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The William Lehman Injury Research Center has conducted multi-disciplinary investigations of one hundred seventy-eight crashes involving adult occupants protected by safety belts and air bags. In all cases, serious injuries were suspected. Nine cases involved serious heart injuries. These cases are not representative of crashes in general. However, when used in conjunction with National Accident Sampling System; Crashworthiness Data System (NASS/CDS) they provide insight into the most severe injuries suffered by restrained occupants in frontal crashes. Heart injuries are rare, but when they occur they are usually life threatening. NASS/CDS shows that heart injuries comprise about 0.2% of the injuries in frontal tow-away crashes. In the NHTSA file of Special Crash Investigations (SCI) of air bag cases, heart injuries are reported in 1% of the occupants over 15 years of age. Twenty-five percent of the fatally injured occupants had heart injuries, and 83% of those with heart injury died.