Kirby R L, Coughlan S G, Christie M
Division of Physical Medicine and Rehabilitation, Faculty of Medicine, Dalhousie University, Halifax, NS.
CMAJ. 1995 Dec 1;153(11):1585-91.
Despite emerging evidence about the high incidence and severity of wheelchair-related injuries, regulations governing wheelchair safety are almost nonexistent in Canada. The authors believe that, to improve wheelchair safety, a concerted effort by government, manufacturers, purchasing groups, users and clinicians is needed. Health Canada's Health Protection Branch should treat wheelchairs as medical devices (as defined in the Food and Drugs Act 1985) and improve its injury-reporting network. Manufacturers should give a higher priority to safety in wheelchair design, improve their educational materials and formalize postmarketing surveillance. Purchasing groups should try to ensure that they do not stifle innovation in wheelchair design by setting unrealistic reimbursement ceilings and should use their market power more effectively. Users should obtain their wheelchairs in specialized settings, heed safety warnings and make more effective use of litigation when such action is warranted. Clinicians should ensure that patients are equipped with the most appropriate wheelchair for their needs, that they are given adequate training in safe wheelchair use and that they understand the dangers involved. Rapid changes in wheelchair technology and emerging evidence about the high incidence and severity of injuries related to wheelchair use suggest that such changes are needed in the wheelchair delivery system.
尽管有新证据表明与轮椅相关的伤害发生率高且严重，但加拿大几乎不存在管理轮椅安全的法规。作者认为，为提高轮椅安全性，政府、制造商、采购团体、使用者和临床医生需要共同努力。加拿大卫生部健康保护局应将轮椅视为医疗设备（如1985年《食品和药品法》所定义），并改善其伤害报告网络。制造商应在轮椅设计中更加重视安全，改进其教育材料，并规范上市后监测。采购团体应确保不通过设定不切实际的报销上限来抑制轮椅设计的创新，并应更有效地利用其市场力量。使用者应在专门场所获取轮椅，留意安全警告，并在有必要时更有效地利用诉讼手段。临床医生应确保患者配备最适合其需求的轮椅，为他们提供足够的安全使用轮椅培训，并让他们了解其中的危险。轮椅技术的快速变化以及与轮椅使用相关的伤害发生率高且严重的新证据表明，轮椅供应系统需要做出此类改变。
