​A risk manager recently wrote to ECRI Institute asking for guidance on bicycle safety for residents and volunteers, key elements to include in bicycle use policies, and effective waivers of liability for riders. In our response, ECRI Institute suggests bundling such a waiver with an orientation program that includes discussion of rules, rights, and responsibilities; preventive maintenance checks for the bicycles, taking bikes out of service when in need of repair and using only authorized repair persons; identifying terrain where bikes should and should not be used; and determining a means for reporting broken equipment and hazards. The following elements can contribute to a strong risk management practice and safe environment for riders.

Storage location and access. If the bicycles are kept in a campus garage or maintenance area or storage shed, consider who will have access to the bikes, whether the location will be locked, and who may authorize bike use. Consider the location and its effect on emergency response, including ease of access for emergency services such as 911 and ambulance response.

Rules for use. Consider developing rules for use of the bicycles. Rules might include access by authorized personnel, times of use, and appropriate clothing (e.g., a ban on loose clothing that can get drawn into the wheel spokes or bicycle chain; a requirement for closed-toe and closed-heel footwear). Consider reviewing the rules as part of the process for orientation of use, posting the rules in the bicycle storage area, and including rules for use in resident handbooks. The rules should be reviewed, along with those for high-risk areas (e.g., aquatic facilities, fitness centers), on a regular basis during resident council or town hall meetings.

Bicycle orientation program. Develop an orientation program for use of the bicycles. Rules and necessary paperwork can be discussed at that time. Residents should sign a copy of the rules, indicating that the conversation took place and that they understand rights and responsibilities associated with the bicycle use. Note that a liability waiver, discussed below, may be more effective when it is incorporated as part of the orientation program and includes affirmation that the orientation to the bicycles and rules of use occurred as part of the orientation.

Equipment. Determine who will provide the equipment. Provision of equipment often becomes a significant issue for bicycle usage. Organizations may be concerned that if they provide the equipment, they assume greater liability risk. While this may be true, ECRI Institute generally assumes that for anyone riding a bike, some liability already exists owing to the many potential hazards that can affect riders. Thus, ECRI Institute suggests more involvement by the organization rather than less, so that the significant risks and potential for harm can be managed with sound practices. Equipment should be inspected by qualified staff (e.g., maintenance) prior to use and a maintenance schedule should be set in place. Bicycle owner's manuals should have a section on safety measures.

Hazard reporting. Design a system for bike riders to report hazards and include the hazard reporting process as part of the rules and orientation.

Access and use. Organizations should consider whether bicycles can be used when a resident is alone; in such situations, residents may be unable to call for assistance if they are injured or an emergency occurs. One practice that can help to control these risks is to have residents check out a key to access the bicycle garage or other storage area, which should remain locked when not in use, and to check it back in when they are finished. This creates a record of when the bicycles are being used and can be consulted to check on a resident if there has been no word or a key has not been returned.

Emergency communication and response. Because bicycle riders will be out of the facility and out of sight while on a trail, organizations should consider an emergency alert system. This can be accomplished, for example, by requiring the rider to carry a personal cell phone or providing walkie-talkies to riders. If a staff member will always be with the residents during their rides, having a first aid kit on the bikes is another consideration. It is a good idea to identify who from the facility should respond to medical emergency notifications from these areas and create a protocol for response that includes contacting 911 in the event of a medical emergency or injury.

Liability waiver. Although liability waivers seldom provide absolute protection and are often challenged, ECRI Institute recommends that a waiver be obtained from residents prior to use of the bicycles and at least annually thereafter. Requiring signing of a waiver provides for an intentional discussion regarding the bicycles, rules and responsibilities of use, and documentation of that discussion. A waiver can be incorporated into an orientation process initially. However, following up on a periodic basis is also important, as resident needs and capabilities can change over time. It may be effective to include the rules of use in the release and waiver, thus creating one comprehensive document that can be discussed with the resident.

Although liability waivers do not provide guaranteed protection (see In the Courts: Court Rejects Hold-Harmless Agreement, from the October 24, 2014, Issues in Continuing Care Risk Management for one example of a waiver rejected by a court). However, when rule-based guidelines are established, implemented, followed consistently, and bundled with other risk management practices such as those described here, the result can be a set of circumstances that is easier for a provider's defense counsel to defend should a claim arise.

The recommendations contained in Ask ECRI do not constitute legal advice. Facilities should consult legal counsel for specific guidance and develop clinical guidance in consultation with their clinical staff.