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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.

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.

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 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.

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.

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.

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.

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.

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.

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.

On-scene investigations of 104 fatal accidents involving 136 fatalities have shown that ejection from the vehicle was the leading cause of the fatalities. The data indicate that the majority of these victims could have survived by the use of the simple lap seat belt. The steering assembly -- the end of the steering column or steering wheel proper -- was the leading cause of the fatalities among drivers. The majority of these driver fatalities could not have been saved even with the seat belt-shoulder harness restraint. Other than death by ejection, the instrument panel was the leading cause of death of the front seat passengers, most of whom could have survived by using seat belts. Impacts to the door caused invasion of the passenger compartment, and most occupants would have died even if restraints had been used. To decrease the number of fatal injuries from automobile accidents, future designs of automobile interiors must include adequate crash attenuation features.

Modulation of the occupant's movement within the vehicle by the seat belt reduces the potential for striking certain structures and decreases severity of the injuries. The seat belt also functions to direct the upper torso, especially the head, to specific interior surfaces. Design modifications of these areas are needed to prevent serious facial fractures that have been seen. Lap belted drivers contact the steering wheel rim or instrument panel in front of the wheel in head-on crashes; the front passenger strikes the upper instrument panel. Improper positioning of the lap seat belts produces serious intraabdominal injury, especially in the case of the rear passengers. Seat belt fatality cases were, in general, due to collapse and compromise of the occupant space as typified by the broadside intersection collision.

Investigations of 1967 and 1968 model cars indicate that the injuries sustained by driver impacts to the steering assembly are markedly reduced because of the energy absorbing steering column. Drivers, however, are sustaining facial injuries from impact to the steering wheel rim even in low speed crashes. In more severe head-on collisions, the driver is compressing the energy absorbing column and is striking his face on the upper padded instrument panel in front of the steering wheel. Relatively severe facial fractures are sustained by impacting this portion of the panel.

An analysis of 211 automobiles having the ball-type E.A. device (GM cars - 1972–1980), involved in frontal crashes was made to determine the relationship between driver injury and the steering assembly. The majority of the drivers had MAIS of 0 or 1 (66%). The head was the most frequently injured body region with the lower extremities next in frequency. Of the unrestrained drivers studied, 43% had a thoracic injury, the majority of which were minor. There is no correlation between injury severity and steering rim or spoke deformation, or the amount of E.A. column compression. Specific terminology for certain aspects of the E.A. performance are suggested.

This paper presents examples of passenger car crashes with 3-point restrained front seat occupants. Detailed case capsule descriptions that include car make and model, injury descriptions and severity, and contacts producing the injuries.

This paper presents an analysis of front seat outboard occupants in frontal and rollover crashes. These occupants were lap belted, lap-shoulder belted or were unrestrained. In the frontal crash the lap-shoulder belt reduces the occurrence of the severe, serious, critical-to-life injuries, and fatalities in all regions of the body (head, neck, thorax, lower torso and extremities). In addition, there is a strong association between belt usage and the occupant escaping from the crash with no injury. In rollover crashes, belts reduce the frequency of the more severe injuries by preventing the occupant from being ejected. For those occupants not ejected from the car, belts effectively reduce fatalities and the more serious injuries.

From field crash investigations conducted by the authors, a series of well documented crashes will be presented. In each, at least one occupant was wearing a lap-shoulder belt. Detailed injury reports will be presented along with photographs of car damage, occupant contact areas, and where possible, the estimated impact speeds.

Mechanisms of thoraco-abdominal trauma were investigated utilizing unembalmed, repressurized human cadavers subjected to frontal impact with a steering wheel assembly. The focus of this research program was on trauma to the soft-tissue organs surrounded by the thoracic cage, as well as on the kinematic response of the thoracic cage. The results are compared to other thoraco-abdominal research programs conducted at the University of Michigan Transportation Research Institute (UMTRI) during the last eight years.

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.