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From the crash investigation files at the University of Michigan Transportation Research Institute (UMTRI), the crashes involving deployed airbags were reviewed. The total number of deployments is 898 of which 764 are frontal crashes with the principal direction of force (PDF) at 11-1 o’clock. Of the drivers in these frontal crashes 83% were using the belt restraint. Overall, seven of ten drivers have an AIS-0 or 1 level injury as the maximum or highest injury severity level (MAIS). Of the survivors, one in six had a moderate level injury (AIS-2) as their most significant injury and one in nine had an MAIS 3 or greater injury. Fatalities are rare. There is a difference between injury severity frequencies of belted vs. non-belted drivers. Three-quarters of the belted drivers had minor injuries compared to only half of those not belted. A difference was also noted at the AIS-2 level—belted vs. unbelted 14% vs. 23%.

In comparison to drivers exposed to steering-wheel airbag deployments in frontal crashes, there have been fewer front-seat passengers exposed to airbag deployments for 1) many of the cars in crashes did not have dual airbags and 2) the front passenger seat is less often occupied. Of the 826 airbag crashes detailed by UMTRI crash investigators at the time of this manuscript preparation, there were 145 front-seat passengers, exposed to instrument panel mounted airbags. Most of these front-seat passengers 124 were involved in the frontal crashes. There were 92 who were 16 years of age or older, 24 were under 12 years of age and 11 young teenagers, 13-15 years of age. Of those who were 16 years or older in frontal crashes 70% had an MAIS-1 injury. None of the MAIS-2 injuries were directly related to airbag deployments. Of the AIS-3+ level injuries, about two-thirds were not airbag related.

At the University of Michigan Transportation Research Institute (UMTRI), 763 crashes involving steering wheel airbag deployments have been investigated in detail (as of 12/1/97). A subset of only frontal crashes, in which the steering wheel airbag deployed, and stature was known, was formed (636 drivers). In these crashes there were 201 “short” stature drivers, 165 cm or less in height (32% of all drivers). The vast majority of all drivers were lap-shoulder belted. Of these drivers, 69% sustained no injuries or an AIS-1 level injury. Of the shorter drivers there were 40 MAIS-2 level injuries and 15 who survived with an MAIS injury level of 3, 4, or 5. These higher level injuries were usually found in only one body area. Details of the injury locations and contacts are presented. Data on the taller drivers (435) were similarly tabulated. Of the taller drivers (> 168 cm), 74% had a MAIS-0 or 1 level injury.

From a review of 722 “airbag” crashes investigated by UMTRI personnel, there were 117 front seat passengers exposed to passenger side airbag deployments. The majority of these were 16 years of age or older (90 of the 117), with 20 passengers. 11 years of age or younger. Two cases, both fatalities, will not be described, for these crashes have been investigated also by NHTSA's Special Crash Investigation Program personnel. The crashes and injuries of these 18 passengers are described. In this group there were 13 children who had MAIS-1 level injuries and two sustained an MAIS-2 injury. One child was without injury, and two had MAIS-5 level injuries. The description of the crash and of the major injuries sustained are detailed in each of the case capsule descriptions. Most of the children were properly restrained.

In a review of 540 crashes in which the steering-wheel airbag deployed, 38% of the drivers sustained some level of upper extremity injury. The majority of these were AIS-1 injuries including abrasions, contusions and small lacerations. In 18 crashes the drivers sustained AIS-2 or-3 level upper extremity injuries, including fractures of the radius and/or ulna, or of the metacarpal bones, all related to airbag deployments. It was determined that six drivers sustained the fracture(s) directly from the deploying airbag or the airbag module cover. The remaining 12 drivers had fractures from the extremity being flung into interior vehicle structures, usually the instrument panel. Most drivers were taller than 170 cm and, of the 18 drivers, 10 were males.

To determine the frequency of facial injuries from steering-wheel airbag deployments, 540 consecutive steering-wheel airbag deployments, investigated by the University of Michigan Transportation Research Institute (UMTRI) personnel, were reviewed. About 1 in 3 drivers sustain an injury to the face. Injuries to the area surrounding the eye (periorbital) or to the eyeball (ocular) rarely occur. The frequencies of facial or ocular injuries are the same for belted and unbelted drivers. Drivers of short stature had a higher frequency of facial injury. Females sustained ocular injuries more frequently than males. Untethered airbags were not overly involved in drivers with an ocular injury. No specific make or model car were overly represented in the ocular injury cases.

This is an overview of air bag injuries, a review of the literature and descriptions of air bag related injuries to the various body areas. Some unusual injuries are also included. The cases presented are from the author's files and one from the Special Studies Division of NHTSA.

Using the CDC (SAE J224), a comparison of the NASS data and the UMTRI field accident files (UM series) indicates a similar distribution of offset frontal crashes. Offset frontal damage occurs in 56-61% of crashes, often involving more than one third of the front of the car. Lap-shoulder belted drivers sustain more AIS 2 or greater injuries when there is interior intrusion and occur more often when the offset damage is in front of the driver. However, this may well be due to the severity of the crash. European studies have no uniformity as to offset frontal collision descriptors are difficult to interpret, or to compare one to another.

From our crash investigations of air bag equipped passenger cars, a subset of upper extremity injuries are presented that are related to air bag deployments. Minor hand, wrist or forearm injuries-contusions, abrasions, and sprains are not uncommonly reported. Infrequently, hand fractures have been sustained and, in isolated cases, fractures of the forearm bones or of the thumb and/or adjacent hand. The close proximity of the forearm or hand to the air bag module door is related to most of the fractures identified. Steering wheel air bag deployments can fling the hand-forearm into the instrument panel, rearview mirror or windshield as indicated by contact scuffs or tissue debris or the star burst (spider web) pattern of windshield breakage in front of the steering wheel.

From the authors' files, case examples of thoracolumbar injuries sustained by lap-shoulder belted front seat occupants, in frontal crashes, are presented. Additional cases were found in a review of the clinical literature. The biomechanical literature was reviewed, identifying laboratory studies on thoracolumbar spinal injuries. Suggested mechanisms in the production of these injuries in frontal type car crashes are postulated.

The “seat belt syndrome”, first described in 1961, identified abdominal organ injuries related to the use of the lap belt. Many articles have further documented detailed descriptions of intraabdominal lap belt related trauma. Lumbar spine distractions were later added to this injury list. Lap belt injury literature not infrequently hypothecates that some, if not all, of these seat belt syndrome injuries would be prevented, eliminated, or at least significantly reduced in frequency by the use of lap-shoulder belts. This report, based on data from crash investigations, documents lap-shoulder belt intraabdominal injuries occurring by belt loading alone, without significant intrusion and without significant dynamic flexing of the torso of the restrained front seat occupant.

The effects of child safety seats have been well documented in the medical literature. Scattered throughout the medical literature are individual case reports of cervical injury to children restrained in child restraint systems. A review of the literature is provided identifying previous documented cases. The authors also provide new case details of children with cervical spine injury without head contact. An overview of the growth of the infant and specific details in the cervical spine that may contribute to significant cervical injury without head impact is presented.

Crash injury reduction via lap-shoulder belt use has been well documented. As any interior car component, lap-shoulder belts may be related to injury in certain crashes. Relatively unknown is the fact that cervical fractures or fracture-dislocations to restrained front seat occupants where, in the crash, no head contact was evidenced by both medical records and car inspection. An extensive review of the available world's literature on car crash injuries revealed more than 100 such cases. A review of the NASS 80-88 was also conducted, revealing more examples. Cases from the author's own files are also detailed.

NASS 80-88 passenger side impacts data were analyzed. Location of primary car damage using the CDC classification, the AIS for injury severity studies, and the interior contacts of the various body areas. Drivers alone, or with passengers were studied separately in both left and right side crashes. Direct impacts to the passenger compartment only are less frequent than to other CDC side zones. Driver interior contacts vary by body region but also by side impacted in the crash. The presence of an unrestrained front passenger appears to enhance driver injury level in left side crashes but the presence of a passenger, in right side crashes appears to moderate driver injury severity.

Frontal crashes (11-1 o'clock) were reviewed from the National Accident Severity Study file (NASS) for years 1980-87. Adult drivers and front right passengers, with lower extremity injuries of the pelvis, thigh, knee, leg or ankle/foot were reviewed. Analysis of age differences, injury contacts, and effectiveness of the 3-point restraint system were studied. Unrestrained drivers have a higher frequency of knee injuries than passengers, fewer leg injuries than passengers and both have the same frequency of ankle/foot injuries. Older unbelted drivers have more injuries to the pelvis, leg, and ankle/foot region than do young drivers. Passengers have more leg injuries. The instrument panel is the major contact for most of the lower extremity injuries. Lap/shoulder belts significantly reduce lower extremity injury frequency.

This paper presents an analysis of the NASS file (1980 - 1986). Cases were selected for near side impacts for drivers, i.e. left side of car, involving unrestrained adult drivers who were alone in the car, and who were not involved in any other collisions following the primary left side impact. Data analysis indicates that 11 % of the near side drivers had crush damage to only the passenger compartment, the ‘P’ zone, that the head, chest and abdomen predominate as the body areas of concern (AIS 3+ injuries), but that these injuries are sustained more often on structures other than the side interior.

The side impact, recently and currently the subject to of much debate, controversy and proposed NHTSA rule making, is a difficult type of crash to significantly reduce serious injuries and fatalites. Results from real-world crash investigations presents a confusing picture for the near-side passenger compartment crash. A direct relationship between the amount of crush and injury severity levels (MAIS) is not apparent. Exemplar cases of tow-a-way/injury crashes are presented at all AIS injury level of drivers in crashes with direct driver door crush damage.

Basilar skull fractures have previously been described as the result of cranial vault impacts. Such fractures resulting from impacts to the chin, face and/or orbital areas (non-cranial vault areas) have not been adequately documented. These types of fractures and the motor vehicle incidents in which the injuries were sustained will be described according to the type of crash and vehicles involved. Data on the tolerance levels of the basilar region of the skull are sparce at best. Case histories of non-cranial vault impacts, presented in a variety of crash types, document that facial impacts can be the sole cause of basilar skull fractures. A historical review of the basilar skull fracture literature is presented.

This report presents nineeen cases of detailed field accident investigations of Toyota Cressida crashes wherein the automatic shoulder belt was worn. Specifics of the accidents and the injuries sustained by the passively restrained occupants are detailed.

A review of the UM series and of NCSS, NASS, CPIR and FARS Files, as well as Michigan accident data files was undertaken, as well as a review of the NTSB “Rear Seat Study”. From these files rear seat occupany is approximately 10%, with children 6 years of age or less being 1/5th of these. About 50-60% of those in the sear seat are adults. Most of the injuries are at the lower AIS levels, with adults being more seriously injured. Of the more serious or fatal injuries, the head and face predominate by far, in all types of crashes involving unrestrainded rear seat occupants. When belts are worn there are few seriously or fatally injured rear occupants and of these, the abdominal area predominates. From available data, rear lap-belted passengers have the same MAIS level (or less) when compared to their front seat lap-shoulder belted counterparts.