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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.

Investigation of wheelchair instability during transport in large accessible transit vehicles