The medical effects of seat-belt legislation in the United Kingdom: one viewpoint from the USA.

Britain introduced a belt-use law in July 1981 to become effective on 31 January 1983, a full 13 years after Australia. In the USA, priority was given to laws requiring infants and young children to be appropriately restrained so that between 1977 and 1984 all 50 states and the District of Colombia enacted child passenger safety laws. It was not until 12 July 1984 that New York became the first USA state to introduce mandatory use of seat-belts by all front-seat occupants beginning 1 December 1984. The New York campaign for a belt-use law began in the spring of 1982 with establishment in November of that year of a state coalition representing medicine, business, education, state agencies and community service groups. The British experience became an integral part of the ammunition in the legislative debate as well as in maintaining media interest in the subject. In New York, as of 1 December 1984, all drivers, front-seat passengers and children in the rear seat up to the age of 10 have been required to buckle up. The driver is responsible for occupants under age of 16. The law permits exemptions for drivers of buses, taxis, liveries, emergency vehicles and large commercial trucks over 18000 pounds gross vehicle weight. Passengers of school buses are not required to use belts, although school bus drivers are covered by a previous statute. Exemptions are allowed for some medical conditions if certified by a physician following an examination of the patient. However, the Medical Society of the State ofNew York declined to approve guidelines for granting medical exemptions which had been drawn up by the State Health Department and the Governor's Traffic Safety Committee, Department of Motor Vehicles, on the basis that no medical contra-indications to belt use have as yet presented themselves. The Medical Society stated that 'the danger of not wearing a belt outweighs the risks involved in every case so far considered'. Potential physician liability for damages should an exempted patient later be involved in an injury-producing crash was also an issue. Pre-law observational surveys conducted in October 1984 showed belt-use to be 16%. In December 1984 when the law went into effect with a one-month warning period, usage increased to 43% for drivers and 38% for front-seat passengers. During the first full month of the law with citations being issued usage increased to 75% for drivers and 67% for front-seat passengers. Beltuse counts for the 6-month period from January to June 1985 indicate that use has probably levelled off at about 57% which is three and a half times higher than pre-law usage. The current level of use, while not satisfactory, was not unexpected given similar experiences of several Canadian provinces in closer proximity to New York State than Great Britain. Occupant fatalities in New York State have decreased by 18% during the first 6 months of 1985 as compared to the same period in 1984 (from 535 to 438). Compared to the previous 5-year average for January-June, occupant fatalities have dropped by 28% (from 608 to 438). The study on the medical effects of seat-belt legislation in the United Kingdom is a major contribution to understanding the relationship between a mandatory belt-use law and motor-