Injuries, seat-belts and further research.

This study is important for three main reasons. Firstly, it demonstrates the success of the seatbelt law in Britain on a detailed multi-hospital basis, illustrating the wisdom of such a law. Secondly, it illustrates the limitations of the seat-belts which have been fitted to cars in the last 10 years, by describing the nature, frequency and severity of injuries to restrained occupants. Thirdly, it illustrates how new knowledge about trauma can be acquired by cooperation between accident and emergency departments in separate hospitals in the UK. This is the first major study of its kind, and the first time that the Department of Health and Social Security has put any significant funding into road injury research. The report analysed the data by Year 1 (pre-legislation) and Year 2 (post-legislation), and, consequently, some of the data cells were small. In the former there was approximately 25% beltuse, and in the latter 90%. The data could be re-analysed solely in terms of belt usage, giving larger cells and, perhaps, greater meaning to some of the findings. What are the long-term consequences of traffic injury? There is a questionable view among some legislators and car manufacturers that AIS 3 is an acceptable level of injury in design terms. AIS 3 to the chest, for example, may be an injury with few residual complications for most healthy adults, but AIS 3 level injuries to the brain or the lower limbs are predominantly disabling to some unknown degree. It would be of interest, therefore, to recall a sub-set of patients who were wearing seat-belts, 2 years after their crashes, to document and classify the long-term consequences of their injuries in functional, social and financial terms. Such a project on disability would be complementary to the initial assessment of their injuries and would give insights into the more general problems of the costs and consequences to the National Health Service and to the community in general of traffic injuries. Present-day cars are designed, in terms of crashworthiness, to protect primarily fiftieth percentile male 'dummies'. Some recognition is given of the fifth percentile female and the ninety-fifth percentile male dummy, but the current state of development of such biomechanical devices, which aim to replicate the human frame, do not address many aspects of the actual population at risk in cars. The study would have to contain a great deal of useful information on certain population groups besides the obvious ones of age and sex (for example, belt function for children, old people, the obese, the arthritic and the pregnant) which could be pursued. The seat-belt is discussed as if it was a uniform device in all cars. In reality, seat-belt geometry and design have varied greatly over the last 10 years. It would be of interest to see how some of these more vulnerable populations feature in the post-law data, particularly in terms ofabdominal and neck injuries. Even allowing for the substantial differences in seat-belt design, one may define from the study four general limitations to current seat-belts which should all be the subject of further investigation. Steering wheel contacts. The study rightly emphasizes the high frequency of head and face contacts by drivers with steering wheels. Current design regulations do not adequately address