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The National Highway Traffic Safety Administration (NHTSA) Special Crash Investigations database contains twelve completed cases of child fatalities in rearward facing child seats caused by deploying air bags. Three of these are now available for examination. An additional two cases were investigated by the William Lehman Injury Research Center at the University of Miami School of Medicine. These five cases are examined to evaluate crash environment, injury mechanisms, and circumstances which caused the child to be in front of the passenger side air bag Four of the cases were crashes with impacts with the side of other cars with crash severities less than 15 mph. The predominate injury mechanism was brain and skull injury from a blow transmitted to the rear of the head through the child seat back. In one case, the force to the head was transmitted downward, directly from air bag contact.

The URGENCY algorithm uses data from on-board crash recorders to assist in identifying crashes that are most likely to have time critical (compelling) injuries. The injury risks projected by using the NASS/CDS data are the basis for the URGENCY algorithm. This study applied the algorithm retrospectively to a population of injured occupants in the database from the University of Miami School of Medicine, William Lehman Injury Research Center (WLIRC). The population selected was adult occupants in frontal crashes that were protected by three-point belts plus an air bag. For the cases with greater than 50% predicted MAIS 3+ injury probability, 96% of the occupants in the study had MAIS 3+ injuries. For the cases with less than 10% predicted MAIS 3+ injury probability, 63% did not have MAIS 3+ injuries. Most of the of MAIS 3+ injuries not predicted involved injuries in multiple impact crashes, pole crashes or close-in occupants injured by air bag deployment.

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.

The U.S. Department of Transportation-sponsored Crash Injury Research and Engineering Network (CIREN) program offers a reasonable look at the efficacy of second-generation air bags. This paper examines the data from the William Lehman Injury Research Center (WLIRC). The WLIRC data is a near census of crashes in the Miami-Dade region with occupants that appear to be severely injured. The percentage of deaths among trauma patients in the WLIRC data as a function of delta-V for first-generation air bags was higher than expected at lower delta-V's. There were nine driver fatalities at delta-V's of less than 20 mph (four involving short stature occupants, four with elderly occupants, and one due to significant intrusion and/or vehicle incompatibility). The data supported NHTSA's conclusion that first-generation air bags were too aggressive for occupants in close proximity to the deploying air bag and too aggressive for older persons.