This is a public service announcement, Via Brad DeLong, who has a more civil tongue then I do.  But after reading the following I was feeling a tad emphatic. 

Do you know how we can tell the difference between people who were wearing their seatbelts and those who weren’t, at the scene of an automobile accident? The ones who were wearing their seatbelts are standing around saying “This really sucks,” and the ones who weren’t are kinda just lying there. This is not to say that all unrestrained traffic accidents are fatals, or that seatbelted folks are invulnerable. But if you’re playing the odds….

The proximate cause of this post is the recent automobile accident involving Jon S. Corzine, governor of New Jersey.

Dr. Robert Ostrum said that Corzine’s surgery was successful but noted that the governor would need two more operations on his leg in the coming days. Doctors also inserted a breathing tube that would remain “for days to weeks, until [Corzine] is able to breathe on his own again,” Ostrum said. Corzine had a broken sternum, a broken collarbone, a slight fracture of his lower vertebrae, a broken left leg, six broken ribs on each side and a laceration on his head, said Dr. Steven Ross, head of trauma for the hospital.

The two other persons in the vehicle sustained minor injuries. Bet you’ll never guess which two were wearing their seatbelts.

(Or—-from a few years back—beautiful young princess, millionaire boyfriend, drunk driver, bodyguard—hit an abutment at a Whole Bunch of Miles Per Hour. Who lived? Answer: the guy who was wearing a seatbelt.)

Did you ever notice how often the words “unrestrained passenger” turn up in Trauma: Life in the ER just before something Really Messy rolls in the door? In a collision, you have three or four sub-collisions all taking place in sequence. First, the vehicle hits some object. The vehicle abruptly slows, but unrestrained objects inside it continue at the same speed, in the same direction. Then the unrestrained body hits the interior of the vehicle, and starts to slow. That’s the second collision. That body’s internal organs are still moving at speed until they hit the inside of the chest (or get cheese-sliced by their supporting ligaments—and that’s where you get things like bisected livers or aortas). The fourth collision is when the bowling ball you left on the rear deck hits you in the back of the head, because that continued at the same speed in the same direction. Newtonian physics: Learn it, live it, love it.

There are two major routes that unrestrained persons take in a front-end MVA (Motor Vehicle Accident). Up-and-over or down-and-under (AKA “submarining”). With up-and-over, the upper body launches forward and up. The head strikes the windshield. (This produces the classic “windshield star”) Your injuries here include concussion, scalp laceration, and various brain bleeds. You can suspect fractured cervical vertebrae (and if you have a fracture with compromise to the spinal cord at C-4 or higher, you’ve lost the nerves that control chest expansion and the diaphragm. “C-4, breathe no more,” as the saying goes).

Go a little farther through the windshield, and it isn’t unexpected to leave some or all of your face behind stuck in the broken glass. You’d be surprised by how easily faces come off the facial bones. You can also expect fractured wrists, arms, and shoulders, from folks trying to brace themselves. A little farther through the windshield, all the way out of the vehicle (a situation we call “pre-extracted for your convenience”), and in addition to whatever damage you took on the way through, you get the damage from hitting the ground, trees, and metal poles at however-many-miles-an-hour.

Sure, you hear people talking about wanting to be “thrown clear” in the event of an accident. If you want to simulate being “thrown clear,” go to the fifth floor of a building and jump out the window. Let’s talk briefly about being thrown clear, because it happens more often than you’d think. Unrestrained driver: side impact. Vehicle spins. Driver goes out the window. In one case I recall, the driver was half-way out his window when the vehicle rolled over on top of him. That was the second-most grotesque scene I’ve ever been to. Another scene, the driver went out the window when it spun. The vehicle went into a snow bank and was drivable from the scene. The driver went into a river and drowned. Any time you go to an accident and the windows aren’t rolled all the way up and unbroken, look 200 feet in all directions for the other patients. It’s pure heck finding them three days later when someone wonders why all those birds are over there, or when someone at the hospital wakes up enough to ask “Where’s Joey?”

Okay, let’s look at down-and-under. In this one the patient goes forward and down, under the dashboard. Here’s where you’re going to find fractured femurs, broken knees, and compression fractures to the lower spine. If you’re asking “Is it possible for a human femur to be pushed through the floor of the pelvis?” the answer is “Yes.” If you ask me how I know that, the answer is: “Seen it done.” Unrestrained driver, 40 MPH impact. As the legs collapse accordion-style, the patient’s chest hits the dashboard. This can give you rib fractures, a fractured sternum, cardiac bruising, or that ruptured aorta that we all love so well. The nice thing about going submarining is that there usually isn’t any brain damage (unless you got clonked on the knob by that bowling ball, and seatbelts won’t help with that). On the other hand, femur fractures can be, and frequently are, fatal.

I think I’ll leave Traumatic Asphyxia, Hemo/Pneumothorax, and Flail Chest for the Trauma and You post that I’m going to do one of these days. Let’s just say that they’re associated with having your chest hit the dashboard or steering wheel, and they Really Suck (and not in a good way).

Seatbelts stop you from going up-and-over or down-and-under, or out the window. Sure, seatbelts can hurt you too, but hey, you’re in the presence of large amounts of free-floating energy. So. Effective May 1, 2000 New Jersey’s seat belt law is being upgraded. Police officers will be able to stop and issue summons to drivers and front seat passengers solely for not wearing their seat belts. The fine is $20 and $26 court costs. The penalty can be death.

I had the shit scared out of me back in high school, by driver’s ed films like Signal 30 and Mechanized Death and other grisly products of The Highway Safety Foundation (HSF) of Mansfield, Ohio (for years I was scared to death to drive in Ohio because I had this image of them being the absolute worst drivers in the world, thanks to those films…).  So I’ve always worn my seatbelt.  When they were available to me.  I’m actually old enough to remember when seatbelts were optional at best.  Maybe.  And controversial.  A lot of people back then really resented the federal government mandating seatbelts in every new car built after 1968.  Ironically, those were also the days when automobile dashboards were all steel and little to no padding.  Had I needed any further encouragement to wear my seatbelts, I could always remember the day I was 7 years old, riding between two adults in the front seat of a 1959 Rambler when the driver had to suddenly slam on his brakes and I was thrown face first into the shiny chrome plated radio in the middle of the solid steel dashboard.  It was my first of several broken noses.

It could have been worse.  That car had no seatbelts in it.  None.  It came without.  They all did back in 1960.  Probably didn’t have a collapsible steering column either.  Or a dual braking system.  Had great big bench seats though.  Bodies could freely bounce and slam around everywhere inside of most cars back then, before getting flung out a window.