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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.

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.

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.

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.

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%.

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.

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.

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.

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.

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.

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.

Based upon nine years of experience in conducting in-depth, clinical motor vehicle accident investigations, the conditions and practices that have been found to be essential to the collection of reliable and adequate information are defined. The role of the director and the selection of personnel for the investigation teams and their qualifications, training, and supervision are discussed. The establishment and maintenance of relationships with the civil authorities, and hospitals and para-medical personnel with which the accident investigation teams must work, are explained. Examples from actual experience are presented to demonstrate the usefulness of the authors' accident investigation information in identifying areas where vehicle design improvement is desirable and evidence that corrective action taken by the vehicle manufacturers has proved effective.

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.

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.

Ejection from a motor vehicle has been considered a hazardous event with the belief that occupant impacts outside of the car are the injury causing event. Analysis of NCSS data, and of Washtenaw County, Michigan crashes indicates, that more than half of the more serious injuries (≥AIS 3) occurred within the car prior to the ejection. Also in rollover crashes, side glass areas are the main portals of ejection, with the major injury being sustained within the car prior to ejection, occurring more often in far side down rollovers.

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.

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.