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Tom Shakespeare

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Tom is a Research Fellow at Newcastle University. His non-fiction books include Genetics Politics: from Eugenics to Genome and The Sexual Politics of Disability.

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Disability: an accident waiting to happen?

11th May 2009

I nearly slid under a truck last week. I thought my partner was pushing my chair, she thought I was … and I stopped myself from veering into the road just in time. My friends Bliss and Helen weren't so lucky. Both wheelchair users already, each of them was hit by a vehicle while crossing the road, one in America and one in Australia.
A man fallen out of his wheelchair
Suffering a major accident when you are already disabled seems unfair, like lightning striking twice in the same place. It's similar to how I felt when, already having restricted growth, I became paralysed last year.

But the truth is, disabled people are more likely to suffer accidental injuries. Like my friend Noeline, who is also short statured. She fell off a stepladder whilst putting away the Christmas decorations and broke several vertebrae. Us restricted growth folk take all sorts of risks, climbing up to get things which are out of reach.
An excellent research report came across my desk last month, from Dr Huiyan Xiang of the Center for Injury Research and Policy, which is based in Columbus, Ohio. His team have been researching the secondary injuries experienced by disabled people, crunching down all the big numbers to find the facts.

And what facts. Children without disabilities had a 2.5% chance of having a non-fatal injury; with disabled children that rose to 3.8%. That's a 50% higher rate, in case you can't be troubled with the maths. The risk was even higher for children with visual impairments (4.2%), ADHD (4.5%) and asthma (5.7%). And the chances of sustaining a burn injury were 103 per 10,000 – which again is nearly 50% higher than for non-disabled children.
Close-up of a wheelchair at a roadside kerb
Almost identical incidence of injury was found among disabled - 3,8% compared to 2.3% for their non-disabled counterparts - rising to an incidence of 5.6% among adults with severe impairments living in the community.

All of which sounds worrying. But wait for this one: children with disabilities are over five times more likely to be hit by a car when walking or cycling, than non-disabled children, according to 2002 US data.
Wheelchairs aren't much safer. My ex-partner broke her leg last year when her chair malfunctioned and toppled over onto her. She wasn't alone. US data reveals that wheelchair-related injuries in 2003 were double the number of such injuries in 1991, amounting to more than 100,000 accidents - mostly tips and falls.

My assumption is that such injuries may be increasing because disabled people are more likely to participate in the community. If we are out and about on the streets, then we are more vulnerable to crashes, just as our increasing visibility may make us more vulnerable to harassment and hate crime.
Close-up of a first aid kit
When I was in rehabilitation, risk aversion ruled. NHS staff were obsessed with patients avoiding accidents, although I did manage to fall off the toilet (we didn't tell anyone). As soon as I escaped, however, I was free to make my own mistakes. I've since fallen out of my chair on two occasions, though thankfully the only thing I have damaged so far is my self esteem.

There's a trade-off between safety and independence. You could stay in all day and remain safe from hassle and impatient drivers (although you can't rule out burns, scalds, falls and domestic abuse). Or you could participate in the big wide world and have a small – but still significant - risk of an accident or encountering a bigot.
You can't eliminate risk - impetuous kids will sometimes rush out into the road, people with sensory impairments may fail to see or hear danger, powerchairs will occasionally malfunction - but you can reduce it. Equally, nobody wants to turn back the clock towards institutionalisation and over-protection. I am sure that the answer lies in working towards a world that respects and includes disabled people. This means wheelchair users having longer to cross the road and creating better visibility at night, just as it also means zero tolerance of bullying, harassment and hate crime.

We need to mainstream disability, so that the injury prevention community understands that we are a group at particular risk. At the World Health Organisation, I am working closely with colleagues specialising in violence and injury prevention to ensure that they include disability in their work. Greater awareness may produce better policies to reduce the dangers - and may also remind disabled people and their families not to take so many risks in the first place.


    • 1. At 11:10am on 11 May 2009, Wheelie EDSer wrote:

      "I nearly slid under a truck last week. I thought my partner was pushing my chair, she thought I was and I stopped myself from veering into the road just in time."

      I have a rule with people pushing me that I take control to cross roads. I'll say something like "got it" or "thank you" to indicate "I'll take over" and "please start pushing me again". Without agreement like that I find it frustrating through to dangerous, but at least my partner and friends have got the hang of the system very quickly.

      I agree, crossing the road can be daunting, and drivers aren't always looking out for people in a wheelchair on their own, they are looking higher up. But we can at least help a bit - by always crossing at proper crossings, and waiting for traffic to stop before moving out, and as you said, by increasing visibility at night, by which I mean that my chair carries lights when using my chair in areas without streetlighting. In my wheelchair I only ever use zebra and pelican crossings - although I would jaywalk on crutches, as long as my view was clear.

      One of the worst things can be crossing with people who don't know how long you take to get across. They will look for smaller gaps. So I simply cross on my own or wait if I'm not confident, rather than risking rushing and falling.

      It's all common sense, isn't it?

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    • 2. At 12:03pm on 11 May 2009, wheelalong wrote:

      Yeah, totally agree FWB, but unfortunately it can be problematic if not downright dangerous even trying to reach a designated crossing. There's one two roads up from me that leads across to one of the so-called disabled friendly routes in our town on the south coast - unfortunately - despite pleas and threats, our council can't find the money to drop 'em. So you're left with the option of risking two roads and double the chance of tipping out or one road and gamble on not being run over!!!

      Until town planners wake up to the fact that simply having town centres and shopping precincts without kerbing - and there's a lot of controversy about that one too - a lot of us are trapped on little islands and without taking risks that normal common sense would usually negate we'd be stuck there forever.

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    • 3. At 11:13pm on 11 May 2009, Agent_Fang wrote:

      What about injuries that make existing impairments more complex being properly compensated for by insurance companies? The 'minor-to-a-non-disabled-person' car accident I had (a guy crashed into my stationary car at 50 miles an hour and knackered my osteoporotic neck), has caused lasting repercussions to my health that I've nowhere near been compensated for.

      The system simply didn't work to recognise how long lasting and complex injuries can be if they interact with an existing impairment. Most claims have to be wrapped up in three years, so mine couldn't take into account the problems and costs I'm still having six years down the line for adjustments to equipment I need to help me carry on working, earning, living etc to somewhere near the standard I enjoyed before the accident. The claims go mostly on loss of earnings too, so if you can only earn a small wage (like many disabled people I work part time), but need a lot of equipment - and this will continue to be a problem down the years - then you're really stuffed. Is this fair?

      I simply couldn't find people educated enough about impairment to help me take that into account. They refused to have the accident assessment carried out by my specialist so i had to see a doctor who had little knowledge of my existing condition - and so how the injuries might add to it, and how they might affect me in the longer term.

      Instead, the people who dealt with my claim treated me like a crip on the make, rather than a crip who simply wanted - and had a right - to have the entire repercussions taken into account and compensated for. My existing impairment was referred to again and again like some kind of get-out-of-jail-free card, like I may or may not have developed problems anyway, so why should they take responsibility to compensate for them?

      Any chance of looking into this too, Tom?

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    • 4. At 6:52pm on 13 Jun 2009, RoseRodent wrote:

      I often joke that I will end up being the only person admitted to hospital with a paralysing injury sustained in a wheelchair accident, but not so sure I would be unusual any more! I've tipped my chair on some off-road adventures, which was fair enough, but I have also tipped slam-bang on the head into a road in front of an oncoming car due to poor curbs. To assist the road user in swinging around left turns and because the council is too tight to move drain grates as part of their assessment of disabled access needs (though will dig up several roads twice to install a white elephant tram system...) the "dropped" curbs over side-roads are set up so you have to go out into the main road to swing around to a 90-degree set-up and then you go up a huge lip and a massive ramp at the top of it and if you fall you will do so into the main road instead of the side-road. One ramp has a double-ramp ski-jump effect where I have rendered an off-road powerchair entirely airborne more than once.

      I now always use my hazard lights on my powerchair when I go into or cross a road, and usually use lights even on pavements at night.

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    • 5. At 6:17pm on 22 Jun 2009, VirgoNews wrote:

      Well, I use a wheelchair about 25% of the time and I am always in a state of anxiety as soon as anyone offers to 'wheel me' somewhere. Mind you I am just about to have a knee operation and that was walking up an access ramp which was not even..... there's no escape from the dangers of independence or 'it seems' disability access traps!

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    • 6. At 4:36pm on 01 Jul 2009, DavidG wrote:

      [remind disabled people and their families not to take so many risks in the first place]

      There's an important difference between not taking risks and choosing whether to take risks - risk-aware is better than risk-averse. Part of the problems we face as disabled people is inadvertent infantilising by organisations or individuals who think that they are 'protecting' us, but instead take away our right to make adult decisions.

      Remind us of the risks involved, by all means, but let us make the final decision on whether to face them -- some of us like adventure sports and the risks that go with them!

      On a different tack, my experience of being bumped into and otherwise barged about by people on the street is that the risk arises not because of any problem with my behaviour, but because of a lack of attention by the other guy. If (actual incident) someone barges into me on a crowded street because they are so busy texting as they walk that they are relying on everyone else jumping out of their way (and I can't), then does the problem lie with me, or with their negligence? It is an awareness problem, but it is one that needs to be tackled at an individual level as much as an organizational one.

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    • 7. At 09:52am on 28 Oct 2009, redcec wrote:

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    • 8. At 00:27am on 31 Oct 2009, auntie CtheM wrote:

      Dear Tom,

      What an excellent eye-opening piece of research this is. Has it appeared in the printed media? I am so pleased to hear that you can try to do something about it too in Europe.

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