Wheelchair Restraint Regulations You Must Know

It is quintessential for a caregiver, nursing professional or a family member of a wheelchair user to know the latest wheelchair restraint regulations in North America.

Needless to mention, the regulations can be different depending on where you live and how the wheelchair is being used. The goal here is to ensure the safety, comfort and general well-being of a wheelchair user.

Knowing the wheelchair restraint regulations is a must if the condition of your loved one or a patient is severe, and as a result, they are going to be wheelchair-bound for the rest of their life.

They may not be able to read up on this subject on their own. It is you who must take the lead and understand the safety rules that apply to wheelchair transportation and physical restraints.

That being said, I would like to thank you for making the effort to read this post. Make sure you check out the resources and research papers shared further in this post.

What Does The Phrase “Wheelchair Restraint Regulations” Mean?

Wheelchair restraint regulations are rules, standards and safety requirements designed to protect people who remain seated in wheelchairs while being transported.

However, there is an important distinction that I want you to understand.

When you are traveling in a bus, van or another motor vehicle, the wheelchair securement system is used to attach the wheelchair to the vehicle. The occupant restraint system, such as a lap-and-shoulder belt, is used to restrain the person sitting in the wheelchair.

These two systems work together. A seat belt or shoulder belt should not be used as a substitute for securing the wheelchair itself.

In the United States, the Department of Transportation’s ADA transportation regulations require covered buses and vans to provide wheelchair securement systems. Federal rules also specify requirements for wheelchair securement locations, securement devices and occupant restraints. 49 CFR §38.23 explains these requirements in detail.

There is another important point here.

The term “restraint” can also refer to a physical restraint used in a nursing home or healthcare setting. That is a different issue from securing a wheelchair during transportation.

The Centers for Medicare & Medicaid Services (CMS) says nursing facilities must not use physical restraints for discipline or convenience. When a restraint is necessary to treat a medical symptom, the facility must assess the resident’s needs and use the restraint appropriately.

So, before buying a wheelchair lap belt or another restraint, first determine what problem you are actually trying to solve.

Here Is A List Of Some Important Wheelchair Transportation Safety Requirements

Wheelchair Securement: The wheelchair should be secured to the vehicle using an appropriate securement system designed for wheelchair transportation. RESNA’s transportation standards specifically address wheelchair tiedown and occupant restraint systems, as well as wheelchairs designed and tested for use as seats in motor vehicles.

Lap And Shoulder Restraints: A wheelchair occupant restraint is separate from the device that secures the wheelchair. Under U.S. ADA transportation rules, covered wheelchair positions are required to have occupant restraint systems, although federal rules do not generally allow transit providers to require wheelchair passengers to use those restraints unless the same requirement applies to other passengers. 49 CFR §38.23.

Wheelchair Tie-Downs: Tie-down straps or another approved securement method attach the wheelchair to the vehicle. The system should be used according to the manufacturer’s instructions rather than improvised with ordinary straps or belts.

Anchor Points: The vehicle needs properly designed anchor points for the securement system. RESNA’s standards address wheelchair tiedown and occupant restraint systems and their use in motor vehicles.

Compatibility: Not every wheelchair is designed to be used as a seat during vehicle transportation. RESNA has a specific WC19 standard covering wheelchairs that are designed and tested for use as seats in motor vehicles.

Crash-Tested Equipment: When a person must remain seated in a wheelchair during vehicle transportation, the wheelchair and transportation system should be appropriate for that purpose. RESNA’s WC19 and WC18 standards address wheelchair crashworthiness and wheelchair tiedown and occupant restraint systems.

Correct Positioning: The wheelchair should be positioned and secured according to the equipment manufacturer’s instructions. In covered U.S. transit vehicles, federal rules also specify how wheelchair securement systems are to be used.

Regular Inspection: Check straps, hooks, docking components, belts and other equipment for damage or wear. If something looks damaged or does not lock correctly, do not assume that it is safe.

Canada has its own transportation requirements and standards. For example, Transport Canada’s technical requirements for certain vehicles include wheelchair securement anchorages and occupant restraint anchorages.

Therefore, do not assume that a U.S. rule automatically applies in Canada, or that a rule for a public transit bus applies to a private family vehicle.

What About Wheelchair Restraints On Airplanes?

Air travel is another area where people can easily become confused.

A wheelchair used to get to the aircraft is not necessarily used as the passenger’s seat during the flight. Depending on the aircraft and the person’s needs, the wheelchair may be transported in the cabin or stored in another part of the aircraft.

The Federal Aviation Administration (FAA) has specific requirements concerning the transportation of wheelchairs and mobility devices. These include requirements involving batteries, protection against damage and preventing accidental activation of powered mobility devices.

Therefore, if you are flying with an older adult who uses a wheelchair, contact the airline before the trip rather than assuming that the same restraint rules used on a bus will apply on an airplane.

Some Important Tips For Caregivers Taking Care Of A Wheelchair User

1. Do Not Treat Every Wheelchair Belt As A Physical Restraint

This is one of the most important distinctions I would make in this article.

A positioning belt that helps someone maintain a safe sitting position is not automatically the same thing as a restraint used to restrict a person’s freedom of movement.

However, the effect of the device matters.

CMS defines a physical restraint in a nursing-home setting based on whether a device restricts the resident’s freedom of movement or normal access to their body. In other words, simply calling something a “positioning device” does not automatically mean that it is not a restraint.

A wheelchair belt should therefore not simply be added because a caregiver finds it easier to keep someone seated. The person’s needs should be assessed first, and less restrictive approaches should be considered.

2. Ask The Patient Before Adopting A New Restraining Method

Before you go ahead and purchase the newest wheelchair lap belt or similar equipment, make sure you take the needs and preferences of the person into consideration.

If the person can communicate, talk to them about what makes them try to get out of the wheelchair abruptly. Find out whether they are uncomfortable, need to use the bathroom, are experiencing pain, are frightened or simply want to change position.

Sometimes the behavior you are trying to stop is actually a sign that something is wrong.

If the person has dementia or another condition that affects communication, you may need help from a physician, nurse, occupational therapist or physical therapist to understand the reason for the behavior and determine whether a positioning device is appropriate.

3. Never Improvise A Restraint System

This is where I would be particularly careful.

Do not use an ordinary belt, rope, strap or homemade device to keep someone attached to a wheelchair during transportation.

Transportation systems are designed and tested as systems. RESNA’s standards specifically address wheelchair tiedown and occupant restraint systems, wheelchair seating systems and wheelchairs intended for use as seats in motor vehicles.

There is also published research showing that incorrect use of physical restraints can cause serious injury and, in some circumstances, death. A systematic review found reported associations between physical restraint use and injuries including strangulation, serious injury and increased mortality, although the researchers also noted limitations in the available evidence. Read the systematic review on physical restraint injuries.

If you are transporting someone in a wheelchair, use the vehicle’s designated securement equipment and follow the instructions provided for that equipment.

4. Never Assume A Seat Belt Can Hold The Wheelchair In Place

A seat belt is designed to restrain the occupant. It is not a substitute for securing the wheelchair.

The U.S. DOT’s transportation regulations specifically distinguish between the wheelchair securement system and the occupant restraint system. The occupant restraint is not intended to replace the device that secures the wheelchair. 49 CFR §38.23.

This distinction may sound small, but it is extremely important during a sudden stop or crash.

5. Remember That More Restraint Does Not Automatically Mean More Safety

If your loved one is in a nursing home or other healthcare setting, do not assume that keeping the person tightly restrained will prevent falls or injuries.

CMS guidance specifically states that physical restraints should not be used for staff convenience or discipline. Facilities are expected to assess the resident’s medical symptoms and consider whether the restraint is actually appropriate.

Research has also documented serious complications associated with physical restraint use. In one forensic study of deaths involving physical restraint, incorrect fastening was common among cases in which restraint itself was determined to have caused death.

If someone keeps trying to leave the wheelchair, I would first want to know why.

Pain, discomfort, toileting needs, poor positioning, hunger, anxiety, confusion or a desire to move may all need to be considered before deciding that a restraint is appropriate.

What Should You Do If The Person Keeps Trying To Get Out Of The Wheelchair?

Do not immediately assume that the answer is a tighter belt.

Instead, look for the reason.

Is the person uncomfortable?

Is the seat causing pressure or pain?

Do they need to use the bathroom?

Are their feet properly supported?

Is the wheelchair positioned correctly?

Are they frightened or confused?

Are they trying to reach something?

Are they simply asking to walk or change position?

These questions are especially important when caring for someone with dementia because a person may not be able to explain the problem clearly.

An occupational therapist or physical therapist can also help evaluate positioning, seating and mobility needs.

Research on removing restraints from nursing-home residents has found that individualized alternatives can include wheelchair adaptations, alternative seating, additional supervision and scheduled toileting. This is one reason I would not jump straight to a tighter restraint when someone is repeatedly trying to leave a wheelchair. Read the research on individualized alternatives to physical restraints.

What About Letting The Person Release The Restraint?

My original advice on this point needs an important correction.

There is no universal rule saying that every wheelchair restraint must always be positioned so that every patient can release it at will. The answer depends on whether you are talking about transportation equipment, a positioning device or a healthcare restraint.

In nursing-home care, CMS guidance recognizes the resident’s right to participate in care planning and to accept or refuse restraints, subject to specific circumstances such as an emergency involving immediate danger.

When restraints are used, the facility must assess the resident’s needs and ensure that the restraint is not being used simply for staff convenience.

If you are unsure whether a wheelchair belt is simply providing positioning support or functioning as a physical restraint, ask the person’s healthcare professional to assess it.

What Should Caregivers Remember About Wheelchair Restraints?

The most important thing is to understand what the restraint is being used for.

If you are transporting someone, you need an appropriate wheelchair securement system and an appropriate occupant restraint system. These are separate safety components.

If you are caring for someone in a nursing home, a wheelchair belt may raise a completely different set of clinical and regulatory questions.

Do not improvise.

Do not assume that a tighter restraint is automatically safer.

And do not use a restraint simply because it makes caregiving easier.

Summary

These are some of the most important wheelchair restraint and securement rules every caregiver or family member of a wheelchair user should understand.

The biggest thing I want you to remember is that securing the wheelchair and restraining the person are not the same thing.

For transportation, the wheelchair needs an appropriate securement system, and the person needs an appropriate occupant restraint system when applicable. These systems should be compatible with the wheelchair and vehicle and used according to their instructions. RESNA’s current wheelchair transportation standards cover wheelchair securement, occupant restraints and wheelchairs intended for use as seats in motor vehicles.

For nursing-home care, the rules are different. A physical restraint should not be used simply because it makes caregiving easier. CMS requires facilities to avoid restraints used for discipline or convenience and to assess the resident’s medical needs when restraint use is considered.

By the way, the Rehabilitation Engineering & Assistive Technology Society of North America (RESNA) has useful information on wheelchair transportation safety and standards. I don’t work for RESNA. I am just sharing the resource because I think it can be useful for caregivers who want to understand the subject better.

A final word of caution: wheelchair restraint laws and healthcare restraint rules can vary by jurisdiction and situation. If you are deciding whether to use a restraint on a particular person, especially someone with dementia or another condition affecting communication, speak with the person’s healthcare team rather than relying on a general internet guideline.