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This paper is based on the crash and casualty experience compiled by the National Highway Traffic Safety Administration's (NHTSA) National Accident Sampling System, Crashworthiness Data (NASS/CDS 1988-1992), and by the William Lehman Injury Research Center (University of Miami/Jackson Memorial Hospital/Ryder Trauma Center) crash data files. The NASS/CDS files provide data on injuries to occupants in all types of tow-away crashes. The William Lehman Injury Research Center files provide detailed crash analysis and injury documentation of more than 100 restrained occupants with injuries from frontal crashes. These files provide a basis for recognizing injury patterns among restrained occupants and postulating their causes. The purpose of this paper is to report on an observed pattern of liver and spleen injuries suffered by drivers wearing shoulder belts without the lap belt fastened.

A multidisciplinary, automobile crash investigation team at the Jackson Memorial Hospital/Ryder Trauma Center in Miami, Florida, is conducting a detailed medical and engineering study. The focus is restrained (seatbelts and/or air bag) occupants involved in frontal crashes, who have also been severely injured. More than 60 crashes have been included in the study to date. Analysis of the initial data 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 providing new challenges in triage and injury diagnosis. In other cases, survival in extremely high severity crashes presents trauma management challenges due to the extent and complexity of the multiple injuries which result. The paper provides case examples to illustrate types of chest and abdominal injuries associated with air bag cases.