II. Epidemiology

  1. Seat Belts reduce risk of MVA related deaths in teens and adults by 50%
  2. Of fatal U.S. MVAs in 2015, >50% of deceased teens were unrestrained
  3. Children ages 4 to 7 years old are prematurely transitioned to Seat Belts in 25% of cases
    1. These children should instead be transitioned to Booster Seats first
  4. References
    1. (2017) NHTSA Occupant Protection in Passenger Vehicles 2015 Data
      1. https://crashstats.nhtsa.dot.gov/Api/Public/Publication/812374

III. Technique: Correct fitting of adult auto safety belts

  1. Use Child Safety Seat if adult belt does not fit
  2. Indications
    1. Weighs more than 80 pounds (36 kg)
    2. Child standing height over 57 inches (145 cm)
    3. Child Sitting Height over 29 inches (74 cm)
  3. Proper fit
    1. Legs bend over edge of seat
    2. Buttocks firmly placed against seat back
    3. Lap belt fits tightly over upper thighs
    4. Shoulder belt crosses mid-clavicle and mid-Sternum
      1. Never use without Shoulder belt
      2. Risk of child submarining under Lap belt

IV. Technique: Children

  1. See Child Safety Seats
  2. Children <13 years old should NOT ride in front seat due to airbag deployment risk
    1. Airbags are associated with Closed Head Injury and Cervical Spine Injury in children <13 years old

V. Technique: Pregnancy

  1. Do not disable Air Bags for pregnant patients
    1. Move seat back as far as possible (at least 10 inches between Abdomen and Air Bag)
    2. Deployed Air Bags save maternal lives
      1. Safe in pregnancy given enough distance between Air Bag and Abdomen
    3. Schiff (2010) Obstet Gynecol 115(1): 85-92 [PubMed]
  2. Seat Belt use is critical
    1. Many pregnant women fail to use Seat Belts despite their protective effects
      1. Fetal death is most commonly due to maternal death in blunt Abdominal Trauma
      2. Protecting the mother is the best way to protect the fetus
    2. MVAs affect 2% of pregnant women (accounts for 50% of all Traumatic injuries in pregnancy)
      1. Maternal (U.S.): 368 maternal deaths per year
      2. Fetal: MVAs account for 82% of fetal deaths
    3. Properly positioned Seat Belts decrease the risk of fetal injury while keeping their mothers safer
      1. Uterine injury and fetal risk does increase if belts are incorrectly placed across the dome of the Uterus
      2. Relative Risk of fetal loss if unbelted: 2.8
      3. Fetal outcomes
        1. Properly restrained women: 29% adverse fetal outcomes
        2. Improperly restrained women: 50% adverse fetal outcomes
        3. Klinich (2008) Am J Obstet Gynecol 198(4): 450 [PubMed]
  3. Proper 3 point Seat Belt application in pregnancy
    1. Apply belts as snugly as possible while still maintaining comfort (remove belt slack)
    2. Lap belt
      1. Place under pregnant Abdomen
      2. Should fit snugly over thighs
    3. Shoulder harness
      1. Keep Shoulder harness off Uterus
      2. Harness should sit between Breasts
      3. Crosses midline of clavicle
  4. References
    1. Hyde (2003) Obstet Gynecol 102:279-86 [PubMed]

VI. Prevention: Miscellaneous

  1. Seat Belt use protects other occupants in car
    1. In accident Unrestrained Passengers become missiles
    2. Unrestrained Passengers strike belted passengers
    3. Unrestrained Passenger raises risk of death for others
    4. Cummings (2004) JAMA 291:343-9 [PubMed]

VII. References

  1. McClung, Ruttan (2019) Crit Dec Emerg Med 33(3): 3-11

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Ontology: Seat Belts (C0036498)

Definition (MSH) Restraining belts fastened to the frame of automobiles, aircraft, or other vehicles, and strapped around the person occupying the seat in the car or plane, intended to prevent the person from being thrown forward or out of the vehicle in case of sudden deceleration.
Concepts Manufactured Object (T073)
MSH D012622
SnomedCT 60054005
English Belt, Seat, Belts, Seat, Seat Belts, Seat Belt, Seat belt, device, seat belt, seat belts, Seat belt, SB - Seat belt, Seat belt, device (physical object)
Swedish Säkerhetsbälten
Czech bezpečnostní pásy sedadel
Finnish Turvavyöt
Russian REMNI BEZOPASNOSTI V KRESLAKH DLIA PASSAZHIROV, РЕМНИ БЕЗОПАСНОСТИ В КРЕСЛАХ ДЛЯ ПАССАЖИРОВ
French Ceintures de sécurité
Polish Pasy bezpieczeństwa
Norwegian Sikkerhetsbelter, Setebelter
Spanish cinturón de seguridad de un asiento (objeto físico), cinturón de seguridad de un asiento, Cinturones de Seguridad
German Sicherheitsgurte
Italian Cinture di sicurezza
Dutch Gordel, veiligheids-, Veiligheidsgordel, Veiligheidsgordels
Portuguese Cintos de Segurança

Ontology: Air Bags (C0162697)

Definition (MSH) Automotive safety devices consisting of a bag designed to inflate upon collision and prevent passengers from pitching forward. (American Heritage Dictionary, 1982)
Concepts Manufactured Object (T073)
MSH D017278
SnomedCT 102384007
English Airbags, Air Bags, Air Bag, Bag, Air, Bags, Air, Motor vehicle airbag, device, airbags, airbag, air bags, air bag, Airbag, Motor vehicle airbag, device (physical object), Motor vehicle airbag, Airbag, NOS, Motor vehicle airbag, NOS
Swedish Luftkuddar
Czech bezpečnostní vzduchové vaky, air bagy
Finnish Ilmatyynyt
Italian Air Bags, Airbags, Air Bag
Russian NADUVNYE USTROISTVA, НАДУВНЫЕ УСТРОЙСТВА
French Airbags, Coussins gonflables, Coussins de sécurité
Polish Poduszki powietrzne
Japanese エアバッグ, エアーバッグ
Norwegian Luftputer, Airbags
Spanish airbag, bolsa de aire en un vehículo automotor (objeto físico), bolsa de aire en un vehículo automotor, bolsa de aire, Bolsas de Aire
German Airbags
Dutch Airbag, Airbags
Portuguese Bolsas de Ar

Ontology: Lap belt (C0553557)

Concepts Manufactured Object (T073)
SnomedCT 257389003
LNC LA9382-8
English lap belt, Lap belt, Lap belt (physical object)
Spanish cinturón de seguridad de falda (objeto físico), cinturón de seguridad de falda