In 1993, there were 40,115 fatalities from motor vehicle crashes and more than 300,000 disabling injuries at a cost to this country of $137 billion. About 75% of all motor vehicle crashes occur within 25 miles of home and more than 40% of fatal crashes occur on roads with posted speed limits under 45 mph.
Motor vehicle crashes are the leading cause of death for persons of every age from 5 to 32 years. The safety belt is the most effective safety device available to every motorist because it prevents the 'second collision' - the collision of the occupant with the inside. Overwhelming evidence proves that lap and shoulder belts double the chances of survival, i.e., reduce serious or fatal injury by 50%. Medical costs for unrestrained occupants are three times higher than for persons wearing safety belts. To be effective, clearly, the safety belt must be buckled around the person.
There have been no reported medical reasons not to use safety belts. The risk of injury for pregnant women and for motorists with arthritis, osteoporosis, stiff joints, and many other medical conditions is greater if safety belts are not used. While it is true that a few injuries have been reported attributable to seat belt use, review of the statistics makes it clear that the risk of injury from wearing safety belts is far less than the benefits of using them.
Safety belts hold the occupant within the vehicle, preventing him or her from being thrown out. Ejection from a crashed vehicle increases the risk of fatal injury four times and accounts for more than 25% of all occupant fatalities. The head and chest, the most frequent sites of fatal damage in motor vehicle accidents, are protected by safety belts. Safety belt usage costs the motorist only a little thought yet provides the most critical crash protection.
Since 1967, federal law has required that all cars and light trucks sold in the United States be equipped with safety belts, yet they are used only by two-thirds of all motorists. From 1980 to 1993, educational campaigns and the enactment of many state safety belt laws have increased safety belt use among car drivers from 11% to 66%. Still, many motorists have not yet been convinced that it is smart to protect their own lives and fasten their safety belt.
Only the United States, among developed nations, does not require safety belt usage by national law. Since 1970 the governments of about 40 countries have required safety belt usage and compliance has ranged from 50% to more than 90%. In Canada, the national rate has climbed to 88%. In the U.S., 48 states and the District of Columbia have passed mandatory safety belt laws and compliance rates in those states range from 24% to 83%.
Traffic crashes in the last three years have killed more Americans than died in Vietnam and Korea combined. The highway carnage is clearly a problem of great consequence for this country and must be attacked by a combination of mandatory safety belt legislation and a thoughtfully conceived and implemented educational campaign.
The American Academy of Orthopaedic Surgeons strongly endorses the use of airbags as an adjunct to safety belts.
The Federal Motor Vehicle Safety Standard on Occupant Crash Protection requires that all new passenger cars must be equipped with both driver and front seat passenger air bags by the 1998 model year. Light trucks and vans must be similarly equipped by the following year.
Maximum passenger protection is provided by the combination of a lap and shoulder belt and the air bag restraint. Air bags are supplemental restraints that only provide an additional 10% reduction in death and injury to those already wearing safety belts. Airbags are not intended to be used without safety belts and are not effective in impacts from the side or rear. Further passive protection through improved dashboards, windshields, steering wheels, door, and seat designs is an achievable objective and is being incorporated in most newly designed vehicles.
The American Academy of Orthopaedic Surgeons believes all head restraints should be of a fixed design.
Headrests have been mandated by federal law since 1960 and have reduced both the frequency and severity of neck injuries. Adjustable headrests require elevating the head restraint to the height of the base of the skull. Only the shortest motorists (5 feet, 2 inches in height or less) are protected with the headrest in the downmost position. Headrests of a fixed design will protect all occupants up to the 95th percentile in height.
The American Academy of Orthopaedic Surgeons believes that all motorists who transport children should properly install and use child safety seats. The Academy urges manufacturers to simplify and improve the design of child restraints to encourage and facilitate their use.
The Academy urges child safety seats be required in all 50 states, the District of Columbia, Puerto Rico and territories of the United States. Child safety seats provide children with the same degree of crash protection available to adults using safety belts. Recent studies show, however, that many child restraints are not properly installed or used. Improper positioning of the restraint, improper attachment of the restraint to the vehicle, or improper buckling of the belt within the restraint are common mistakes and can lead to injury of a restrained child.
The American Academy of Orthopaedic Surgeons believes that lap belts and padding on the backs of seats should be required on all newly manufactured school buses.
Most children going to school for the first time have been required by law to use child restraints or safety belts while riding in passenger cars. As part of their education and to protect them, children should be required to continue this life-saving habit while riding on school buses. Safety belts in school buses provide additional protection in side impacts and roll-over accidents. Padding on the seat backs provides extra head protection.
Mandatory safety belt usage, fixed design head restraints, simplified child restraint systems, and seat belts in new school buses are the most cost effective measures this country should adopt to prevent further death and injury from motor vehicle crashes.
© July 1984 American Academy of Orthopaedic Surgeons
Revised January 1987, December 1992, February 1995
This material may not be modified without the express written permission of the American Academy of Orthopaedic Surgeons.
Document Number: 1121
For additional information, contact Alvin Nagelberg at (847) 384-4138 or email nagelberg@mac.aaos.org