (the curb side) to facilitate passenger loading/unloading. However, the door can be located anywhere from the extreme rear to the very front of the passenger side.
These doors typically have a laminated (safety) glass window unit mounted in rubber gasket molding material, and both interior and exterior mechanical door release mechanisms to release the door latch assembly in routine or emergency operations. These door release mechanisms are typically of a contrasting color and are well labeled as to their operation.
If a school bus type vehicle is designated to transport handicapped passengers, the rear emergency exit door of the bus typically will be enlarged to a width of 30 inches and a height of 48 inches to accommodate exiting wheelchairbound people.
Ramps
Located at the exit door for the handicapped is a wheelchair loading/unloading ramp. These ramps store completely inside the bus when not in use. Weight carrying capacities are generally rated at a minimum of 650 pounds. The ramps are constructed of openmesh steel or treadplate materials. The ramps attach to the bus inside at the floor level. They are generally three times longer than the vertical lift distance. The minimum width of the ramp usually equals the width of the door.
Continued on page 58
Photos by Ron Moore
Continued from page 56
Power lift
Integrated into the wheelchair loading/unloading system is a power lift system. Basic components of the system include the electric/hydraulic pump, hydraulic lift cylinders, the ramp, and the lift system control device. The lift system stores completely inside the vehicle when in the stowed position and completely obstructs the wheelchair exit door in this position. These lift assemblies must have a device to allow movement of the lift from obstructing the special wheelchair door opening in the event of an emergency or vehicle power failure.
Power lift emergency procedures
Operation of the power lift and ramp equipment without vehicle electrical power is possible by two safety systems. Located inside the bus at or on one of the power lift cylinders is a permanently mounted, standard hydraulic pump and handle. Rescue personnel may be able to operate the system by manually pumping the hydraulic unit. This will raise or lower the wheelchair ramp assembly. The action is slow and tiresome. The power lift assembly will only work if there has been no significant damage to the cylinders, hoses, or the mounting hardware.
Another fail-safe method to lower the ramp assembly in the event of electric power failure are strategically located pull pins or rods. These pins are color-coded red and allow the main ramp assembly to pivot from the stowed position to a horizontal position. The action is simply one of disconnecting the ramp from the power lift assembly and allowing it to be manually operated. The ramp does not lower by these pull pins being removed, it only opens from stowed to horizontal position.
INTERIOR SPECIAL EQUIPMENT
Passengers inside the bus may be seated in several different types of units. Ambulatory persons may be located in conventional school bus style seats known as standard type, utility, or transit seats. Occupants with mobility impairments may be in school bus style seats that have physical restraint devices incorporated into the seat design.
The seat units in vehicles designated for handicapped person transport may be typical forward facing units, or they may be in rear-facing, longitudinal, or diagonal positions.
Some bus passengers, those confined to wheelchairs, will most likely remain seated in their wheelchair units, and the passenger and wheelchair are then fastened to the interior of the bus.
The positive fastening devices are designed to secure wheelchairs into place and are attached to the floor or wall or both. The fastening device is usually a manually operated slide pin or lever and must be capable of holding the wheelchair in place during normal bus motions that are typically encountered during driving. The wheelchairs may be fastened in place as rear, forward, longitudinal, or diagonal facing passenger positions.
Seatbelt units, working exactly as typical installations do, provide lap-belt fastening for the seated wheelchair occupant.
Federal and state regulations provide for the safety features incorporated into conventional school buses. Vehicles equipped to transport handicapped people generally have these safety features as well as additional items to accommodate the needs of their special passengers. For example, if there are emergency hatches in the roof structure of the bus, the hatches on vehicles carrying handicapped persons are increased in size from 18 X 18 inches to as large as 30 X 30 inches.
If the vehicle carries handicapped people, particularly those who are wheelchair-bound, the aisle space in the center of the bus is widened from 12 to 15 inches (the width of a typical school bus) to 30 inches. Aisles wide enough for a wheelchair to pass through are commonly encountered.
Side windows designed as emergency egress windows are much larger than those in conventional school bus units. There will, however, be fewer windows in each side of the vehicle. Also, the entire enlarged window and frame unit may be designed as a swing-out type emergency window. The small van and van-conversion type (Types A and B) handicapped transport vehicles maintain the standard size 18 X 22-inch window with the split-sash type aluminum frame.
Emergency windows, designated as such, will generally be labeled as emergency exits. The latch release devices, located inside the vehicle, will also be labeled and/or distinctively color-coded.
THE VEHICLE’S PASSENGERS
If adult monitors or chaperones are on the vehicle and must be attended to medically, routine medical and rescue procedures generally are sufficient.
With the handicapped, because of their physical and/or developmental impairments, they may not be able to protect themselves from secondary impacts inside the bus. During the dynamics of the collision, victims can be injured by impact with interior trim, seats, windows, or door assemblies.
Several unique patient handling circumstances may present themselves at incidents involving the handicapped, and emergency personnel must anticipate these problems when rendering their services. Injured victims of the accident may have their rehabilitative body devices in place, complicating extrication or EMS operations. Physical restraints designed to protect the handicapped during normal vehicle transport may or may not have been able to hold up under the stress of the collision impact. Rehabilitative devices, including wheelchairs, canes, and walkers, can cause additional injury to passengers and result in unusual entrapment and therefore extrication situations.
Emergency personnel must be familiar with the various types of vehicles and the special equipment used in transporting the handicapped. Emergency personnel must also be prepared to handle the unique extrication problems presented by this special group of people.
Emergency personnel should use various means of surveying the injuries received by accident victims. Medical personnel are encouraged to use all their senses in their assessment of their victims being treated. Normal communication between the medic and victim may be impossible when handicapped persons are involved. Pre-existing conditions of physical and/or mental impairments may preclude gathering any necessary information by oral communication. Consider too the possibility that the injured person may be unable to comprehend what’s happening around him.
Accident-induced injuries may be disguised by the handicapped person’s existing conditions as well. Internal injuries, not immediately obvious during initial patient survey and history workup by medics, may not even be detected by conventional means due to handicapped impairments.
Emergency personnel must be prepared to encounter extremely difficult and demanding conditions under which they must work at these special rescue incidents.
