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Shaw Chiropractic
A Medical-Legal Newsletter for Personal Injury Attorneys
by Dr. Steven W. Shaw

Air Bags Save Lives But at What Cost?

We all know that air bags save lives. Data from the National Highway Traffic Safety Administration (NHTSA) indicate that air bags are effective in preventing fatalities in 11% of all crashes; 31% in purely frontal crashes, and 19% in all frontal crashes. Based on the 11% overall figure, they have saved 1,198 lives between 1987 and 1995, with 475 lives saved in 1995 alone.

While the mortality benefits of air bags have been well documented we also need to look at some of the morbidity considerations. Minor abrasions and ocular injuries are common. In one study, 96.1% of all injuries were classified as minor, with facial injuries accounting for 42%, followed by the wrist (16.8%), forearm (16.3%), and chest (9.6%).
Common ocular injuries reported from air bag deployment are corneal abrasions, retinal detachment, corneoscleral laceration, lenticular subluxation, blindness, corneal rupture, alkali keratitis from chemical burns, retinal hemorrhage, and vision-compromising injuries from broken eyeglasses.

When the air bag mechanism is fired, a sodium azide propellant burns which inflates the bag which deploys at 165-210 mph. If the driver's hands are over the plastic module cover when it opens, serious injuries can result, including traumatic amputations of fingers, degloving, and fractures. Lower extremity injuries have occurred when passengers had their feet over the passenger module covers when they inflated. Temporomandibular joint injuries have also been reported from air bag deployment.

At the 40th Association for the Advancement of Automotive Medicine program (1996), Dalmotas presented a report titled Supplemental Restraint Systems: Friend or Foe. The report demonstrated that air bags at low speed collisions serve no useful purpose and can actually negate the cost effectiveness provided by these systems in their life saving role in higher speed collisions.

Of great concern are the fatalities directly attributable to air bags. Paradoxically, most of the fatalities have occurred at low speeds where air bag deployment would not have been necessary. Commonly, the victim is a female driver of short stature who has adjusted her car seat in a far forward position. The bag deploys, it strikes the driver at full deployment speed (165-210 mph) resulting in violent shear and tensile forces through the spine, often causing severe hyperextension of the neck. Most deaths have been instantaneous, with fracture through the occipital condyles and traumatic rupture of the spinal cord or medulla. Other cases involve elderly women who have expired due to chest and cardiac trauma. The deaths that have stirred the greatest controversy are the infants and children killed by the deploying passenger side air bag. As of October 1, 1996, NHTSA had identified 31 crashes where air bags caused critical-to-fatal head or neck injuries to children. Eleven involved infants in rear-facing child seats, including seven deaths. All but one of the other 20 children (19 deaths) were determined to have been unrestrained or improperly restrained at the time of the crashes.

The research suggests that the benefits of air bags are well documented in high velocity collicions. Fortunately, data is surfacing which demonstrate the coexisting risks. This new morbidity and mortality data for lower speed collisions has resulted in design changes which allow the option to disarm the air bag when appropriate. As better designs are developed the risks will decrease. At this time, physicians and attorneys will need to deal with the mixed benefits and complications of air bag use. This is particularly the case in the low speed crash when they serve little to no injury prevention benefit. In fact, they are the injury inducing mechanism itself