BY MICHAEL DALEY
“Medic 510, from Command.”
“510, Go ahead with your message.”
“Engine 5’s crew is stabilizing both vehicles, and the crew from Rescue 3 is getting ready to start opening up that van. We have two victims visible inside that van and one walking wounded from the 2nd vehicle involved. Send one of your personnel through the back window of the van to begin patient assessment.”
One of the EMTs climbs through the back window and makes his way up to the front of the van, noticing a power wheelchair as he passes through the center of the vehicle. He makes his way to the driver, who is unconscious. The area surrounding the driver is equipped with electronic devices and controls with finished surfaces and sleek designs that accent the driver’s area. He reaches for the ignition key, turns it off, and throws it on the center of the dashboard. “That’s odd,” he thinks: “The engine is still running.
Continuing his operation, he reaches for the door-mounted controls for the door locks and windows, inadvertently striking a T-handled electronic control mounted on the door. As he hits this control, the van begins to move forward toward the stabilization crew. The vehicle stops. He asks himself, “What just happened here?”
The vehicle involved here is a personal mobility vehicle. These vehicles are designed and fitted with ergonomic controls to allow people with physical challenges to experience the freedom of operating their personal vehicles to expand their lifestyle. Many of these cars ride our highways every day, and approximately 6,000 are added to the roads annually (photo 1).
Vehicles such as these are not readily available to just anyone. Individuals wishing to acquire one of the vehicles must go through the following process.
• Initially, the person is evaluated at a rehabilitation clinic to determine the limitations of the person’s physical challenges.
• Once the limitations are identified, a “prescription” is written based on the following information:
- -What are the physical needs of the driver?
- -What lifestyle needs are important to the driver?
- -What is the status of the disability?
- -What are the personal preferences of the driver?
- -Is there any supplemental funding available to the driver to defray some of the costs of the vehicle?
- -What is the five- to 10-year outlook for the driver’s physical challenges?
Once these questions are answered, the vehicle is then designed to suit the specific needs of the driver. As of this writing, there are no federal regulations relating to the construction of these vehicles. The only standard that exists in the industry is that all mobility controls mounted in these vehicles must have a manual backup and release for operation in the case of an emergency (photo 2).
(2) The yellow handle to the right of the lift gate is the manual release, allowing the gate to be operated when there is no power. All vehicles are required to have manual releases for their ramps and gates.
Additionally, mobility add-ons are independent of any original equipment manufacturer’s systems and must not interfere with the deployment of any inherent safety device the vehicle may possess. Ramps and lifts can be installed in these vehicles to facilitate entry from the side or the rear of the vehicle, depending on the user’s preference. Rear-entry vehicles, while available for use in this application, are not best-suited for personal independent usage, because it is not easy for the person to gain access to the driver’s seat from the power chair in most cases (photo 3). Side-entry vehicles can facilitate easier access to the driver’s seat, which makes them much more user-friendly for independent operators (photo 4).
(3) Rear-entry vehicle with a manual ramp.
(4) Side-entry vehicle with electric ramp deployed and “kneeling” option activated.
While the vehicle is being outfitted, the floor of the vehicle is removed and replaced with a steel floor that is one-quarter inch thicker for strength and support. This floor is also set in place 10 inches lower than the original floor, to facilitate the driver’s ease of entry and allow maximum head room for the power chair and user. During the construction phase, the intended driver comes into the shop for a few “fittings” for the controls that will be outfitted in the vehicle. In approximately six months, the vehicle is completed and the driver is trained on how to operate it. The driver is given ample time to train on the vehicle, and any needed adjustments to the controls are made.
ELECTRICAL/MANUAL ENTRY OPTIONS
The driver may choose from many options. Some of these options are strictly manually operated; others are operated electrically with a remote control. Some of the options include the following:
• Straps and slide clips used to hold power chairs and scooters in place while the vehicle is operated.
• Ramps can be deployed by manually folding out the interior floor deck, or they can slide out from underneath the floor area. They can be set to be deployed from the side or rear of the vehicle. Manual ramps will be fitted with handles for easy deployment. The ramps are constructed mainly of aluminum and can be made to stow compactly, to allow easier access from side and rear doors. Hinges and release handles are located on the ramp where it will fold and stow.
• Lifts can be mounted and deployed from side doors, rear doors, and underneath the vehicle. While most lifts are made to lift the person straight into the vehicle, they can also be made to have the platform of the lift pivot into the vehicle. These pivoting lifts can operate in an area as small as four feet. Lift gates are made mostly of steel and can support weights of 750 to 1,000 pounds.
• Kneeling vehicles work with an activator mounted to the vehicle’s suspension and connected to a chain mounted to the underside of the floor. This activator pulls the chain downward, which allows the vehicle to “kneel” close to the ground.
• Six-way seats allow the driver to get into the seat from the power chair or scooter. These seats have controls that are usually mounted on the right side of the seat and can propel the seat to move up and down, swivel left and right, and forward and backward slide (photo 5). These seats can be designed to be interchangeable between the driver position and the passenger position. An E-Z lock is mounted at floor level to allow the power chair or scooter to be secured behind the wheel or secured in place in the location of the front passenger seat once the seat has been removed (photo 6).
(5) Six-way seats are installed to assist the driver from the power chair to the driver seat. The control box on the right side of the seat, under the seat-belt clip, controls the seat’s movement.
• Doors can be controlled electrically from the vehicle’s key remote. A manual release is in the vicinity of the door to operate the gate or lift assembly. The automatic door operating mechanism includes a steel track, mounted to the end of the door, with a removable pin at the end of the track that holds the track to the hinge. This track has teeth that mesh with an electric motor, mounted by the door post. The motor and track open the door outward when activated with the remote control.
• These options are powered by the primary battery in the vehicle. When the battery is disconnected, these assemblies will not operate.
ELECTRONIC ERGONOMIC DRIVING CONTROLS
Many control devices are available to the operator (photo 7):
(7) An overview of the driver’s ergonomic controls. Shown here are the accelerator/brake T-handle controller, the steering control device, and the digital display.
• Accelerator and brake hand controls can come in many shapes and grip types, such as T-handle, hook grip, and tri-pin grip (photo 8). These controls are usually mounted near the driver’s door and send a signal to a servo assembly mounted above the accelerator and brake pedals. The servo activates the throttle pedal or the brake pedal, depending on the signal it receives from the hand controller. Along with these controls, an acelerator/brake guard is mounted over the pedals to prevent the driver from inadvertently resting his foot on the pedals. This guard features a quick-release mechanism for easy removal (photo 9).
(8) A tri-pin grip accelerator/brake hand controller mounted to the driver side door.
(9) The servo control assembly, which operates the throttle and brake pedal. The pedal guard plate is shown folded down.
• Steering control devices can be mounted to the right side of the driver’s seat. This controller can feature a miniature steering wheel, a hook grip, or a tri-pin grip, depending on the operator’s ergonomic needs. Also, ergonomic grips and devices can be mounted directly on the steering wheel.
• The digital display is usually mounted to the right of the driver’s seat. This screen will control the vehicle’s function. The ignition key is used only so that the vehicle’s main computer can recognize the identification chip in the key. Since there is no formal standardization for these displays, it is important to identify which buttons on the digital display shift the vehicle into park, neutral, and drive and which ones start and shut down the vehicle’s engine (photo 10).
(10) A close-up of the steering controller and the digital display control panel.
• The electronic controls for the vehicle’s steering, accelerating, braking, and display are controlled by a separate battery backup system, usually located under the floor/seat area of the passenger side seat (photo 11). This system will not be accessible to rescuers at the incident.
(11) The battery backup system, located under the passenger seat area.
RESCUE CONSIDERATIONS DURING THE INCIDENT
Rescue scenes are dynamic events that are constantly changing; they require constant reevaluation and tactical adjustments. Extrication scenes are no different. Personal mobility vehicles present challenges the rescuer must recognize while operating at an incident. Some of these challenges are listed below.
It is important to identify the presence of these vehicles when approaching the extrication scene. During the inner circle survey, an inward-facing walk-around evaluation of the accident scene, the following clues are helpful for identifying the presence of these vehicles:
• a handicapped license plate;
• a sticker that suggests the vehicle is equipped with a ramp (photo 12);
(12) Notification that the vehicle has a ramp.
• body flaring on the lower section of the vehicle, put in place to hide the 10-inch lowered floor;
• logos and markings from the vehicle conversion company on the outside of the vehicle indicating that the vehicle is equipped with a ramp or lift (photo 13); and
(13) Lower body flaring and conversion logo, indicating a personal mobility vehicle.
• two splits in the rear bumper, one on each side, in vehicles equipped with rear-entry ramps and lifts (photo 14).
(14) The split bumper is evident during ramp operation.
The extrication scene can present many hazards. Take all necessary safety steps, and make sure all hazard abatement equipment is in place. These vehicles have specific safety considerations of which you should be aware.
• Be careful of what you touch! Pushing or pulling against any vehicle control prior to shutdown can result in unexpected vehicle movement.
• Medical response should include an advance life support team, if one is not already en route. This team will be better prepared to provide for the victim’s medical needs in addition to any injuries that may have resulted from the accident.
• To shut down the vehicle, the digital display controls drivetrain shifting and engine starting and shutdown. Turning the ignition key to the “off” position will NOT shut off the engine. Shut the engine off using the digital display.
When stabilizing these vehicles, consider the following factors when formulating a plan:
• Even if the ignition key is removed and on the dashboard, the vehicle may still be running and capable of moving unless it is shut down using the digital display.
• When deploying cribbing, be aware of the location of any under-vehicle lifts and ramps. If it becomes necessary to operate these devices for victim removal, all cribbing and stabilization materials must be free from impeding the travel of the ramp or lift gate (photo 15).
(15) This lift is under the vehicle in the tray under the double doors. Be sure any stabilization equipment does not interfere with the ramp’s operation.
• Disconnecting the vehicle’s battery is a major concern and is a critical part of interior stabilization. However, the battery may need to be reconnected to operate the ramp or lift. Therefore, it is not advisable to cut the battery cables. BEWARE: When you reconnect the vehicle’s battery, the air-bag and seat-belt pretensioner sensors become reenergized, which compounds the hazards inside the vehicle.
Considerations for Making Entry
It can be more difficult to gain access into these vehicles than other vehicles for the following reasons:
• Door tracks installed for remote-control operations can add difficulty when trying to force doors. Not only will you have to defeat the locking mechanism and hinges, you will also be fighting the presence of the steel track. Try to operate the automatic door before forcing the door. If there is no power, remove glass and the hinge pin for the track, separating it from the door.
• Sliding doors are very difficult to force, and the situation becomes compounded when automatic-control devices are installed. Whenever possible, try to operate the door with the remote control or manually before forcing it. Remember, even if it becomes necessary to force or remove the door, you may still have to operate the lift gate or ramp.
• One possible policy for these types of vehicles may include complete door removal instead of just defeating one side of the door to make entry. The victim’s needs will require as much room as you can make.
• Ramps and lift assemblies weigh an average of 335 pounds. For this reason, it would be easier to operate these devices during the rescue to assist in victim access and removal instead of cutting through it or removing it.
These vehicles have more potential for entanglement issues, which must be addressed by the rescuers:
• Numerous additional controls are installed around the driver’s area and directly on the driver’s side door. Impact from the accident can compound any entrapment issues, including additional traumatic injuries from being struck by these devices. Considering that these devices are difficult to deenergize, it may become necessary to unbolt and disconnect some of these devices instead of cutting or forcing them with conventional extrication tools. Be sure to have a complement of hand tools available for this task.
• Accelerator and brake guard plates can add to lower extremity injuries and entanglement. These plates can be released by operating a slide latch located at the floor area. This may prove more efficient than pedal displacement.
• Removing seats in these vehicles may be necessary to allow for more room to package the patient. Large-handled latches are located at the rear of the seats. Move the latch in the direction noted on the handle, tilt the seat forward, and remove the seat from the vehicle (photo 16).
(16) A seat release lever is located at the rear of the seat assemblies.
• The average power chair weighs approximately 275 pounds. If the power chair is tangled in metal from the wreckage, it may be easier to remove the victim from the power chair than to remove the power chair during initial operations. The power chair can be removed after the victim has been taken from the vehicle.
Personal mobility vehicles have defined a new level of freedom for thousands of individuals. Streamlined construction, sporty appearances, and sleek styling have made these vehicles virtually impossible to differentiate from ordinary, similar types of vehicles on the road. Some rescuers will have their first interaction with these vehicles at the scene of an extrication call. When deciding on a tactical plan of action, they must recognize that they must identify and consider additional issues when this type of vehicle is involved so that the hazards inherent in these vehicles do not cause responders to be injured.
MICHAEL DALEY has served nearly 20 years in the fire service and has held many officer positions in career and volunteer departments. He is a lieutenant/training officer with the Monroe Township (NJ) Fire District #3 and is an instructor at the Middlesex County (NJ) Fire Academy, where he is responsible for rescue training curriculum development. He is also a rescue specialist with the USAR NJ-TF1 and has been a presenter and a H.O.T instructor for FDIC, FDIC West, and FDIC East.