Street Safety

Posted by Nurse Linda in Life After Paralysis on December 16, 2020 # Safety

The other day I was out driving. An unusual activity during this time of COVID but I had an appointment in an area that was new to me when zoom, someone in a powerchair cut across the middle of the street. The person had plenty of time and made it safely. They had their power chair set at a super-fast speed. As suddenly as the person appeared, they were gone. This experience made me think about safety when out on the street.

In many ways, street safety for all individuals is the same. The primary caution for everyone is always to be aware of your surroundings. You need to know what is in front of you, on each side of you and behind you. It is easy to get distracted when you see someone you know or look at an item in a store window but keep an awareness of what is happening around you. It does not matter where you are, where you are going, or what you are doing. Being aware of your surroundings in real-time is important to maintain safety for everyone. Being able to ‘read’ situations is helpful.man at crosswalk

Knowing what is going on behind you can be a challenge, especially if you have limitations in body movement or in turning your neck. Listening to the sounds of activity is one way to get a feel for the activity behind you. If you wear glasses, be sure to have them on when out and about. Being able to clearly see will assist you in your mobility. Many individuals will attach a rear-view mirror to their chair so they can keep an eye on what is happening behind them. As you pass through an area, you will see what is ahead of you and can surmise that the same activity will be behind you soon. If a situation looks tense, try another route, or wait for a minute to understand what is going on before landing in the middle of it.

A personal safety precaution is to carry your mobile phone with you in case of an emergency. I think most people carry their mobile phone with them anyway. Instead of keeping your mobile phone in your backpack, have it handy, so you can access it if necessary. You might also want a pocket alarm positioned on your chair where it can be easily activated. An alarm app on your phone will work as well. These alarms do not always activate an emergency call, but the sound will deter anyone from approaching you. The sound will get attention and cause people who hear the alarm to call 911.

When you are using a wheeled mobility device, your body is positioned lower. It does not mean that you are invisible, but you might not be as easily seen. In the situation of rolling out into traffic, it can be a startle for drivers. Pedestrians who walk, use assistive devices or chairs need to follow the rules of the road. This means crossing at corners, using crosswalks, stopping at lights, etc. It may be much quicker to cut across the middle of the street, but drivers do not expect that to happen. This does not mean drivers are exempt from being alert, but it can be a safety issue for you if there is not enough time to cross or if something should happen along the way, like hitting a pothole or getting stuck.

Wheeled mobility devices require charging the battery. Before going out, double-check to make sure you have an effective charge of your battery. Even if the device has been charging all night, sometimes connections are not complete, and your battery is low. In the cold weather, batteries tend to drain more quickly. You might not get as long of a time on a battery charge as typical when out in cold weather.

For your own personal safety, you want to alert others in traffic that you are there. Reflective strips attached to your chair or clothing can help provide a warning. Some people like a caution flag attached to their chair, while others find this intrusive. A bicycle light or flashlight attached to your mobility device is especially helpful to you at night. A reflector on the back of your chair is also helpful. It is up to you how you want to provide visual safety of your presence, but if you are in crowded areas, high traffic areas, or out at night, some alert is necessary.

When moving about outside, check the quality of the sidewalks and streets. Uneven walkways can be perilous for the traveler with wheeled devices or individuals who are walking. Stumbling or tripping on an uneven walkway can lead to a disastrous fall. Not having curb cutouts can make movement impossible in some areas as getting onto a sidewalk is then limited. Notify your streets department if there is an issue with the walkways or streets in your area. They usually want to fix these issues. In some areas, road repairs can be a challenge, but with enough complaints, the issue can be resolved.

Poorly maintained streets are another issue. Potholes can lead to stuck wheels, tipping over, and falls. A pothole is the bane of existence for everyone who uses the street no matter how they are getting around. Potholes typically become worse over the winter months when water gets in a crack in the street, freezes, and thaws, leaving a hole. Unfortunately, there are so many that it is difficult to keep up with them. In larger cities, in the spring, there might be a community pothole fill day. This is organized where individuals volunteer to fill potholes with materials supplied by the city. It is a massive day of filling small potholes all at once. Check with your city’s street department to see if your city is having one. Then request your travel route to be placed on the list for filling the potholes. This can help smooth your way quickly in the spring.

If you are using a wheeled mobility device, have the speed set to your driving ability. Some have variable speeds for different uses. Be sure you can handle higher speeds before using them. Just as with any vehicle, practice is needed. Higher speeds can lead to more disastrous falls because of the intensity. You may get to your destination faster but hitting even a little bump at high speed can cause tipping of the entire wheeled mobility device or even eject you from your seat.

Use precautions such as a seat belt and limb security. If walking, wear properly fitting, safe soled shoes. Know how to get yourself back upright or back into your mobility device, or how to instruct someone to help you. Even more important is to know how to stop someone from generously attempting to help you if they don’t know-how.

You might not immediately know if you are hurt after a tip or fall. Moving your body with an injury can make the injury much worse. If there is an injury or if you are not sure, you should not be moved but call 911. Emergency personnel will know how to move your body safely. Strangers can be strong but generally do not know how to lift someone safely back into their mobility device.

When going out, you should take the same personal precautions as anyone. Wear sunscreen to protect your skin. Wear a hat and sunglasses. The ozone is much thinner these days, so protection from the sun, even in winter, is a good habit. You will want to carry catheter supplies if you do intermittent catheterization. Going out means you might get delayed and you do not want to be caught unprepared. Also, bring water and a snack as a ‘just in case.’

Dressing appropriately for the weather is important. Individuals with sensation issues do not always cover their bodies appropriately because ‘I don’t feel it’. But your body does feel it even if that message is not able to be transmitted to your brain. Frostbite and sunburn are very real and can be extremely damaging to your body. Your body will react. In the winter, dress in warm clothes, covering your head, hands, and feet appropriately. Be sure your back is covered with a coat or blanket. Since you might be sitting in a chair, people often forget their backside. The chair is made of metal and vinyl. Those substances retain cold. Therefore, the protection of your body is needed as it can overheat or over cool more quickly.

Monitor your length of time in the cold or heat. The autonomic nervous system (ANS), which is affected by spinal cord injury, can have difficulty in regulating your body temperature. Becoming too cold (hypothermic) or too hot (hyperthermic) is difficult to resolve. Rewarming or cooling your body is a challenge as your internal thermostat is not being adjusted by the ANS. Using blankets as well as supplying motion can help warm your body. In order to cool your body, a cool, wet towel will help. Generally, the body does not adjust until after sleep, when the ANS resets itself. This process can take hours and people are miserable until the issue resolves. It is much easier to avoid extreme changes in body temperature than to correct it.

Everyone needs to have a means available to pay for items and services. Decide if you want to carry money or a credit card. During this time of COVID, many individuals have given up carrying cash as credit or debit card is much safer in handling. If you need assistance in the use of a wallet, a credit or debit card might work better. The tap cards are easiest to manipulate as you just need to tap the merchant device to make the transaction. Tap cards can be used with a universal cuff if you have issues with hand grasping. You can request a tap card from the credit card company. Some merchants still require the swipe, but the tap card can do both. Keep your money or card in a protected area so it is not out in the open where people might take advantage of you. There are security wallets that will protect your card from being electronically stolen.

Being prepared to go out is an important activity for your mental health as well as for your daily needs. Once you have a routine established, safety factors become second nature. In this time of history, remember your COVID-19 safety factors as well. Nurse Linda

Pediatric Consideration:

Children are generally accompanied outdoors by an adult. When you, with input from your child, decide they are ready to be outside alone is a decision you need to make. Older children want some freedom of movement to go to a friend’s house that is close by. Be sure to check to make sure they have arrived safely and know when they will be returning. All parents and guardians must know where their children are and with whom they are interacting. Older teens generally don’t like this so much, but it is a good rule for all parents.

Start early with safety practices. Include the child in looking both ways before crossing the road, as well as crossing appropriately. Stop occasionally and ask your child for a safety check of the surroundings to see what they are noticing. They might see something happening or a bump in the way that you missed. This is a good opportunity to learn from each other. Nurse Linda

Linda Schultz, Ph.D., CRRN, a leader and provider of rehabilitation nursing for over 30 years, and a friend of the Christopher & Dana Reeve Foundation for close to two decades. Within our online community, she writes about and answers your SCI-related healthcare questions in our Heath & Wellness discussion.

This project was supported, in part, by grant number 90PRRC0002, from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration for Community Living policy.