The field performance of frontal air bags: a review of the literature

The ethics, applications, and contributions of cadaver testing in injury prevention research

OBJECTIVE

This study aims to establish best practices and guidelines to ensure that experimental research utilizing Postmortem Human Subjects (PMHS) for injury prevention adheres to relevant ethical principles, which are also commonly accepted in research involving human tissues and living subjects. Furthermore, it reviews existing literature to underscore the pivotal role of PMHS testing in evaluating the efficacy of safety systems, with a particular focus on airbag performance.

METHODS

This paper conducts an examination of the primary ethical principles governing human subject research as outlined in the Declaration of Helsinki (1965) and traces their evolution up to the latest framework proposed by the Council for International Organizations of Medical Sciences (CIOMS) in 2002. Input was solicited from international experts and laboratories experienced in PMHS testing to understand how these ethical principles are implemented in practice. This is complemented by a comprehensive review of literature that assesses the contribution of PMHS testing to airbag performance enhancements in frontal impacts.

RESULTS

The findings underscore the importance of informed consent from donors or their next-of-kin, as highlighted in CIOMS declarations, to ensure the ethical integrity of the donation process in line with international standards. The study also finds it customary for an independent review board to evaluate the research methodology and the necessity of employing PMHS tissue over alternative methods, such as computational models or crash test dummies. Despite various national regulations on human subject participation and living tissue research, no specific legal framework governing PMHS tissue use was identified. The systematic literature review revealed that PMHS testing has been crucial in identifying potential injury mechanisms not detected by Anthropomorphic Test Devices (ATD), significantly contributing to the enhancement of computer human body models and the biofidelity of crash test dummies.

CONCLUSION

The International Council on the Biomechanics of Injury (IRCOBI) recognizes the need to provide guidance for research involving human cadaveric tissue to be conducted with the highest ethical standards. This study proposes five recommendations to ensure adherence to these ethical principles in PMHS testing, highlighting the paramount importance of obtaining informed consent and securing independent committee approval. Moreover, IRCOBI emphasizes that until a thorough understanding of tissue damage tolerance levels is achieved and human surrogates, such as ATDs or Human Body Models (HBM), reach full biofidelity, the use of human cadavers remains indispensable for developing effective injury prevention strategies and measures.

History of airbag safety benefits and risks

OBJECTIVE

The history of airbags was reviewed for benefits and risks as they became a supplement to lap-shoulder belts. Sled and crash tests were evaluated and field data was analyzed for airbag effectiveness. Field data on airbag deaths and studies on mechanisms of deployment injury were analyzed. The history was reviewed as airbags evolved from the early 1970s to today.

METHODS

Airbag benefits were determined from NHTSA crash tests with unbelted and belted dummies in 40, 48, and 56 km/h (25, 30, and 35 mph) frontal impacts with and without airbags. The literature was reviewed for testing of passive restraints with and without airbags. Recent NCAP tests were compared with earlier tests to determine the change in occupant responses with seatbelts and supplemental airbags in modern vehicles. 1994-2015 NASS-CDS field data was analyzed for MAIS 4 + F injury. Risks were compared for belted and unbelted occupants in frontal impacts by delta V. Airbag risks were identified from field deployments and research. The 1973-76 GM fleet had two deaths due to the occupant being out-of-position (OOP). The mechanisms of injury were determined. From 1989-2003, NHTSA investigated 93 driver, 184 child passenger, and 13 adult passenger airbag deaths. The data was reviewed for injury mechanisms. Second generation airbags essentially eliminated OOP airbag deaths. More recently, three suppliers were linked to airbag rupture deaths. The circumstances for ruptures were reviewed.

RESULTS

The risk for serious head injury was 5.495% in drivers and 4.435% passengers in 40-48 km/h (25-30 mph) frontal crash tests without belts or airbags. It was 80.5% lower at 1.073% in drivers and 82.0% at 0.797% in passengers with belts and airbags in 35 mph NCAP crash tests of 2012-20 MY vehicles. NASS-CDS field data showed a 15.45% risk for severe injury (MAIS 4 + F) to unbelted occupants and 4.68% with belted occupants in 30-35 mph frontal crash delta V with airbags, as deployed. The reduction in risk was 69.7% with belt use and airbags deploying in 96.1% of crashes. There were benefits over the range of delta V. Two airbag deaths were studied from the 1970s GM fleet of airbags. The unbelted driver death was caused by punchout force with the airbag cover blocked by the occupant and membrane forces as the airbag wrapped around the head, neck or chest with the occupant close to the inflating airbag. The unbelted child death was from airbag inflation forces from pre-impact braking causing the child to slide forward into the deploying airbag. Research showed that unrestrained children may have 13 different positions near the passenger airbag at deployment. NHTSA investigation of first generation airbag deaths found most driver deaths were females (75.3%) sitting forward on the seat track, close to the driver airbag. Seatbelt use was only 30%. Most child deaths (138, 75.4%) involved no or improper use of the lap-shoulder belts. Of these, 115 deaths involved pre-impact braking. Only 37 (20.2%) children were in child seats with 29 in rear-facing and 8 in forward-facing child seats. Eight child deaths (4.4%) occurred with lap-shoulder belt use. Airbag designs changed. More recently, Takata airbags were related to at least 24 deaths by airbag rupture prompting a recall; the successor company Joyson had an airbag recall. ARC airbags have experienced a chunk of the inflator propelled into the driver during deployment with several deaths leading to a recall.

CONCLUSIONS

Airbags are effective in preventing death and injury in crashes. They provide the greatest protection in combination with seatbelt use. NHTSA estimated airbags saved 28,244 lives through 1-1-09 while causing at least 320 deployment deaths, which has prompted improved designs, testing, and recalls.

Safety at the edge: a safety framework to identify edge conditions in the future transportation system with highly automated vehicles

Automated driving systems (ADS) have the potential for improving safety but also pose the risk of extending the transportation system beyond its edge conditions, beyond the operating conditions (operational design domain (ODD)) under which a given ADS or feature thereof is specifically designed to function. The ODD itself is a function of the known bounds and the unknown bounds of operation. The known bounds are those defined by vehicle designers; the unknown bounds arise based on a person operating the system outside the assumptions on which the vehicle was built. The process of identifying and mitigating risk of possible failures at the edge conditions is a cornerstone of systems safety engineering (SSE); however, SSE practitioners may not always account for the assumptions on which their risk mitigation resolutions are based. This is a particularly critical issue with the algorithms developed for highly automated vehicles (HAVs). The injury prevention community, engineers and designers must recognise that automation has introduced a fundamental shift in transportation safety and requires a new paradigm for transportation epidemiology and safety science that incorporates what edge conditions exist and how they may incite failure. Towards providing a foundational organising framework for the injury prevention community to engage with HAV development, we propose a blending of two classic safety models: the Swiss Cheese Model, which is focused on safety layers and redundancy, and the Haddon Matrix, which identifies actors and their responsibilities before, during and after an event.

Quantification of Skeletal and Soft Tissue Contributions to Thoracic Response in a Dynamic Frontal Loading Scenario

Thoracic injuries continue to be a major health concern in motor vehicle crashes. Previous thoracic research has focused on 50^th percentile males and utilized scaling techniques to apply results to different demographics. Individual rib testing offers the advantage of capturing demographic differences; however, understanding of rib properties in the context of the intact thorax is lacking. Therefore, the objective of this study was to obtain the data necessary to develop a transfer function between individual rib and thoracic response. A series of non-injurious frontal impacts were conducted on six PMHS, creating a loading environment commensurate to previously published individual rib testing. Each PMHS was tested in four tissue states: intact, intact with upper limbs removed, denuded, and eviscerated. Following eviscerated thoracic testing, eight individual mid-level ribs from each PMHS were removed and loaded to failure. A simplified model in which ribs of each thorax are treated as parallel springs was utilized to evaluate the ability of individual rib response data to predict each subject's eviscerated thoracic response. On average across subjects, denuded thoraces retained 89% and eviscerated thoraces retained 46% of intact force. Similarly, denuded thoraces retained 70% and eviscerated thoraces retained 30% of intact stiffness. The rib model did not adequately predict eviscerated thoracic response but provided a better understanding of the influence of connective tissue on a rib's behavior with-in the thorax. Results of this study could be used in conjunction with the database of individual rib test results to improve thoracic response targets and help assess biofidelity of current anthropomorphic test devices.

Are airbags a dangerous safety measure? A meta-analysis of the effects of frontal airbags on driver fatalities

A meta-analysis has been conducted of the effectiveness of frontal airbags in reducing driver fatalities, and some potential moderator variables for airbag effectiveness have been investigated. The results confirm the assumption that airbags reduce accident fatalities among belted drivers, but the results are too heterogeneous for drawing conclusions about the size of the overall effect. No support has been found for the hypothesis that airbags increase overall fatality risk, as has been found in the study by Meyer and Finney (Meyer, M., Finney, T., 2005. Who wants Airbags? Chance, 18 (19) 3-16). The results do not seem to be affected by publication bias, and no indications of confounding effects of vehicle characteristics or impact velocity have been found. In frontal collisions belted driver fatalities were found to be reduced by about 22% when all types of airbags are regarded together. The revision of the test criteria for airbags in the USA in 1997 has improved airbag effectiveness. For unbelted drivers airbags are neither effective nor counterproductive, but may increase fatality risk in single vehicle accidents. The results show that there is a lack of knowledge about the effects of airbags in accidents that are not frontal collisions.

Airbag pneumonitis

The widespread and mandatory use of airbags has resulted in various patterns of injuries and complications unique to their use. Airbags have been implicated in a spectrum of pulmonary conditions ranging from exacerbation of asthma, reactive airway diseases to new onset asthma. We report a case of inhalational chemical pneumonitis that developed after exposure to the airbag fumes.

Injury risks in frontal crashes by delta V and body region with focus on head injuries in low-speed collisions

PURPOSE

This study investigated injury risks in frontal crashes by belt use and crash severity (delta V) with a focus on studying whether there is a pattern to the crashes causing serious head injuries in low-speed frontal collisions.

METHODS

1996-2007 National Automotive Sample System-Crashworthiness Data System (NASS-CDS) was analyzed for frontal crashes involving front-outboard occupants. Light vehicles were included with model year 1997+. Injuries of maximum severity MAIS 0-6 and fatalities were determined by crash severity and belt. Body region injury (AIS 0-6) was also determined. NASS-CDS electronic cases involving <15 mph crashes were evaluated to determine the crash circumstances causing serious head injury (AIS 3+) in occupants with overall severe injuries (MAIS 4+F).

RESULTS

More than half (51.3%) of belted occupants in 10-15 mph delta V crashes were uninjured compared with 30.2 percent for unbelted occupants. The ratio of the fraction (relative risk) of belted occupants who were uninjured to the fraction of unbelted, uninjured occupants was highest at 3.74 in the 30-35 mph delta V. For 10-15 mph crashes, 0.40 +/- 0.15 percent of unbelted occupants were severely injured (MAIS 4+F) compared to 0.033 +/- 0.009 percent for belted occupants. For 30-35 mph crashes, 8.51 +/- 2.20 percent of unbelted and 5.83 +/- 1.93 percent of belted occupants were severely injured. Overall, seat belt use was 87.4 percent effective in preventing severe injury (MAIS 4+F). The effectiveness decreased with increasing crash severity. The highest relative risk for severe injury of unbelted compared to belted occupants was 12.3 in crashes of 10-15 mph delta V. The relative risk was 8.8 in <10 mph crashes. Overall, the relative risk was 8.0 for severe injury (MAIS 4+F) in frontal crashes. 16.5 +/- 0.98 percent of unbelted occupants experienced serious (AIS 3-6) injury. This risk was 6.49 times greater than the 2.53 +/- 0.10 percent risk with belted occupants. The largest relative risk for serious injury (AIS 3-6) was to the neck (367 times), face (15.5 times) and head (10.2 times).

CONCLUSIONS

The highest relative risk for severe injury of unbelted occupants was in frontal crashes <15 mph. Most of the crashes involved multiple impacts and air bag deployment in the accident sequence. The use of long fill-time side curtains, additional curtain deployment logic, limited deflation front air bags and broader curtain coverage of the front interior may address these injuries.

Road traffic injuries: a stocktaking

Once we accept that road traffic injury control is a public health problem, and that we have an ethical responsibility to arrange for the safety of individuals, then it follows that health and medical professionals have to assume responsibility for participating in efforts to control this pandemic. Over 1.2 million people die of road traffic crashes annually. Road traffic injuries are among the second to the sixth leading causes of death in the age groups 15-60 years in all countries around the world. Control of road traffic injuries is going to require very special efforts as patterns are different in high- and lower-income countries, and while some countermeasures are applicable internationally, others will need further research and innovation. We will need to focus on the safety of pedestrians, bicyclists and motorcyclists, speed control, and prevention of driving under the influence of alcohol.

Differences in the effectiveness of frontal air bags by body size among adults involved in motor vehicle crashes

OBJECTIVE

There is concern that small stature occupants (particularly women) involved in motor vehicle crashes (MVCs) may be at risk of injury or death from frontal air bags, though evidence to substantiate this concern is lacking. We sought to assess how occupant body size (measured through height and weight) affects air bag effectiveness in mitigating the risk of serious injury, after adjusting for important crash factors.

METHODS

This was a retrospective cohort study using a national population-based cohort of adult front-seat occupants involved in MVCs as included in the National Automotive Sampling System Crashworthiness Data System database (NASS CDS) from 1995 to 2006. Drivers and front-seat passengers 15 years and older involved in MVCs involving passenger vehicles and light trucks were included in the analysis. The primary outcome was serious injury, defined as an Abbreviated Injury Scale (AIS) score >or=3 in any body region. Multivariable logistic regression models were used to test interaction terms (effect modification) between air bags, body size, and injury. The predicted probability of injury across body sizes was plotted to further illustrate potential differences.

RESULTS

Sixty-nine thousand three hundred eighty-seven adult front-seat occupants during the 12-year period were included in the analysis, of which 9333 (2.3%) were seriously injured. There was no evidence that height or weight modified air bag effectiveness among all crashes (p > .40). In primary frontal collisions, there was some evidence for effect modification by weight (p = .04) but not by height (p = .59). When assessed using air bag deployment, height was a strong effect modifier (p = .0078), but not weight (p = .43). Predicted probability figures confirmed that occupant height modifies the effect of air bag deployment, but there was no similar visual evidence for body weight.

CONCLUSIONS

In this sample, we found no consistent evidence that body size modifies the overall effectiveness of frontal air bags. However, among crashes involving air bag deployment, the effect of deployment on injury differs by occupant height, with a relative increase in the odds of serious injury among smaller occupants. In such crashes, the probability of injury with (versus without) deployment began to increase with occupant heights less than 155 cm (5'), reaching a level of statistical difference below 138 cm (4' 6'').

Air Bag-Induced Orbital Blow-Out Fractures

RATIONALE

Although air bags have decreased the risk of serious injury from motor vehicle crashes, their deployment is not innocuous and can result in injury. The force of the deploying air bag can cause orbital blow-out fractures. We investigated the circumstances that predispose a crash occupant to this particular injury.

STUDY DESIGN

The authors conducted a case series.

METHODS

A total of 150 orbital fractures occurred among 2,739 occupants in crashes included in the Crash Injury Research and Engineering Network (CIREN) database from January 1997 to July 2005. Ten orbital blow-out fractures attributed solely to air bag deployment were extracted and four reported in depth. Occupant, vehicle, and crash characteristics were reviewed for predisposing similarities and to investigate the mechanism of injury.

RESULTS

All crashes had air bag deployment and a frontal or near-frontal principle direction of force. Nine of 10 injured occupants were positioned within the air bag's deployment zone at the time of impact as a result of a forward seat track position, falling asleep at the wheel, being unrestrained, or having decelerated before impact. Six of 10 occupants experiencing orbital blow-out fractures were of shorter than average height. Based on rigorous crash reconstructions, the orbital blow-out injuries were felt to be causally related to air bag deployment.

CONCLUSION

Air bag deployment may result in orbital blow-out fractures. Occupants positioned in close proximity to the air bag during its deployment phase appear to be at increased risk for orbital blow-out fractures.

Biomechanics of side impact: injury criteria, aging occupants, and airbag technology

This paper presents a survey of side impact trauma-related biomedical investigations with specific reference to certain aspects of epidemiology relating to the growing elderly population, improvements in technology such as side airbags geared toward occupant safety, and development of injury criteria. The first part is devoted to the involvement of the elderly by identifying variables contributing to injury including impact severity, human factors, and national and international field data. This is followed by a survey of various experimental models used in the development of injury criteria and tolerance limits. The effects of fragility of the elderly coupled with physiological changes (e.g., visual, musculoskeletal) that may lead to an abnormal seating position (termed out-of-position) especially for the driving population are discussed. Fundamental biomechanical parameters such as thoracic, abdominal and pelvic forces; upper and lower spinal and sacrum accelerations; and upper, middle and lower chest deflections under various initial impacting conditions are evaluated. Secondary variables such as the thoracic trauma index and pelvic acceleration (currently adopted in the United States Federal Motor Vehicle Safety Standards), peak chest deflection, and viscous criteria are also included in the survey. The importance of performing research studies with specific focus on out-of-position scenarios of the elderly and using the most commonly available torso side airbag as the initial contacting condition in lateral impacts for occupant injury assessment is emphasized.