A. C. Malliaris

Occult abdominal injuries to airbag-protected crash victims: a challenge to trauma systems.

A multidisciplinary, automobile crash investigation team at the University of Miami School of Medicine, William Lehman Injury Research Center of Jackson Memorial Hospital/Ryder Trauma Center in Miami, Florida, is conducting a detailed medical and engineering study. The focus is restrained (seatbelts, airbag, or both) occupants involved in frontal crashes who have been severely injured. More than 60 crashes have been included in the study to date. Analysis of the initial data supports the general conclusion that restraint systems are working to reduce many of the head and chest injuries suffered by unrestrained occupants. However, abdominal injuries among airbag-protected occupants still occur. Some are found among occupants who appeared uninjured at the scene. Case examples are provided to illustrate abdominal injuries associated with airbag-protected crashes. The challenges of recognizing injuries to airbag-protected occupants are discussed. To assist in recognizing the extent of injuries to occupants protected by airbags, it is suggested that evidence from the crash scene be used in the triage decision. For the abdominal injury cases observed in this study, deformation of the steering system was the vehicle characteristic most frequently observed. The presence of steering wheel deformation is an indicator of increased likelihood of internal injury. This may justify transporting the victim to a trauma center for a closer examination for abdominal injuries.

HEART INJURIES AMONG RESTRAINED OCCUPANTS IN FRONTAL CRASHES

The William Lehman Injury Research Center has conducted multi-disciplinary investigations of one hundred seventy-eight crashes involving adult occupants protected by safety belts and air bags. When used in conjunction with National Accident Sampling System/Crashworthiness Data System (NASS/CDS) they provide insight into the most severe injuries suffered by restrained occupants in frontal crashes. Heart injuries are rare, but when they occur they are usually life threatening. NASS/CDS shows that heart injuries comprise about 0.2% of the injuries in frontal tow-away crashes, In the NHTSA file of Special Crash Investigations (SCI) of air bag cases, heart injuries are reported in 1% of the occupants over 15 years of age. Twenty-five percent of the fatally injured occupants had heart injuries and 83% of those with heart injury died. In the Lehman Center cases, heart injuries are present in 5.1% of the cases. Forty percent of the fatally injured had heart injury, and 78% of the victims with heart injury died. This paper suggests two additional triage criteria, based on observations from multi-disciplinary studies. These include: (1) passengers in 2-point belts and crashes of 25 mph or higher, with the lap belt unfastened or with the seat full forward; (2) drivers in crash conditions which delay the air bag deployment or permit the driver to be close to the air bag at deployment. (A) For the covering abstract see IRRD 893297.

AIRBAG PROTECTED CRASH VICTIMS - THE CHALLENGE OF IDENTIFYING OCCULT INJURIES

At the Ryder Trauma Center of the Jackson Memorial Hospital in Miami, Florida, a multidisciplinary, automobile crash investigation team is conducting a detailed medical and engineering study. The focus is on restrained (seatbelts and/or air bag) occupants involved in frontal crashes who have been severely injured. More than 60 such crashes have been included in the study to date. Initial data analysis indicates that restraint systems are working to reduce many of the head and chest injuries which unrestrained occupants suffer. However, internal injuries among air bag-protected occupants may be unrecognized in the field. Also, extremely high severity crashes are presenting trauma management challenges. This paper provides case examples to illustrate types of chest and abdominal injuries associated with air bag cases. To assist in recognizing the extent of injuries to occupants protected by air bags, it is suggested that additional evidence from the crash scene be used in the triage criteria. For the occult chest/abdominal cases in the Jackson study, deformation of the steering wheel was the vehicle characteristic most frequently observed.