Update: Fatal Air Bag-Related Injuries to Children -- United States, 1993-1996

Dual air bags will be required standard equipment in all new passenger cars sold in the United States beginning in 1997 and all light trucks sold in the United States in 1998 but are available now in many earlier-model vehicles. Air bags are designed to supplement the protection provided by safety belts in frontal crashes; when combined with lap and shoulder safety belts, air bags assist in preventing fatal and nonfatal injuries in motor-vehicle crashes. However, passenger-side air bags have been associated with injuries to children who, in almost all cases, were unrestrained or incorrectly restrained in the front seat (1-4). In 1993, approximately 1.4 million (0.8% of all vehicles registered) were equipped with passenger-side air bags, compared with an estimated 21.6 million vehicles (11.4% of all vehicles registered) in 1996 (National Highway Traffic Safety Administration {NHTSA}, unpublished data, 1996). NHTSA, the National Transportation Safety Board (NTSB), and CDC collaborated with the American Academy of Pediatrics, the Children's Hospital of Philadelphia, The Air Bag Safety Campaign, the National Safety Council, the Brain Injury Association, the National Association of Governors Highway Safety Representatives, the National Association of Children's Hospitals and Related Institutions, and the Health Resources and Services Administration to examine crashes from the Special Crash Investigation Data File maintained by NHTSA, in which fatal injuries in children (aged less than 12 years) were associated with passenger-side air bags. This report presents the findings of this review, which indicate that during January 1993-November 1996, annual increases occurred for both the number of fatal injuries to children resulting from air-bag deployments and the proportion of dual air bag-equipped vehicles (Table_1).

Of the 32 fatal injuries during January 1993-November 1996, a total of 21 occurred among children who were unrestrained or incorrectly restrained. Nine other fatalities occurred among children who had been seated in rear-facing child-safety seats in the front passenger seat. Two reports of incidents in 1996 suggest that children who are restrained by lap and shoulder belts also may be at risk for severe injury and death associated with air-bag deployment: in separate incidents, two 5-year-old children who were using lap and shoulder belts died as a result of air-bag deployment.

Reported by: Office of Traffic Safety Programs, National Highway Traffic Safety Administration. FK Winston, MD, The Children's Hospital of Philadelphia, Pennsylvania. National Transportation Safety Board. American Academy of Pediatrics, Elk Grove Village, Illinois. The Air Bag Safety Campaign, Washington, DC. National Safety Council, Chicago, Illinois. Brain Injury Association, Washington, DC. National Association of Governors Highway Safety Representatives, Washington, DC. National Association of Children's Hospitals and Related Institutions, Alexandria, Virginia. Maternal and Child Health Bur, Health Resources and Svcs Administration. Div of Unintentional Injury Prevention, National Center for Injury Prevention and Control, CDC.

Editorial Note

Editorial Note: Use of a vehicle's lap and shoulder belts is essential to protect an occupant; a fully deployed air bag provides supplemental restraint and protects the occupant from impact with the dashboard or steering wheel. Air bags deploy within 0.05 seconds at velocities of 140-200 miles per hour to ensure rapid and full deployment before the occupant has any contact with the bag. However, for at least six reasons, children are more likely than adults to be improperly positioned in relation to a deploying air bag, and therefore at increased risk for serious injury. First, children are more likely to move around or lean forward to look out of a window. Second, because of the positioning of forward-facing child restraints, children who are properly buckled into such restraints are several inches closer to the intense forces of air bag deployment. Third, because children's feet usually do not touch the floor, they cannot brace themselves on the floor during precrash braking. Fourth, children too small to have the shoulder belt fit properly across their shoulder and the lap belt across their hips may place the shoulder belt under their arm or behind their back, allowing their upper torso to move forward into the deploying air bag during precrash braking. Fifth, because most children are shorter than adults (5), a child's neck and head are more likely to contact the deploying air bag, increasing the risk for fatal or serious injury. Finally, a rear-facing child-safety seat cannot be positioned far enough from the air bag to eliminate any risk of serious or fatal injury.

To reduce the risk for injuries associated with air bags, automotive safety engineers are designing "smart" air bags that will be appropriate for different ages and sizes of occupants (4). Until passenger vehicles and light trucks are equipped with these smart air bags and they are shown to be safe and effective (3), all children aged less than 12 years should ride in the back seat using age- and size-appropriate occupant restraints (6,7) (see box). The NTSB and NHTSA are requesting case reports of serious air-bag-induced injuries to children and adults. Cases can be reported to Vernon Roberts, NTSB, telephone (202) 314-6483, or to NHTSA, telephone (202) 493-0400, or by e-mail to airbag.crash@nhtsa.dot.gov. Additional information about air-bag- related injuries or child-occupant restraints is available from the NHTSA Hotline, telephone (800) 424-9393.

References

1. CDC. Warnings on interaction between air bags and rear-facing child restraints. MMWR 1993;42:280-2.

2. CDC. Air-bag-associated fatal injuries to infants and children riding in front passenger seats -- United States. MMWR 1995;44:845-7.

3. Winston FK, Reed R. Air bags and children: results of a National Highway Traffic Safety Administration special investigation in actual crashes. In: Proceedings of the Stapp Car Crash Conference. Warrendale, Pennsylvania: Society of Automotive Engineers, 1996:383-9.

4. National Highway Traffic Safety Administration. NHTSA announces comprehensive plan to improve air bag technology and reduce air bag dangers {Press release}.Washington, DC: US Department of Transportation, National Highway Traffic Safety Administration, November 22, 1996.

5. National Transportation Safety Board. Safety studies: the performance and use of child restraint systems, seat belts, and air bags for children in passenger vehicles. Vol 1, Analysis. Washington, DC: National Transportation Safety Board, 1996; report no. NTSB/SS-96/01.

6. American Academy of Pediatrics. 1996 Family shopping guide to car seats: guidelines for parents. Elk Grove Village, Illinois: American Academy of Pediatrics, 1996.

7. National Highway Traffic Safety Administration. Air bag alert. Washington, DC: US Department of Transportation, National Highway Traffic Safety Administration, 1996; report no. DOT-HS-808-456.

   
   
   

Recommendations to Prevent Air Bag-Associated Injuries to Infants and Children

• Infants (aged less than 1 year and weighing less than 20 pounds) in rear-facing child-safety seats should never ride in the front seat of a vehicle equipped with a passenger-side air bag. Infants in rear-facing child-safety seats always must ride in the back seat facing the rear of the car.

• All children aged less than 12 years should be properly secured in the back seat. For older children who have outgrown child-safety seats and booster seats, shoulder belts never should be placed either behind the back or under the arm.

• All children should be placed in the restraint device that offers the maximum protection for their size and age. *

• If possible, children should not be placed in the front seat. If a child must be placed in a forward-facing seat in the front of a vehicle with a passenger-side air bag, the vehicle seat should be adjusted as far back as possible from the dashboard. The child's restraint harness also should be secure and tight over the child's shoulder.

• Because unrestrained occupants of any age can be injured or killed by a deploying air bag, all vehicle occupants should use lap and shoulder belts. For all front-seat passengers, the seat should be moved as far back as possible from the steering wheel and dashboard.

• Children who are aged less than or equal to 1 year and weigh less than or equal to 20 pounds must ride in a rear-facing child-safety seat; children who are aged greater than 1 year, weigh approximately less than or equal to 40 pounds, or are less than or equal to 40 inches tall should be in a forward-facing restraint; and children who weigh greater than 40 pounds or are greater than 40 inches tall regardless of age should use a booster seat until the lap and shoulder belt fits properly.

Source: National Highway Traffic Safety Administration, National Transportation Safety Board, American Academy of Pediatrics, and CDC.

+------------------------------------------------------------------- -----+ |             | | Erratum: Vol. 45, No. 49 | | ======================== | | SOURCE: MMWR 46(02);40 DATE: Jan 17, 1997 | |             | | In the article "Update: Fatal Air Bag-Related Injuries to | | Children -- United States, 1993-1996," the recommendations should | | have indicated that children aged less than or equal to 12 years, | | instead of less than 12 years, should always ride in the back seat | | in age-appropriate occupant restraints. On page 1075, in the first | | full paragraph, the second sentence should read, "Until passenger | | vehicles and light trucks are equipped with these smart air bags | | and they are shown to be safe and effective (3), all children aged | | less than or equal to 12 years should ride in the back seat using | | age- and size-appropriate occupant restraints (6,7) (see box)." On | | the same page, in the box titled "Recommendations to Prevent Air | | Bag-Associated Injuries to Infants and Children," the first | | sentence of the second bulleted item should read, "All children | | aged less than or equal to 12 years should be properly secured in | | the back seat." | |             | +------------------------------------------------------------------- -----+

                                                                                                                 
TABLE 1. Fatalities among children aged <12 years related to passenger-side air bag                                                
deployment, by restraint method and year, and percentage of registered vehicles with                                               
dual air bags -- United States, 1993-1996                                                                                          
=========================================================================================                                          
                          No. Deaths                                                                                               
     ------------------------------------------------------------                                                                  
                                        Restrained with                                                                            
       In rear-facing     Incorrectly     lap and         Total   % of vehicles                                                    
Year  child safety seat   restrained    shoulder belts    deaths  with dual air bags                                               
-----------------------------------------------------------------------------------------                                          
1993            0                1            0               1       0.8                                                          
1994            0                5            0               5       2.6                                                          
1995            3                5            0               8       6.4                                                          
1996            6                9            2              17      11.4                                                          
         
Total           9               21 *          2              32                                                                    
-----------------------------------------------------------------------------------------                                          
* Three of these cases were classified as restrained with lap and shoulder belts by the                                            
  National Transportation Safety Board.                                                                                            
         
Source: Special Crash Investigation Data File, National Highway Traffic Safety                                                     
Administration and reviewed by the National Transportation Safety Board.                                                           
=========================================================================================                                          
         

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