{"id":7229,"date":"2025-12-12T09:52:38","date_gmt":"2025-12-12T14:52:38","guid":{"rendered":"https:\/\/www.coto.org\/?post_type=resource&p=7229"},"modified":"2025-12-17T11:32:52","modified_gmt":"2025-12-17T16:32:52","slug":"college-response-to-the-coroners-report-death-related-to-wheelchair-lap-belt-2025","status":"publish","type":"resource","link":"https:\/\/www.coto.org\/resources\/college-response-to-the-coroners-report-death-related-to-wheelchair-lap-belt-2025\/","title":{"rendered":"College Response to the Coroner\u2019s Report: Death Related to Wheelchair Lap Belt, 2025"},"content":{"rendered":"\n\n
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Introduction<\/h2>\n <\/div>\n\n
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At the request of the Office of the Chief Coroner of Ontario, the Geriatric and Long-Term Care Review Committee (GLTCRC) released a report on the death of a hospital patient following a near asphyxia episode while in a wheelchair with a lap belt.<\/p>\n\n<\/div>\n <\/div>\n<\/div>\n\n\n\n

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Summary of Case Review<\/h2>\n <\/div>\n\n
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The GLTCRC reviewed the death of a 91\u2010year\u2010old male with advanced dementia who died in July 2023 following a near asphyxia episode while in a wheelchair with a lap belt.<\/p>\n\n\n\n

The patient was seen by an occupational therapist in an acute care hospital for a seating and wheelchair assessment. Recommendations were provided to his family about wheelchair measurements, cushion and an \u201cauto\u201d positioning belt which means a buckle with a button that can be pushed to release. The wheelchair was intended to be a rental, to be used while he was in hospital and for the Assistive Devices Program (ADP) assessment post discharge. There was no documentation by the occupational therapist to indicate whether the patient could undo the belt or when the belt should be used. The physiotherapist documented that the patient could not undo the belt, but the care team did not recognize that this made the lap belt a restraint.<\/p>\n\n\n\n

The patient was transferred to an Alternative Level of Care (ALC) unit managed by the same hospital. The family entered his room to find that he had slid down from the wheelchair and was trapped by the seat belt around his chest. He was holding the lap belt with both hands trying to relieve some of the pressure. Staff were able to release the belt and lift the patient to bed. Following this incident, the patient continued to medically decline, and he died 11 days later. The physician\u2019s discharge summary states \u201cthe decedent was restrained without authorization of a physician\u201d. The physician\u2019s summary also stated, \u201cthe indications of use of the restraint is not clear but presumably inferred to have been used to mitigate falls risk.\u201d<\/p>\n\n\n\n

GLTCRC recommendation to the College:<\/strong>

When prescribing a lap belt, a \u201cwearing schedule\u201d or instructions on use should also be provided. Alternatives to a lap belt for positioning should be considered such as wedge cushions and tilt wheelchairs. Occupational Therapists should assess the user\u2019s ability to release the belt buckle, and if unable, then remove the lap belt or initiate the facility restraint policy.<\/p>\n\n<\/div>\n <\/div>\n<\/div>\n\n\n\n

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Use of wheelchair lap belts<\/h2>\n <\/div>\n\n
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A lap belt (also commonly known as seat belt or safety belt) is a device that is worn over a person\u2019s lap to help position their pelvis in a wheelchair to optimize seating posture. The lap belt is attached to the wheelchair and has a front buckle with a push button to release. A lap belt may be included as a standard part of the wheelchair from the manufacturer. It can also be ordered separately to be installed on a wheelchair. While lap belts and wheelchairs are usually prescribed by a health professional for people in facilities such as hospitals or long-term care homes, they can also be purchased by clients and caregivers without input from a health professional from home medical supply stores.<\/p>\n\n<\/div>\n <\/div>\n<\/div>\n\n\n

Benefits of using lap belts<\/strong><\/strong><\/th>Risks of using lap belts<\/strong><\/strong><\/th><\/tr><\/thead>
\u2022 Promote postural support and alignment in the wheelchair by positioning the pelvis.
 
\u2022 Increase sitting tolerance and stability in a wheelchair which in turn can enhance function, engagement and independence.
 
\u2022 Promote safety and security in the wheelchair when being transported outdoors, moving in a power wheelchair or while riding on public transit.<\/td>		\u2022 Used as a restraint<\/strong>. A restraint<\/strong> refers to any method\u2014physical, chemical, or environmental\u2014that restricts an individual\u2019s freedom of movement or access to their own body, that they are unable to easily remove or refuse.

\u2022 If a physical device is used and the client is both physically and cognitively unable to remove it independently, it is considered a restraint <\/strong>which can cause harm, injury and even death.
 
\u2022 Improper fit or changes in the belt\u2019s positioning can cause harm such as pressure points, discomfort, skin irritation\/abrasions, or even entrapment and death.
 
\u2022 Improper use for purposes it was not intended for, such as restrict movement to mitigate falls, can cause harm such as agitation, mental distress and physical injury.<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n\n
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College Response<\/h2>\n <\/div>\n\n
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Occupational therapists are trained healthcare professionals with the knowledge and skills to assess clients and their environments and identify the risks and benefits of appropriate equipment and devices to optimize safety, functioning and well-being.<\/p>\n\n\n\n

When assessing clients and implementing intervention plans, occupational therapists are expected to follow the Standard for Assessment and Intervention, 2023<\/a>:<\/p>\n\n\n\n