For many years I have worked as a front-line emergency care doctor treating people who have been injured in road traffic collisions. One of the biggest changes that I have seen in my career in trauma care is the impact of seat belt legislation on the pattern of injuries suffered by the patients who come under my care.

In 1983 I was a third-year medical student having my first experiences of meeting patients on the wards. At this time, before seat belt use became normal, we often saw horrendous facial and head injuries caused by the impact of the patient’s face into the windscreen, and serious chest injuries caused by deceleration injury with the steering wheel impacting the chest. We also often saw people who had been ejected from the vehicle – meaning that an unrestrained occupant of the vehicle had been thrown out through one of the windows during a road traffic collision. This was all too common and if you imagine the force required to throw a person through a car window and the multiple impacts that they would have with the glass, the metal surrounding the window, and the road outside, you can understand why this was a very well-known indicator of very serious injury or death.

This all changed with the advent of seat belt legislation. Being restrained by a seat belt:

  • prevents the head and face impacting on the windscreen;
  • prevents the chest being crushed against the steering wheel; and
  • prevents the vehicle occupants being ejected through a window with the accompanying severe or fatal injuries.

At the same time there have been other innovations such as airbags and pre-tensioners, as well as better design and crash resistance in vehicles.

Seat belts changed trauma care. It used to be that the maxillo-facial surgery was the most common type needed by road traffic victims. Thankfully, this is no longer the case. Despite initial passionate arguments that mandatory seat belt use was a violation of individual freedom, it has been well established from the national trauma data sets that wearing a seat belt gives a much lower injury severity to anyone unfortunate enough to be involved in a road traffic collision.

However, we still sometimes see collisions involving unrestrained passengers, and it is very noticeable that they have much more severe injuries and are more likely to die. In road traffic collisions where some of the vehicle occupants have seat belts and others are unrestrained, it is the unrestrained people who are most severely injured or killed.

In 2012, the NHS system for treating major injury changed with the designation of 32 hospitals across the UK as ‘Major Trauma Centres’ with all of the specialist facilities to treat the most severely injured, with the remaining 200 hospitals being designated ‘Trauma Units’ which are able to deal with a lower severity of injury. After a crash, paramedics will use a trauma triage tool to evaluate the patient and guide them as to whether it is necessary to transport the patient up to a major trauma centre bypassing any of the smaller trauma units who are not able to deal with these types of major injuries. Major trauma centres always have a senior doctor present within 10 minutes of the casualty’s arrival, with a trained trauma team and all the necessary specialist surgical and critical care facilities to treat all of the different types of injuries that patients with multiple trauma may have.

In my work I have seen the difference made by seat belts and other improvements in road safety. This makes me passionate about the need to promote safe and environmentally responsible road use.

Tim Coats

Professor Tim Coats

Professor of Emergency Medicine at the University of Leicester, Brake trustee