gated. These portray vividly the fatal injuries and the mechanism of their infliction. Talks using these slides have been presented to professional and lay organizations at national meetings in various parts of the country as well as in our State. According to available reports these lectures have been very convincing and enthusiastically received. I would welcome an opportunity to make such a presentation before your committee if you think this would benefit your study.

At the invitation of State Representative Harold A. Katz of Chicago, I testified before a committee of the Illinois State House of Representatives on April 21 concerning automobile safety legislation introduced by Representative Katz. I have been invited back to testify before an Illinois State Senate committee concerning the same legislation June 8. If I can be of similar help to you in your study of the Federal role in traffic safety, especially problems concerning vehicle design, please feel free to call upon me. I may be reached at the VA hospital, area code 313, 663–8541, ext. 357 (FTS number 8-313-663-8357). With kind personal regards.

Sincerely,

P. W. GIKAS, M.D.,

Chief, Laboratory Service and Assistant Professor, University of Michigan Medical School.

SUMMARY OF LECTURE DELIVERED AT TRAUMA CONFERENCE AT STATE UNIVERSITY OF JOWA MEDICAL SCHOOL ON APRIL 23, 1965

Accidents are exceeded only by heart disease, cancer, and strokes as a cause of death in the United States today. Of all the accidental deaths, the automobile accident is the most frequent type. There are two approaches to decreasing mortality from automobile accidents.

1. Prevent the accident from occurring.

2. Prevent or modify the injury sustained by the victim in the event that the accident occurs.

The first approach of accident prevention involves many factors since the causes of accidents are complex. All attempts at accident prevention are necessary and should be encouraged, however, we should realize that as long as there is a human being in control of the motor vehicle, there is a potential accident situation since human beings are subject to error. This is not a negativistic approach, it is merely a realistic one. The second approach, therefore, becomes very important because it assumes an accident will occur and stresses the importance of a "safer package" for the occupant of the vehicle. The second approach has been long neglected, and I personally believe there is a great potential for reduction of morbidity and mortality if this second approach of a "safer package" would be emphasized.

In order to make recommendations for safer interior design and construction of vehicles and for the use of restraint systems, such as seat belts or shoulder harnesses, one must know the mechanism of infliction of the fatal injury. In order to obtain this information, a research project sponsored by the U.S. Public Health Service is being conducted at the University of Michigan Medical Center. This project is involved with the investigation of fatal automobile accidents which occur in Washtenaw County, Mich. The investigation team is called to the scene of all on-the-scene fatalities in the county on a 24-hour basis by the law enforcement agencies. The victim is examined as well as the vehicle, and an attempt is made to correlate pattern of injury sustained by the victim with pattern of design and damage of the vehicle.

To date 146 fatalities have been investigated. These deaths were produced by 111 accidents. It has become obvious as a result of this study that there are essentially two ways in which a person is killed in an automobile accident. The individual dies as a result of being ejected from his vehicle or he dies from injuries sustained in the secondary collision between him and the inside of his vehicle. Certain features of interior design have considerable influence on the type and extent of injury received by the individual in the secondary collision within the vehicle. Color slides were shown to point out front and rear seat ejection deaths as well as deaths resulting from collision with lethal areas within the car such as instrument knob, gear shift lever, header, door, etc.

It is concluded that on the basis of space available in the vehicle after the collision 40 percent of the victims in our series could have survived if a simple

lap seat belt would have been worn in either the front or rear seat; 45 percent of the victims died under unsurvivable conditions within the vehicle due to obliteration of space. It is also concluded that certain features of interior design, particularly dash panels, projecting knobs and levers significantly influence the type of injury received.

CAUSES OF DEATHS IN AUTOMOBILE ACCIDENTS'

CAN SEAT BELTS REALLY SAVE LIVES?

(By Paul W. Gikas, M.D., and Donald F. Huelke, Ph. D., Ann Arbor, Mich.2) The authors are on call 24 hours a day with the law enforcement agencies for the investigation of fatal automobile accidents in Washtenaw County, Mich. The results of a detailed personal investigation of 79 deaths in automobile accidents are presented with special emphasis on correlating patterns of injury of the victims with patterns of damage to the vehicle. Thirty-four percent of the victims would have been saved by a simple lap-type seat belt. The value of the seat belt in both front and rear seats is emphasized. Certain features of the interior design of automobiles contribute to fatal injuries in automobile accidents. The superiority of the shoulderstrap lap-belt combination over the simple lap belt for front seat occupants is also discussed.

Accidents are exceeded only by heart disease, neoplasms, and strokes as a cause of death in the United States. More than 90,000 persons are killed in this country annually by accidental causes. Of the 41,000 killed in motor vehicle accidents in 1962, approximately 27,000 were drivers or passengers in motor vehicles. In addition, about 1,500,000 persons were injured in automobile accidents the same year. [1]

These statistics identify the motor vehicle accident as a major public health problem in this country. The tragedy of this annual slaughter on our roads is compounded by the fact that most of these deaths are preventable. There are two obvious means for reducing this death toll. One approach, of course, is to reduce the number of accidents. This requires proper maintenance of motor vehicles, proper design and maintenance of roads, strict enforcement of sensible traffic laws, maximum driver skill and alertness, only to mention a few of the many facets of the accident prevention program. The authors believe that, in spite of the above-mentioned steps, it is only realistic to assume that as long as a human being is in control of a motor vehicle, there is a potential accident situation.

The second approach is to employ measures to reduce fatal injuries in the event one has an automobile accident. The purpose of this study concerns itself with this latter approach. To determine what measures are necessary to prevent fatal injury in an automobile accident, one must know the exact cause of death and the means by which the fatal injury was inflicted.

In order to collect this information, the authors have arranged with the law enforcement agencies and the medical examiner's office in Washtenaw County, Mich., to be called to the scene of all fatal automobile accidents in the county. The two authors serve as coprincipal investigators. A personal thorough investigation at the scene is made, and detailed information concerning the collision course, the position of the vehicle or vehicles, location of victims, and pattern of exterior and interior damage to the vehicle is collected. A detailed external examination of the victim is made and, when proper permission is granted, a necropsy is performed. The pattern of injury of the victim is then correlated with the pattern of damage and interior design of the vehicle. From this information, the position of the victim at the time of the impact and the

1 Reprinted from the Journal of the Michigan State Medical Society, vol. 63, pp. 351-354, May 1964.

2 This project is supported by PHS grant No. AC-00107 from the Accident Prevention Division, Bureau of State Services.

Dr. Gikas is Chief, Laboratory Service, Veterans Administration Hospital, and assistant professor of pathology, University of Michigan Medical School, Ann Arbor, Mich.

Dr. Huelke is associate professor of anatomy, University of Michigan Medical School, Ann Arbor, Mich.

STANDARD BUMPER HEIGHTS AND QUADRANTS

Senator RIBICOFF. Now, how about standard bumper heights?
Mr. CHESEBROUGH. To my knowledge, we comply.

Senator RIBICOFF. You comply now?

Mr. CHESEBROUGH. Yes, sir.

Senator RIBICOFF. How about standard quadrants?

Mr. CHESEBROUGH. To my knowledge, we comply and always have.

AUTOMATIC TRANSMISSION STANDARD

Senator RIBICOFF. How about PRNDL? Is that on your cars?
Mr. CHESEBROUGH. That is the standard gear-

Senator CURTIS. What is that?

Senator RIBICOFF. Will you explain what that is? Parking, reverse, neutral?

Mr. CHESEBROUGH. It is the position of the various gear shifts in the action of the shifting mechanism, namely the important consideration there is that you have to go through neutral in order to engage a position that will reverse the direction of the car. Reverse, neutral, forward drive.

Senator CURTIS. And does it go to the problem of inability to start the motor if it is in gear?

Mr. CHESEBROUGH. No, not this specific, but we have always had what we call a neutral start switch with our automatic transmission. You cannot start the engine of our automobiles equipped with automatic transmission unless the lever is in the position of either park or neutral.

Senator RIBICOFF. Isn't the reason for this that if you are in reverse, and you want to go forward, you have to go through neutral, and disengage your reverse so you don't suddenly step on the gas and find yourself backing up?

Mr. CHESEBROUGH. Correct.

Senator RIBICOFF. A safety feature. You have to go to neutral before you go into drive. It disengages reverse.

Senator CURTIS. Is there any GSA requirement about protection from starting the car when it is in gear?

Senator RIBICOFF. The standard gear quadrant is what they have. Senator CURTIS. Is that what that means?

Mr. CHESEBROUGH. I do not believe there is, sir. I hesitate to say positively, because I have not read the exact wordage.

Senator CURTIS. The industry has pretty well taken care of it? Mr. CHESESBROUGH. Oh, yes, sir. This has been practiced ever since we have used automatic transmissions.

Senator CURTIS. Pretty much for the whole industry?

Mr. CHESEBROUGH. Yes, sir.

WINDSHIELD WIPERS AND WASHERS STANDARDS, GLARE REDUCTION
SURFACES, INSTRUMENT PANEL

Senator RIBICOFF. How about windshield wipers and washers?
Mr. CHESEBROUGH. We will comply.

Senator RIBICOFF. You don't comply now, but you will comply?
Mr. CHESEBROUGH. Yes, sir. Well, we have windshield wipers,

TABLE III.-Effectiveness of seat belts in all accidents investigated

When the criteria are applied to all of the victims, whether they were killed by a secondary collision within their car or whether they were ejected, it was found that a minimum of 34 percent of these victims would have survived if the lap-type seat belt had been used. The figure of 34 percent survival with a laptype seat belt compares favorably with the results of the study by Tourin and Garret in 1960, utilizing data collected by the California Highway Patrol. Their study showed that the use of the seat belt could be expected to reduce the incidence of major-to-fatal grades of injury by approximately 35 percent [2]. An additional 11 percent of all fatalities in our study would have survived with a shoulder strap-seat belt combination. Forty-seven percent were in an unsurvivable situation due to severe destruction of the occupant compartment. In 8 percent of the fatalities, survivability could not be predicted (see table III). In certain situations, it is believed that the shoulder strap-lap belt combination would be more effective in preventing the fatal injury than only the laptype seat belt. This is due to the fact that a tall individual may flex and strike the instrument panel with his head even when wearing the seat belt. This is particularly true in compact automobiles. Also, seat belts stretch on sudden deceleration and this may allow the victim to strike his head against an interior structure of the automobile. The steering wheel and post are also significant objects for inflicting fatal injuries. A lap-type seat belt often would not prevent collisions between the victim and these objects. A shoulder strap-lap belt combination would in some instances prevent or buffet this collision. It is in these situations that the shoulder strap-lap belt combination may be the determining factor for survival.

It was noted in this series that certain features of interior design of automobiles, particularly knobs and the contour of instrument panels, have a significant influence on the type of fatal injury. In one case a radio knob served as the instrument of infliction of the fatal injury. The victim's head struck the knob and it penetrated the calvarium and entered the frontal lobe of the brain (figs. 1 and 2). In other accident situations, sharp edges on instrument panels or levers inflicted the fatal injuries (fig. 3). We believe that seat belts are equally important in the rear seats, since some of the victims in this study were catapulted from the rear seat into the instrument panel (fig. 3) or they were ejected from the automobile. In one instance a passenger was ejected from the rear seat of a two-door car and killed.