Prevention and treatment of brain ischaemia.

brought before parliament in early 1986. The next and obvious stage is to extend the requirement to rear seat occupants. Britain is one of the last of the motorised nations which does not yet require fitting rear seat belts. In depth studies of crashes have shown that one of the limitations to the protection of front seat occupants occurs in frontal collisions when correctly belted front occupants are injured by unrestrained rear seat passengers. If rear seat occupants used seat belts as frequently as front seat occupants do now there would be two benefits: rear seat occupant deaths and injuries would be reduced by some 70%, and there would be a further reduction of some 6% in front seat casualties.'0 Beyond this obvious measure many technical improvements to restraint systems and car interiors can and should be made. By design, drivers wearing restraints suffer face contacts with the steering wheel in most cars in a crash of more than some 25 mph. The answer lies in better padding or supplementary airbags in the steering wheel together with preloading of seat belts. Anchorage points mounted on the seat improve the lap belt geometry and diminish abdominal injuries due to submarining, which occurs when the pelvis rotates out from under the lap belt section in a frontal collision. But what about the obese, the aged, the pregnant woman, and the child? Have we really provided adequate protection for all those who actually use cars? What about a truly "friendly" interior, in which rational crash protective design has been applied effectively? In each case the introduction of such protective measures as seat belts, laminated windscreens, head restraints, antiburst door latches, and airbags represents a potential advance comparable with the introduction ofa new drug. In epidemiological terms the benefits and side effects of such measures when used by the population at risk can be profound and often unexpected. And yet these measures do not receive the attention and evaluation from the medical community which they deserve. Perhaps the Rutherford study on the effectiveness of seat belts will generate some new interest in traffic injury research and its prevention. Road accidents cost Britain about £2 5 billion annually. Research into traffic injury reduction has an annual budget of less than one tenth of 1% of that figure. Most other industrialised countries devote far greater resources to the problem. Cannot the success of the seat belt legislation be used as a spur to more effort in tackling the general problems of trauma in our motorised society? MURRAY MACKAY