What is a gait belt, and should NEMT drivers use one?

What the belt is for

A gait belt gives the helper something solid to hold other than the rider’s arm or clothing. OSHA’s nursing home ergonomics guidelines list gait and transfer belts with handles for people who are partly dependent, can bear some weight, and cooperate. The uses they name fit NEMT work closely: moving from a chair to a car or from one chair to another, steadying someone while they walk, and in some cases guiding a fall or helping a person up after one.

OSHA’s transfer chart, which covers car-to-chair moves, sorts riders by weight bearing, cooperation, and upper-body strength:

The last row is the one that matters for scheduling. A van driver working alone has no sling lift, so that rider belongs on a stretcher or other higher level of service, booked before the day starts. The seated row needs a chair with arms that lower or come off, so check the wheelchair before counting on it.

Using one well

OSHA’s points for a belt transfer, with two from MedlinePlus’s caregiver instructions:

1. Fasten the belt securely over a layer of clothing, so it does not rub the skin and the rider cannot easily undo it during the move.
2. Clear the path first: move footrests, armrests, and anything else in the way.
3. Stand close, keep your back straight, bend your knees, and turn the rider toward the side that is stronger.
4. Rock and pull rather than lifting. Some riders need a second helper.
5. Ask the rider to push up with their hands rather than wrap their arms around your neck.
6. If the rider starts to go down, lower them to the nearest flat surface, whether a seat, a bed, or the floor.

After a fall, OSHA advises checking for injury before moving the person. If the rider cannot get up with minimal help, the next step is equipment a van does not carry, so follow your emergency procedure. CareOregon’s manual, for example, has providers call 911 when an emergency needs ambulance transport and then notify the broker’s dispatch. The guide to safe passenger transfers walks through each move in more detail.

Lifting limits and program rules

The belt does not change what a driver may lift. OSHA has no lifting limit, but its April 2014 interpretation letter quotes research in which the revised NIOSH lifting equation yields 35 pounds as a recommended maximum for patient handling. Nearly every adult rider weighs far more, which is why the belt only guides a person who is doing most of the work.

Broker manuals draw the line in writing:

• CareOregon’s manual puts two tasks outside a driver’s job: moving a member into or out of a wheelchair or bed, and holding up a member’s full weight while they walk. The exception is a driver the brokerage has licensed, trained, and authorized for it.
• MTM Health in Virginia states that curb-to-curb and door-to-door assistance does not include lifting any member.
• Ohio’s developmental disability rules treat a gait belt used to support or position a person as a medically necessary device, not a mechanical restraint.

Training is what makes a belt safe. NEMTAC’s levels of service standard expects drivers offering transfer services to be educated in proper transfer methods. Record who was trained, when, and on what, alongside the rest of your driver training file, and match the belt to the level of assistance each trip allows.

Matching riders to the right vehicle

Most belt problems start when the ride is booked. HealthRide records the rider’s service type on every trip, and the dispatch board matches wheelchair, stretcher, and oxygen needs to a vehicle equipped for them, so a rider who cannot bear weight is not sent out with one driver and a belt.