Views of American and Australian mobility device users and ambulant bus users regarding occupant restraint systems on public buses

Introduction: With an ageing population, increasing numbers of people are using mobility devices, such as wheelchairs or scooters, whilst travelling on public route buses. The regulations and availability of active (wheelchair tie down and occupant restraint systems or WTORS) and passive (rearward facing) mobility device restraint systems on buses varies between countries. To date few studies have investigated passenger feedback on the use of restraint systems. This study aimed to gather feedback about WTORS on buses from passengers where these are in use (United States) and not in routine use (Australia) to guide decisions on their introduction. Methods: A prospective study using a purpose-designed electronic survey. Participants, predominantly recruited by Qualtrics, comprised two groups; mobility device and ambulant bus users in two countries; Australia and the United States (US). Results: The 448 participants rated the top two most important factors when deciding if buses should have WTORS as safety and comfort. Ninety-two percent of respondents believed people using mobility devices should use a WTORS which was rated 7.66/10 (SD1.97) as effective to prevent injuries to self or others. Only a minority of participants (13.2%) had ever slid or fallen from their mobility device, or seen a person slide or fall (13.6%) while on a bus with no differences between countries despite WTORS not being in use in Australia. Respondents reported it was OK to delay a journey an average of 5.52 (SD 2.89) minutes to secure/release a restraint system, which compares favourably to literature-reported real time of one to 4 min. Conclusions: Although WTORS were widely perceived by participants as important for safety, questions concerning their effectiveness to prevent slide or tip remain. Prior to the introduction of any securement system in Australia, the effectiveness of passive occupant containment systems to prevent slide or tip also warrants investigation.