320
Injury, 6, 320-324
The use of seat belts by motor car occupants involved in road traffic accidents C. S. 6. Galasko* Accident
and D. H. Edwardst
Service, Radcliffe Infirmary, Oxford
Summary
Two hundred and forty-four motor car occupants involved in road traffic accidents, who sustained injuries sufficiently severe to require admission to hospital, have been investigated in order to assess the value of seat belts. The results indicated that the use of seat belts significantly reduced the mortality and the number of severe, multiple and facial injuries.
INTRODUCTION THERE is now a lot of evidence which suggests that seat belts decrease the mortality and morbidity of individuals involved in road traffic accidents (Lister and Neilsen, 1966; Bohlin, 1968; Grattan and Hobbs, 1968 ; McKie, 1973). However, there have been several reports of injuries which may have been due to the seat belt (Dehner, 1971; Michelinakis, 1971; Snyder, 1972). During an investigation into the cause of injuries of sufficient severity to require the admission of the patient to hospital, we also investigated the effect of wearing seat belts.
METHODS
AND
PATIENTS
During the four-month period September to December 1971, each patient admitted to the Accident Service of the Radcliffe Infirmary, Oxford, was questioned about the cause of his or her injury. Where the patient was unconscious or did not remember details of the accident these were obtained either from the ambulance crew, the police who investigated the accident, or some other individual who was in the same vehicle. Only patients whose injuries were severe enough *Current address: Orthopaedic Unit, Royal Postgraduate Medical School, London, WI2 OHS. tcurrent address: Nuffield Orthopaedic Centre, Oxford.
to require admission to hospital were investigated. Patients who were dead on arrival at the hospital were included in the study. Every patient who died had an autopsy.
RESULTS During this period, out of 1417 patients who were admitted to hospital, 24 died. This included 483 patients who were involved in road traffic accidents and there were 15 fatalities in this group. The type of vehicle used by these patients is shown in Table I. Two hundred and forty-four
Tab/e /.-The distribution of patients involved in road traffic accidents and who were admitted to hospital because of the injuries they sustained Road traffic accidents No. Car Lorry Van Bus/coach Pedestrian Moped Scooter Motor cycle Cycle Tricycle Total
244 6 12 15 98 11 15 47 34 1 483
Fatal 9 0 0 0 3 0 0 2 0 1 15
patients were in motor cars (Table II). There were 135 motor car drivers, 6 of whom sustained fatal injuries, 68 front seat passengers with 1 fatality, 38 back seat passengers with 2 fatalities,
321
Galasko and Edwards: Use of Seat Belts
and 3 children who were in a child’s seat and none died. One hundred and nineteen of the motor car drivers did not wear a seat belt and all 6 fatalities
Table Il.-Motor car occupants who were involved in road traffic accidents and sustained injuries sufficiently severe to require admission to hospital Motor car No. Driver Front seat passenger Back seat passenger Child seat Total
Fatal
135 68 38 3 244
6 1 2 0 9
Tab/e ///.-The use of seat belts by motor car drivers who were injured in road traffic accidents Motor car drivers No. Without seat belt With seat belt
119 16
in TabIe VI. One patient sustained a mild head injury and a fractured scapula, one a mild head injury and fractured patella, one a mild head injury, one patient a fractured sternum associated
Tab/e /V.--The injuries sustained by motor car, drivers who wore seat belts Injuries No. Mild head injury Mild head injury and fractured metatarsal Mild head injury and fractured ribs Fractured ribs and finger phalanx Fractured ribs and pubic ramus Fractured sternum Ruptured diaphragm Injured hip Fractured tibia Whiplash injury Multiple minor fractures Total
2 1 1 1 16
Fatal 6 0
occurred in this group. Sixteen drivers wore seat belts and there were no fatalities (Table III). The injuries sustained by the drivers who wore seat belts are shown in Table IV. Six patients sustained a mild head injury. In one patient this was associated with a fractured metatarsal and in another with two fractured ribs. Five other patients sustained chest injuries; one fractured several ribs and a finger phalanx, another fractured several ribs and a pubic ramus, two patients sustained fractures of their sternum and one a ruptured diaphragm. In the other 5 patients the injuries did not involve the cranium, chest or abdomen. One patient had a dislocated hip, another a fracture of the acetabulum extending into the hip joint. One patient fractured a tibia, one sustained a whiplash injury and one sustained multiple but minor fractures. Sixty-three of the front seat passengers who were injured were not wearing seat belts and there was one fatality in this group (Table V). Five patients wore seat belts. There were no fatalities in this group, whose injuries are listed
with a very minor compression fracture of the fourth thoracic vertebra, and the final patient sustained a fractured tibia. During the same period 19 patients were found to be dead on arrival at the hospital. Eighteen
Table V.-The use of seat belts by front seat passengers who were injured in road traffic accidents Front seat passengers No. Without seat belt With seat belt
63 5
Fatal 1 0
were involved in road traffic accidents. There were 10 motor car occupants, 4 motor cyclists or pillion passengers, 2 pedestrians, 1 van passenger and 1 cyclist (Table VII). Two of the car occupants wore seat belts. A 22-year-old driver of a left-hand drive motor car sustained a ruptured aorta, bruising of his chest wall along the line of the seat belt and fractures of his nose, multiple ribs and femur, and a dislocated patella. A
322
injury: the British Journal of Accident Surgery Vol. ~/NO. 4
37-year-old car driver sustained a head injury associated with cerebral contusion and pontine haemorrhage, a hyperextension cervical spine injury, a laceration of his tongue from which he inhaled blood, multiple fractures of his rib cage and lacerations of both lungs as well as a fractured clavicle.
DISCUSSION
21 per cent of the drivers and 40 per cent of the passengers wore seat belts. In roads where the traffic was mainly local, 13 per cent of the drivers and 6 per cent of the passengers wore seat belts. These percentages are higher than the percentage of injured passengers and drivers who wore seat belts and were admitted to hospital. Comparison of these figures indicated that the reduction in fatalities in seat belt users was significant (PC
These results indicate that the majority of drivers and front seat passengers of motor cars who are Table V//.-The distribution of patients who were found to be dead on arrival at the hospital and who had been involved in a road traffic accident
V/.-The injuries sustained by front seat passengers who wore seat belts
Table
Injuries
Road traffic accidents Patients dead on arrival at hospital
No.
Mild head injury and fractured scapula Mild head injury and fractured patella Mild head injury Fractured sternum and 4th thoracic vertebra Fractured tibia Total
1 1 1 1 1 5
invollved in road traffic accidents and who sustain injuries sufficiently severe to require admission to hospital do not wear seat belts. During the period of this investigation, the City of Oxford Road Safety Organization carried out a survey (Harris and Neville, 1971) of the number of drivers and passengers of cars who wore seat belts (Table VZIZ). They found that, in all, 13 per cent of drivers and 19 per cent of front seat passengers wore seat belts. However, in through roads
Car (without a seat belt) Car (with a seat belt) Motor cycle Pedestrian Van Cycle
8 2 4 2 1 1
0.05) as was the reduction in injuries sustained by front seat passengers who wore seat belts (PC 0.05). The reduction in the number of drivers who wore seat belts and were injured was not significant (0.1 >P>O.O5), although the reduction in severe and multiple injuries was. The majority of injuries sustained by seat belt wearers were minor although they did warrant admission to hospital. None of this group of patients suffered severe multiple injuries nor severe facial or head
Table V///.-The number of vehicles fitted with seat belts and the number of drivers and passengers who used them (survey carried out by the City of Oxford Road Safety Organization) Seat belts in Oxford
(From Harris and Neville, 1971)
No.
Per cent wearing seat belts
Per cent with seat belts fitted but not worn
No seat belts in car
Driver Passenger
424 221
21 40
69 50
10 10
Through and local traffic Driver Passenger Local traffic only Driver Passenger Driver Total Passenger
932 330 182 74 1538 625
9 7 13 6 13 19
80 76
11 17 17 16 11 14
Through traffic
;: 76 67
Galasko
and Edwards:
323
Use of Seat Belts
There were no fatalities amongst the injuries. seat belt users who were alive on arrival at the hospital. Ten car occupants were found to be dead on arrival at the hospital. Two had worn seat belts. It is possible that some of their injuries may have been due to direct pressure from the seat belt and this was confirmed by the chest wall bruising in one of these patients. During 1971 there were 64 fatalities involving drivers or passengers of motor cars which were recorded by the Thames Valley Police (personal communication). Only 6 (9.4 per cent) had been wearing seat belts. This figure is less than half the proportion of drivers and passengers using seat belts in this area, and again indicates that seat belts significantly reduce the mortality from road traffic accidents (P < 0.05). During the period of this investigation, one of us counted the number of drivers and front seat passengers in police vehicles and in motor cars belonging to officially registered driving schools during a lesson. Fifty-one of the 139 (36.7 per cent) police car drivers and 21 of the 43 front seat passengers (48.3 per cent) wore seat belts. This is a much higher percentage than that shown by the general public, but if any campaign advising the routine use of seat belts is to be successful, then a higher proportion of police officers should wear these restraints, particularly when driving on a through road. What is much more disquieting is the fact that not a single driver nor front seat passenger in 150 driving-school motor cars wore seat belts. If learner drivers are not taught to wear seat belts, they will never get into the habit. If a campaign is to be successful, then the wearing of seat belts by learner drivers and instructors must be insisted upon, and any individual should be failed the driving test if he does not wear his seat belt. There has been some discussion in the lay press (Daily Mirror, 1973) suggesting that the examiner should not wear a seat belt so that he is able to reach the driving wheel rapidly in an emergency. This does not excuse the pupil from wearing a seat belt. Although the results in this series confirm other studies that seat belts significantly decrease the mortality and morbidity of road traffic accidents (Lister and Neilsen, 1966; Bohlin, 1968; Grattan and Hobbs, 1968; Huelke, 1972; McKie, 1973), occasionally they may be responsible for injuries (Dehner, 1971; Michelinakis, 1971; Snyder, 1972). In our series the fractures of the sternum and ribs, the lacerations of the lungs and the ruptured diaphragm and aorta may
have been due to seat belts. These injuries seem to occur when the seat belt was worn too loosely or where the lap strap fitted across the abdomen rather than across the pelvis, resulting in injuries to the spleen, liver and gut (Michelinakis, 1971; Snyder, 1972) when the pressure is not taken by the pelvis. It is unfortunate that the seat belts available on some current motor vehicles do not allow adequate fitting of the lap strap below the anterior superior iliac spines, and in some models the buckles allow the belt to loosen during long distance travel. The use of the lap strap alone is associated with seat belt injuries involving the abdominal viscera as well as the spine (Dehner, 1971). Fractures of the vertebrae are due to acute flexion over the lap belt resulting in a horizontal ‘ fulcrum fracture ’ of the vertebral body, disruption of the posterior elements or a compression fracture of the vertebral body. It is important to ensure that only properly designed seat belts be used. Before legislation is introduced to make the wearing of seat belts compulsory, the optimal design of such restraining devices should be determined, and only suitable seat belts allowed. Much research is being done into the design of seat belts, for example the use of self-adjusting inertia-reel harnesses, a strong seat with an integral seat harness, or a fixed seat with adjustable controls (Thomas, 1970). In the meantime the wearing of seat belts should be actively encouraged. Acknowledgements We would like to thank the City of Oxford Road Safety Organization and the Thames Valley Police for their help and co-operation, and the Consultant staff, Accident Service, Radcliffe Infirmary, for allowing us to investigate patients admitted under their care.
REFERENCES BOHLIN, N.
I. (1968), ’ A Statistical Analysis of 28,000 Accident Cases with Emphasis on Occupant Restraint Value ‘, Publication TY 903-4 AB Volvo,
Gothenberg, Daily Mirror,
Sweden. 4 March, 1973. ‘Clunk-click
ban onthe
L-test men ‘.
‘ Seat belt injuries of the spine and abdomen ‘, Am. J. Roentgenol. Radium Ther.
DEHNER, J. R. (1971),
Nucl. Med.,
111, 833.
A. (1968), ‘ Mechanism of serious lower limb injuries to motor vehicle occupants ‘, R.R.L. Report L.R. 201, Crowthorne (Road Research Laboratory).
GRATTAN, E. and HOBBS, J.
324
Injury: the British Journal of Accident
HARRIS,I. G. W. and NEVILLE,P. C. (1971), Wearing of Seat Belts in Oxford, City of Oxford Road Safety Organisation. HUELKE, D. F. (1972), ’ Mechanism of injury automobile crashes ‘, Calif: Med., 116, :. LISTER,R. D. and NEILSEN,I. D. (1966), ‘ The effectiveness of seat belts ‘, R.R.L. Report No. 16, Requests for WI2 OHS.
reprints
should
he addressed
BIOMECHANICS
to:-C.
S. B. Galasko,
OF TISSUE
Surgery Vol. ~/NO. 4
Crowthorne (Road Research Laboratory). MCKIE, D. (1973), ‘ Seat Belts ‘, Lancet, 1, 1173. MICHELINAKIS,E. (1971), ‘ Safety-belt syndrome Practitoner,
‘,
207, 77.
SNYDER, C. J. (1972), ‘ Bowel injuries from automobile seat belts ‘, Am. J. Surg., 123, 312. THOMAS,L. H. (1970),‘ Safer cars ‘, Br. J. Hosp. Med., 4, 451. Esq.,
VIABILITY
Royal
Postgraduate
Medical
School,
Ducane
AND CLINICAL APPLICATIONS
A Seminar on the Biomechanics of Tissue Viability and Clinical Applications will be held on Wednesday 13 August to Friday 15 August, 1975, at the University of Strathclyde. Topics include pressure sores, tissue biomechanical background, ulceration causation, cure and cost effectiveness, patient monitoring, body Information from: Professor R. M. support characteristics and workshops. Kenedi, Bioengineering Unit, Wolfson Centre, University of Strathclyde, Glasgow, G4 ONW, Scotland.
Road,
London,
Injury, 6, 320-324
The use of seat belts by motor car occupants involved in road traffic accidents C. S. 6. Galasko* Accident
and D. H. Edwardst
Service, Radcliffe Infirmary, Oxford
Summary
Two hundred and forty-four motor car occupants involved in road traffic accidents, who sustained injuries sufficiently severe to require admission to hospital, have been investigated in order to assess the value of seat belts. The results indicated that the use of seat belts significantly reduced the mortality and the number of severe, multiple and facial injuries.
INTRODUCTION THERE is now a lot of evidence which suggests that seat belts decrease the mortality and morbidity of individuals involved in road traffic accidents (Lister and Neilsen, 1966; Bohlin, 1968; Grattan and Hobbs, 1968 ; McKie, 1973). However, there have been several reports of injuries which may have been due to the seat belt (Dehner, 1971; Michelinakis, 1971; Snyder, 1972). During an investigation into the cause of injuries of sufficient severity to require the admission of the patient to hospital, we also investigated the effect of wearing seat belts.
METHODS
AND
PATIENTS
During the four-month period September to December 1971, each patient admitted to the Accident Service of the Radcliffe Infirmary, Oxford, was questioned about the cause of his or her injury. Where the patient was unconscious or did not remember details of the accident these were obtained either from the ambulance crew, the police who investigated the accident, or some other individual who was in the same vehicle. Only patients whose injuries were severe enough *Current address: Orthopaedic Unit, Royal Postgraduate Medical School, London, WI2 OHS. tcurrent address: Nuffield Orthopaedic Centre, Oxford.
to require admission to hospital were investigated. Patients who were dead on arrival at the hospital were included in the study. Every patient who died had an autopsy.
RESULTS During this period, out of 1417 patients who were admitted to hospital, 24 died. This included 483 patients who were involved in road traffic accidents and there were 15 fatalities in this group. The type of vehicle used by these patients is shown in Table I. Two hundred and forty-four
Tab/e /.-The distribution of patients involved in road traffic accidents and who were admitted to hospital because of the injuries they sustained Road traffic accidents No. Car Lorry Van Bus/coach Pedestrian Moped Scooter Motor cycle Cycle Tricycle Total
244 6 12 15 98 11 15 47 34 1 483
Fatal 9 0 0 0 3 0 0 2 0 1 15
patients were in motor cars (Table II). There were 135 motor car drivers, 6 of whom sustained fatal injuries, 68 front seat passengers with 1 fatality, 38 back seat passengers with 2 fatalities,
321
Galasko and Edwards: Use of Seat Belts
and 3 children who were in a child’s seat and none died. One hundred and nineteen of the motor car drivers did not wear a seat belt and all 6 fatalities
Table Il.-Motor car occupants who were involved in road traffic accidents and sustained injuries sufficiently severe to require admission to hospital Motor car No. Driver Front seat passenger Back seat passenger Child seat Total
Fatal
135 68 38 3 244
6 1 2 0 9
Tab/e ///.-The use of seat belts by motor car drivers who were injured in road traffic accidents Motor car drivers No. Without seat belt With seat belt
119 16
in TabIe VI. One patient sustained a mild head injury and a fractured scapula, one a mild head injury and fractured patella, one a mild head injury, one patient a fractured sternum associated
Tab/e /V.--The injuries sustained by motor car, drivers who wore seat belts Injuries No. Mild head injury Mild head injury and fractured metatarsal Mild head injury and fractured ribs Fractured ribs and finger phalanx Fractured ribs and pubic ramus Fractured sternum Ruptured diaphragm Injured hip Fractured tibia Whiplash injury Multiple minor fractures Total
2 1 1 1 16
Fatal 6 0
occurred in this group. Sixteen drivers wore seat belts and there were no fatalities (Table III). The injuries sustained by the drivers who wore seat belts are shown in Table IV. Six patients sustained a mild head injury. In one patient this was associated with a fractured metatarsal and in another with two fractured ribs. Five other patients sustained chest injuries; one fractured several ribs and a finger phalanx, another fractured several ribs and a pubic ramus, two patients sustained fractures of their sternum and one a ruptured diaphragm. In the other 5 patients the injuries did not involve the cranium, chest or abdomen. One patient had a dislocated hip, another a fracture of the acetabulum extending into the hip joint. One patient fractured a tibia, one sustained a whiplash injury and one sustained multiple but minor fractures. Sixty-three of the front seat passengers who were injured were not wearing seat belts and there was one fatality in this group (Table V). Five patients wore seat belts. There were no fatalities in this group, whose injuries are listed
with a very minor compression fracture of the fourth thoracic vertebra, and the final patient sustained a fractured tibia. During the same period 19 patients were found to be dead on arrival at the hospital. Eighteen
Table V.-The use of seat belts by front seat passengers who were injured in road traffic accidents Front seat passengers No. Without seat belt With seat belt
63 5
Fatal 1 0
were involved in road traffic accidents. There were 10 motor car occupants, 4 motor cyclists or pillion passengers, 2 pedestrians, 1 van passenger and 1 cyclist (Table VII). Two of the car occupants wore seat belts. A 22-year-old driver of a left-hand drive motor car sustained a ruptured aorta, bruising of his chest wall along the line of the seat belt and fractures of his nose, multiple ribs and femur, and a dislocated patella. A
322
injury: the British Journal of Accident Surgery Vol. ~/NO. 4
37-year-old car driver sustained a head injury associated with cerebral contusion and pontine haemorrhage, a hyperextension cervical spine injury, a laceration of his tongue from which he inhaled blood, multiple fractures of his rib cage and lacerations of both lungs as well as a fractured clavicle.
DISCUSSION
21 per cent of the drivers and 40 per cent of the passengers wore seat belts. In roads where the traffic was mainly local, 13 per cent of the drivers and 6 per cent of the passengers wore seat belts. These percentages are higher than the percentage of injured passengers and drivers who wore seat belts and were admitted to hospital. Comparison of these figures indicated that the reduction in fatalities in seat belt users was significant (PC
These results indicate that the majority of drivers and front seat passengers of motor cars who are Table V//.-The distribution of patients who were found to be dead on arrival at the hospital and who had been involved in a road traffic accident
V/.-The injuries sustained by front seat passengers who wore seat belts
Table
Injuries
Road traffic accidents Patients dead on arrival at hospital
No.
Mild head injury and fractured scapula Mild head injury and fractured patella Mild head injury Fractured sternum and 4th thoracic vertebra Fractured tibia Total
1 1 1 1 1 5
invollved in road traffic accidents and who sustain injuries sufficiently severe to require admission to hospital do not wear seat belts. During the period of this investigation, the City of Oxford Road Safety Organization carried out a survey (Harris and Neville, 1971) of the number of drivers and passengers of cars who wore seat belts (Table VZIZ). They found that, in all, 13 per cent of drivers and 19 per cent of front seat passengers wore seat belts. However, in through roads
Car (without a seat belt) Car (with a seat belt) Motor cycle Pedestrian Van Cycle
8 2 4 2 1 1
0.05) as was the reduction in injuries sustained by front seat passengers who wore seat belts (PC 0.05). The reduction in the number of drivers who wore seat belts and were injured was not significant (0.1 >P>O.O5), although the reduction in severe and multiple injuries was. The majority of injuries sustained by seat belt wearers were minor although they did warrant admission to hospital. None of this group of patients suffered severe multiple injuries nor severe facial or head
Table V///.-The number of vehicles fitted with seat belts and the number of drivers and passengers who used them (survey carried out by the City of Oxford Road Safety Organization) Seat belts in Oxford
(From Harris and Neville, 1971)
No.
Per cent wearing seat belts
Per cent with seat belts fitted but not worn
No seat belts in car
Driver Passenger
424 221
21 40
69 50
10 10
Through and local traffic Driver Passenger Local traffic only Driver Passenger Driver Total Passenger
932 330 182 74 1538 625
9 7 13 6 13 19
80 76
11 17 17 16 11 14
Through traffic
;: 76 67
Galasko
and Edwards:
323
Use of Seat Belts
There were no fatalities amongst the injuries. seat belt users who were alive on arrival at the hospital. Ten car occupants were found to be dead on arrival at the hospital. Two had worn seat belts. It is possible that some of their injuries may have been due to direct pressure from the seat belt and this was confirmed by the chest wall bruising in one of these patients. During 1971 there were 64 fatalities involving drivers or passengers of motor cars which were recorded by the Thames Valley Police (personal communication). Only 6 (9.4 per cent) had been wearing seat belts. This figure is less than half the proportion of drivers and passengers using seat belts in this area, and again indicates that seat belts significantly reduce the mortality from road traffic accidents (P < 0.05). During the period of this investigation, one of us counted the number of drivers and front seat passengers in police vehicles and in motor cars belonging to officially registered driving schools during a lesson. Fifty-one of the 139 (36.7 per cent) police car drivers and 21 of the 43 front seat passengers (48.3 per cent) wore seat belts. This is a much higher percentage than that shown by the general public, but if any campaign advising the routine use of seat belts is to be successful, then a higher proportion of police officers should wear these restraints, particularly when driving on a through road. What is much more disquieting is the fact that not a single driver nor front seat passenger in 150 driving-school motor cars wore seat belts. If learner drivers are not taught to wear seat belts, they will never get into the habit. If a campaign is to be successful, then the wearing of seat belts by learner drivers and instructors must be insisted upon, and any individual should be failed the driving test if he does not wear his seat belt. There has been some discussion in the lay press (Daily Mirror, 1973) suggesting that the examiner should not wear a seat belt so that he is able to reach the driving wheel rapidly in an emergency. This does not excuse the pupil from wearing a seat belt. Although the results in this series confirm other studies that seat belts significantly decrease the mortality and morbidity of road traffic accidents (Lister and Neilsen, 1966; Bohlin, 1968; Grattan and Hobbs, 1968; Huelke, 1972; McKie, 1973), occasionally they may be responsible for injuries (Dehner, 1971; Michelinakis, 1971; Snyder, 1972). In our series the fractures of the sternum and ribs, the lacerations of the lungs and the ruptured diaphragm and aorta may
have been due to seat belts. These injuries seem to occur when the seat belt was worn too loosely or where the lap strap fitted across the abdomen rather than across the pelvis, resulting in injuries to the spleen, liver and gut (Michelinakis, 1971; Snyder, 1972) when the pressure is not taken by the pelvis. It is unfortunate that the seat belts available on some current motor vehicles do not allow adequate fitting of the lap strap below the anterior superior iliac spines, and in some models the buckles allow the belt to loosen during long distance travel. The use of the lap strap alone is associated with seat belt injuries involving the abdominal viscera as well as the spine (Dehner, 1971). Fractures of the vertebrae are due to acute flexion over the lap belt resulting in a horizontal ‘ fulcrum fracture ’ of the vertebral body, disruption of the posterior elements or a compression fracture of the vertebral body. It is important to ensure that only properly designed seat belts be used. Before legislation is introduced to make the wearing of seat belts compulsory, the optimal design of such restraining devices should be determined, and only suitable seat belts allowed. Much research is being done into the design of seat belts, for example the use of self-adjusting inertia-reel harnesses, a strong seat with an integral seat harness, or a fixed seat with adjustable controls (Thomas, 1970). In the meantime the wearing of seat belts should be actively encouraged. Acknowledgements We would like to thank the City of Oxford Road Safety Organization and the Thames Valley Police for their help and co-operation, and the Consultant staff, Accident Service, Radcliffe Infirmary, for allowing us to investigate patients admitted under their care.
REFERENCES BOHLIN, N.
I. (1968), ’ A Statistical Analysis of 28,000 Accident Cases with Emphasis on Occupant Restraint Value ‘, Publication TY 903-4 AB Volvo,
Gothenberg, Daily Mirror,
Sweden. 4 March, 1973. ‘Clunk-click
ban onthe
L-test men ‘.
‘ Seat belt injuries of the spine and abdomen ‘, Am. J. Roentgenol. Radium Ther.
DEHNER, J. R. (1971),
Nucl. Med.,
111, 833.
A. (1968), ‘ Mechanism of serious lower limb injuries to motor vehicle occupants ‘, R.R.L. Report L.R. 201, Crowthorne (Road Research Laboratory).
GRATTAN, E. and HOBBS, J.
324
Injury: the British Journal of Accident
HARRIS,I. G. W. and NEVILLE,P. C. (1971), Wearing of Seat Belts in Oxford, City of Oxford Road Safety Organisation. HUELKE, D. F. (1972), ’ Mechanism of injury automobile crashes ‘, Calif: Med., 116, :. LISTER,R. D. and NEILSEN,I. D. (1966), ‘ The effectiveness of seat belts ‘, R.R.L. Report No. 16, Requests for WI2 OHS.
reprints
should
he addressed
BIOMECHANICS
to:-C.
S. B. Galasko,
OF TISSUE
Surgery Vol. ~/NO. 4
Crowthorne (Road Research Laboratory). MCKIE, D. (1973), ‘ Seat Belts ‘, Lancet, 1, 1173. MICHELINAKIS,E. (1971), ‘ Safety-belt syndrome Practitoner,
‘,
207, 77.
SNYDER, C. J. (1972), ‘ Bowel injuries from automobile seat belts ‘, Am. J. Surg., 123, 312. THOMAS,L. H. (1970),‘ Safer cars ‘, Br. J. Hosp. Med., 4, 451. Esq.,
VIABILITY
Royal
Postgraduate
Medical
School,
Ducane
AND CLINICAL APPLICATIONS
A Seminar on the Biomechanics of Tissue Viability and Clinical Applications will be held on Wednesday 13 August to Friday 15 August, 1975, at the University of Strathclyde. Topics include pressure sores, tissue biomechanical background, ulceration causation, cure and cost effectiveness, patient monitoring, body Information from: Professor R. M. support characteristics and workshops. Kenedi, Bioengineering Unit, Wolfson Centre, University of Strathclyde, Glasgow, G4 ONW, Scotland.
Road,
London,
