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AM 69-3

PATHOLOGY OF TRAUMA ATTRIBUTED TO RESTRAINTSYSTYEMS IN CRASH IMPACTS

r Richard G. Snyder, Ph.D.

Clyde C. Snow, Ph.D.

"Joseph W. Young, A.M.

Warren M. Crosby, M.D.

ct Col. G. Townley Price, USA (Ret.) D.V.M.

Approved by Released by

9 .Ta0FR DILL; M.D. P. V. SIMoL, M.D.CuIEF, CIVIL AxROMEDICAL FDMRAL Ari Su-•GEox

INSTITrrr

February 1969

Department of Transportation

FEDERAL AVIATION ADMINISTRATION

Office of Aviation Medicine

!

ACKNOWLEDGMENTS

The author3 wish to gratefully acknowledge the support and assistanceof a number of organizations and individuals who contributed to the workreported in this paper. We especially wish to thank Richard 1 , Chandi-r,Capt. Richard Sonntag, M.D.. and Capt. Peter Hanson, 6571st AeromedicalResearch Laboratory, Holloman AFB, New Mexico; Allan Katzberg, Ph.D..Chairman. Department of Apatomy, Southwest Foundation for Medical Re-search, San Antonio;, and Jeffry S. Life and Bruce Pince. Space/DefenseCorporation, Birmingham, Michigan. Pathological histology was conductedat CAMI, except for one series of radiographic analysis made by Dr. F. R.Birkhill, Detroit, specific tissue examinations made by Dr. Allan Katzb rg.Southwest Research Foundation, San Antonio. and selected brain tissuesstudied by Dr. Raphael Cilejnto, Detroit.

AUTHORS

Richard G. Snyder. Ph.D.. Highwasy Safety Research Institute. Instituteof Science and Technology. University of Michigan. Ann Arbor. Michigan.

Clyde C. Snow, Ph.D., Civil Aeromedical Ihstitute. Federal AviationAdministration. Department of Transportation. Oklahoma City. Oklahoma.

Joseph W. Young, A.M.. Civil Aeromedical Institute. Federal AviationAdministration. Department of Transportation. Oklahoma City. Oklahoma.

Warren M. Crosby. M.D., Department of Gynecology and Obstetrim.University of Oklahoma School of Medicine- Oklahoma City. Oklahoma.

CoL G. Townley Price, USA (Ret.) D.V.M.. Civil Aeromedical Institute.Federal Aviation Administration. Department of Transportation. OklahomaCity., Oklahoma.

Qualified requefters may obtain Aviation Medical Reports from Defense DocumentationOester. The general public may purcha.e from Ceanringhouse for Federal Scientific and

Tecbnical Information. U.S. Dept. of Commerce. Sprini,11ld. Va. 22151.

PATHOLOGY OF TRAUMA ATTRIBUTED TO RESTRAINTSYSTEMS IN CRASH IMPACT

L Introduction general population which include infants and

Although restraint systems have been used for 'hildren. women, and the aged and infirm.over 50 years in military aircraft, and in some Thq work reported here was conducted on theform for about 113 years in lighter-than-air USAF 6571st Aeromedical Research Laboratorytypes of vehicles, their use in other forms if Dais.. Decelerator as a project of the Protectiontransportation has been relatively new. Su -4 and Survival Laboratory. Civil Aeromedical In-systems have conclusively demonstrated their stitute (CAMI). Federal Aviation Administra-overall protective value to vehicle occupants:- tion. These studies involved a series of relatedhowever, experimental evaluation of the various investigations issessing the protection from im-systems is necessary for the design of bi.proved pact trauma provided by various restraint sys-

4 future systems. as well as for developing even temns commonly found in airrraft and automotivebetter protective use of present systems. In re- vehicies. The latter phases of this series alsocent years considerable attention has been focused included two experimental systems.

on the more sophisticated military restraint ays- The initial project uas designed to investigatetems. and in particular on the protection of injur%, to the pregrant female and or fetus duerather specialized occupants of apace vehicles, to lap belt forces at impact. This questi hasInjuries reported in the past have primarily re- -had some discrussion, but very little clinical datalated to problems ef high-speed ejection ivertical are availableY1 and no prior experimental study.

G-(}) decelerations involving vertebral trauzaa. has been conductei Tho dereleration patternsisoled clinical findings, or to by-products of selecteri for this study were based tspon the hypo-experimental studies involving other basic oh- thetical situatior. of a pregnant woman pamngerjestives. ubjected To the impact forces of a specifi type

Very little ateation '-as been given to the type of airline Jet tram pr-. at Ma,') lbs. grand severity of injuries which may be attributed weight. crash lard,ng after lo.ing power on one

to the vast majoriky of restraint syste more engine at 207-e R" altitude after =k09 (451:generally used. Com..rial aire t body orientaxion. forward facing. -W9g.. 5 f& -currently utiFze only lap belts for passenger 'e- impacz veloc;v, and ,'A2- sonds dationprotection as do ahmst all general aviation air- of initial impari - The passei u- was assumedcraft in the United S-.ates. military troop to be oted in the first row of the first-ctm

section. Since this condition proved to be non-ports. and military hAicopter transports. Even survivale for the firsm experimental baboon sub-such advanced aircraft as the 34-p2eLsenger jc rtce ylpbl ay usqettaBoeing SST. the 75 0 -passenger IL,-kheed (5•A. px' poteced by lap be-h only. subsequent tess

Bere conducted at ;ower levels for this svstem.and the 490-pasw .r Boeing 747 will have onlythe lap-belt system in all but aircrew cockpit T vvrk Zd LZ s st wa b (Ira

positions. In addition. similar systems are now of'--t- o w•t±,-- .ýkiffi•ma cITY. vwtait te

being installed in some &5 million tutortotive LU-- arty ioio•m Am. NfB mto the ti•eb ex

vehicles per year. PilX populations such as the •,- Ms .- at, . Acs do ma t We• t a

Apollo astronauts, airline trainsot and military e -,-'- Is =,d fw tb,• elp v." iawty *t.pilots represent very select young male physical = Iwa d =i I b•- t• Ambm Fat " Sa u1ti

types. and their restraint needs and injury toler- c ,iu*at , I A• t Caran-, uS Deps••_ w •cances may differ considerably from those of the ..

and included patterns simulating exposures in tionately for the baboon, and as noted in Table I,forward- and rear-facing seats in aircraft as well the F-ill test frame, mounted on the ARL Omni-as automotive impacts.-' The preliminary Directional sled was used for most of the tests.work in which 11 pregnant baboons were sub- The 4,500-pound tensile test nylon webbing usedjected to 12 experimental impacts, indicated that in each test was replaced after each run; lapat 20g. maternal trauma was minimal, but fetal belt angle was 550 to the plane of the seat pan.death occurred in association with fetal head Prior to each run. static belt tension for eachinjury, placental separation, and maternal shock.s side was stabilized at 1.5 kg. (3.3 lb.).

In response to requests by the Society of Auto- Subject orientations (presented in Table I)motive Engineers S-9 Committee and the Stew- were 900 sideward facing (450 seat pitch). 50^ard and Stewardess Division of the Air Line sideward facing (13c arid 200 seat pitch), for-Pilots Association. a second test series examined ward facing (130. 200. and 450 seat pit-h), andthe problem of lap belt only restraint protection rearward facing (130 and 200 seat pitcL) bodyfor aircraft occupants in lateral seating positions orientations.such as lounge. aircrew. or stewardess station. Time duration varied from 0.059-0.121 second.Twenty-four deceleration tests were performed the latter being the longest duration at 30g. theon 24 adult female baboons, in controlled experi- Daisy track was capable of providing safely withmerts comparing sideward. rearward, and for- this sled load. Entrance velocities varied fromward impact effects. Impact levels causing X4 ft. 'sec. to 94A ft. 'sec.. rate of onset frominjury to the baboon subjects in 14 lateral orien- 1.200 to 6.%00 g. sec.. and peak sled forces fromtations were determined to be much lower than 15g to 57g. Figure I diagrams the configurationin either rearward- or forward-facing body of the various restraint systems used. Since the

ao with fatal iniuries occurring as low air-bag and inverted-Y yoke s-yr..ems were ex-as 16.5g. when the occupant wore a lap belt only.- perimental. a brief additional description for

A final tro series compared two types of ex- these follows: The air-bag restraint for thepu~iuimtal systems. the inverted-Y yoke with baboons was -scaled down to be of the same rela-ibmtia 1e0l Mnd the airbag restraint system.- tire size as the full-size version for the humans12 addition, forward- reMrwar-d and sideward pre-iously tested with anthropomorphic durm-t-i*s wa mad. of other sstaems c-rently in mies for automotive use. Each bag was foldeluss, sdo as the 3-point (lap belt-diagonal belt into a test instmment panel 10" forward of thesystm) and the diagonal only restraint system seated baboon fFi. I-F). Bag inflation wasfavred ian some Fropean automotive vehikl. initiated by electronic impulse as the sled probe

ThU eami sries of related readies of resm int penetrated the brake system at impact. As theSaWE6otat i impact injures using baboo sub- subject came into contact with the bag duringjts has ben batW• together in this a to impact. the bag was deflated through pressureptm an overall ew of trauma sustained b. relief diaphragms on either side. This producedthe oempa restrained by the systems evalsd, a dynamic s.s em with deflation occurring as

the occupant moved into the res-traint during theIL lfee and Matas impact sequenae. Air bag t,.. were designed

Sixty-two deederation tests wvm performed on as paired te:-ts from 30 g. to 50g. avg. g- sled59• adult female .Savann~ah~ bao (Pap~o y acceleratm). with one animal terminated im-

cepiasla,. rangi in body weight from 15.5 to mediately post-impa2. 0"-6 minutes). and tae36 pomds t9.5 to 163 kg.). .g• estimates based second animal for each g-level allowed to sur-on detoal examination ranged from 41; to 12 rive for chronic pwsa-impact monitoring. Twoyears (CS). of the latter were monitored for 4 weeks (and

The tests of this series were conducted on the one for 12 weeks) to allow any possible traumaDaisy Deelermaor between 23 May 1966. and as a reslt of impact to become evident.3 June 1967.32 Several sled and set combina- The urper torso inverted-Y yoke restrainttioms were used. depending upon tlhe particular system consisted of a singie lap belt with anprofile run. U1 seats were scaled down propor- experimental upper torso harne Strain gauges

were mounted on both sides of the lap belt to(.Pqv d rMW tU. Irecord belt fortes. The upper torso portion of

2

* the harness attached separately at each side ad- impact injury oecurred in about 50% of the ani-

*: jacmnt to the lap belt tie-downs, and was also mals when impacted with lap belt only restraint

ecuipped with strain gauges (Fig. 1-E). The systems. Sled g. was chosen as a measure since

yoke of the harness was formed at the psterior this could be accurately determined and corn-

aspect of the head, but did not touch the head pared to previous tests. Subject decelerations

or neck. IR provided some rearward motion pro- had proven to be extremely unreliable in previous

tection, but we did not test to what degree it tests due to probl'ems of orientation and mounting

could offer protection frm hyper-cxtension in procedures.rear impacts. The hariess, continuing as a The seat was padded with 1-inch Ensolite on

single belt frow the yoke. was attached overhead the back and seat. No physiological measures

at a 450 shoulder angle (relative to the hori- were made in 50 tests to reduce chances of surgi-

zontal plane) into the inertia reel. which was cal artifacts. In another 12 tests, involving

activated at 0.3g. For the irigerttl-Y :ioke sys- pregnant animals. physiological monitoring con-

tern tests protocol was established for one run sisted of the following:" intra-abdominal pressure

at 30g. (sled X, avg. g.) in both forward-facing was measured in the peritoneal cavity with a

and side-facing positions. one run at 43g.. and Micro-systems 1017 pressure transducsr im-

one run at 49g. An initial value of 30g. was planted in the wall of the uterus or by an intra-

selected because this wa3 the level at wh;ch lethal amniotic Statham 222 pressure transducer.

SIX RESTRAINT SYSTEMS TESTED

A. LAP BWC

.4

B.~~ ~ DIGOA BU I AP1 WEK DOMLE F. AMR SAO RWSTANW

Fictru 1. T1e mix tyws- of rettraint cpstents test4ed

Maternal blood pressures were recorded pre- systems. Each strain gauge buckle was instru-and post-impact by sphygmomanometer or inented with four strain gauges to measure thethrough a trans-femoral catheter in the abdomi- bending moment due to the force imposed on thenWl aorta, connected to a Statham P-23 pressure belt. Although each buckle contained eight ele-transducer. Material electrocardiograms were ments, it electrically appeared as a four-active-obtained with Beckman silver-silver chloride ad- rr bridge. When the belt was stretched, thehesive electrodes. Fetal electrocardiograph leads metal cf the ouckle was stressed and deflected.of insulated stainless steel wires were inserted Resistance of tne electrical elements changed asinto the scalp and arm of the fetus. Fetal heart a result of changes of strain on the metal. Cali-rates were monitored by stethoscope and/or re- brations were made by placing a known forcecorded continuously by electrocardioLrraphy. on the belt and measuring the electrical outputSerum electrolyte determinations and arterial of the bridge.002 for 13 pregnant animals were determined. Photographic coverage included use of a Wad-For details of blood chemistry technique for each del 16-1A 2,000 fps camera for frontal view,case the reader is referred to Crosby.,- and one or two Ippolito Feastex 2.000 fps cameras

Each subject was anesthetized with 1 mg./1 kg. for lateral views. In some runs. film from onebody weight Sernalyn (R) prior to each run. I-V of the lateral views was processed immediatelyNembutal (R) was used on one animal and In- and wet-viewed to examine results of each testnovar-vetca) on two animals. Ether, atropine, quickly prior to the succeeding tests, 16 mm.and diphenylhydantoin were also used prior to documentary -olor film. 35 mm. still color film.surgery in the pregnant series. These drugs did and 4x5 still photography were also ,btained.not appear to significantly alter physiologic re- In addition. pre-impact, during impact and post-sponses to impact impact black and white Polaroid () photos were

obtained. These served as useful references toThe subject was then removed from the cage cross check specific position. run numbers, and

after the drug had taken effect and prepared for other details cf notes.the test in the adjacent surgical room. Hands In 12 iuns, the pregnant animals were clint-and feet were covered with tape and the animals cally monitored for perinds from 20 minutes tomuzzled in order to facilitate handling. In the 4 hours. In the seven animals impacted with air-lateral tests, 1-inch targets were posi.tioned along bag restraints a post-impact blood sample wasthe head and trunk for later photometric analysis drawu prior to termination (5-20 minutes post-of body kinematics. The anuimals were next taken impact), and in all the others the animal wasto the test sled. positioned. and the seat belt ten- terminated within 5 minutes post-impact.sion adjusted. Low-strength masking tape was Gr autopsy was conducted at the 6571stused to keep the legs and thorax in proper posi- Aeromedical Research Laboratory immediatelytion for the run: however, this easily tore upon post-impact for the terminated subjects, or theimpact and did not provide additional restraint, animals were packed in ice and immediatelyIn the air-bag tests a loop of rope under the transported by air to the autopsy facilities ofarms and attached over the seat back supported CAMII in Oklahoma City. where autopsy wasthe animal in an upright position until mechan- completed within 24 hours. Three animals wereically released by cable 0.6 second prior to impact. not immediately terminated, two being allowedMuscle touus was carefully monitored to assure to survive for 4 weeks, and one for 12 weeks.that all runs wer? made at the same level of post-impact to determine chronic impact effects.anesthesia. In these cases, the animals were observed and

T1e strain gauges were fabricated for the autopsied at facilities of the Space Defense Cor-6571st Aeromedical Research Laboratory b. poration. Birmingham. Michigan.Land-Air DivivAr. of Dynalectron at Holioman In the lateral series two Field Emission high-AFB. They wise originally designed for the speed roentgenograms were taken of each run.standard 2-inch wide belt. but were modified to the first shot being triggered at impact and thethe 1-inch webbirg used in these tests. Gauges second at about 0.65 second after initial sledwere placed at each end of the belt., two were entry into the brake: however, none of theseused for l*p belts and four gauges for the other proved useful. Whole body post-impact anterior-

4

po-jterior and lateral view radiographic studies strains the body by its strongest structural ele-were made prior to autopsy., Gross and micro- ments and reasonably close to the total bodyscopic tissue study of the brain was complemented center of gravity. It prevents ejection, whichby electronmicroscopy examination for fibrin- has been demonstrated to be the major singleolytic activity. Blood analyses were cooducted cause of fatal injury in automotive type acci-in a search for biochemical indicators of impact dents;31 however, in forward or lateral impactstress and/or tissue damage. Blood samples for it offers no upper body support, thus head andthese analyses were taken for the seven air-bag thorax are free to "jackknife" over the lap belt.

subjects prior to impact. immediately post- The lap belt restraint is the most commonlyimpact, and for the three animals observed for used system for botb aircraft and automotive1-3 months post-impact, at 7-day intervals for occupants. Its effectiveness has been well docu-one month. The hematology is summarized in mented by many investigators, their studies in-

E Snyder, et al.'" Specific techniques emplo,-ed dicating "that the lap belt alone can r-iduceSare those provided in detail by Life."• injuries by substantial amount&s,'' Huelke

and Gikas found in their study of fatal accidentsRthat "of 48 ejectees. 38. or 80 percent, would have

In each restraint system tested in this series, survived if they had been wearing only the lapinjuries to occupants were found which could be seat belt."" Nevertheless. as Fish & Wright 2

4

attributed to the system itself. The patterns of have recently noted. this device can in itself betrauma were found to differ in each case as a responsible for distinctive injury patterns. In-function of the type of restraint and the body jury to the jejunum.1.2.43•71 spleen." pancreas,,'kinematic action during impact. Additional duodenum," ileum.62 and abdominal hernia"3 hasSvariables found to be of importance included been attributed directly to the lop belt. In addi-magnitude. onset rate. velocity, and time dura- tion. lumbar compression fractures have been re-uon of impact, distribution of force upon the ported since the body hyper-extends over the

Sbody. and direction of force (body orientation belt ,,.. as well as transverse fracture of theSto the impact). Variables not studied. but also vertebral body3' attributed to the high placementbelieved to be of imp tance would include the of the lap belt which allowed the belt to act as aage, sex. and physical condition of the restrained fulcrum, literally "splitting apart" the vertebralsubject, body. A "splitting fracture" of the pedicles,

This series of tests provide a basis for the transverse processes, and lamina of the thirdassessment of traumatic and protective qualities lumbar vertebra has been reported." Smith andof these restraint systems for the baboon sub- Kaufer have recently reported finding 10 of 17ject. The confidence with which results observed cases of spine injuries from seat belts. involvingon the baboon may be extrapolated to the human a tension-type fracture to the lumbar vertebrae."is reinforced by the fact that the injuries found In pregnant women traumatic rupture of thein these tests are similar to those which have been uterus.'. ventral hernia." and placental sepa-reported for human subjects in accidents involv- rations have been reported.ing similar restraint systems. Such an experi- Teare's findings of abdominal and thoracicmental approach testing living systems is a aortic ruptures. attributed to the jackknifing ofr necessary orollary to studies based on the Use occupants over the lap belt during a 1951 Cometof cadavers or anthropomorphic dummies, jet airliner crash in England" the report of

Tables I-VI (Appendix A) provide the results DuBois of 2.3 cases of intra-abdominal traumaof gross and microscopic pathology and note the and 32 cases of contusions in 858 aircraft aces-individual conditions for each test. a summary. dents in 1952.20 and that of DeHaven. et ,4,19 inof the physical data. and records of peak belt which they attributed only bruises due to the

forces. Our findings for each systeem will be belt to 1,029 survivors of 670 light aircraft acci-briefly discussed here. but for further detail refer dents, were early efforts at investigating thisto these tables. problem. Lap belts are being worn more by

A. Lap Belt Only. Lap belt refers to a single larger numbers of individuals as airline travelbelt worn across the anterior aspect of the pelvic lbecomes more common. and because all new auto-.iructure (Fig. 1-A)., Properly worn. this re- mobiles manufactured in the U.S. are required

5

to have belts installed. Thus, it should not be hemorrhages were noted in the brain, spleen,surprising to note that there has recently been heart, uterus, and pancreas. In general, however,a sharp increase in the incidence of trauma at- the pathology appeared to be reversible and com-tributed to the seat belt, reflected in the more patible with recovery. Above 25g., injury wasthan 20 clinical reports in the literature con- more severe and along with damage to the pre-cerned with this problem since 1961.5 viously mentioned organs, ruptured urinary blad-

Forward-fNcing lap belt impacts were con- ders, pulmonary lacerations and interstitial andducted in 18 of the 36 lap belt tests (Table I-A). pericapsular renal hemorrhages were increasinglyOf these, five were impacted with seat pitch atti- frequent. Beyond 30 g. survival could be consid-tude of 450 to simulate a jet airliner crash, while ered marginal and beyond 40g., the impacts weretwo were at 13% and 11 at 200 to simulate seating definitely lethal.profile in a level aircraft or automotive accident. Since previous clinical reports hiave suggestedEntrance velocities ranged from 38.2 to 87 ft./sec., that incorrect wearing (loose. high) of the laponset rates hom 1,400 to 6.800 g./sec., time dura- belt may have contributed to the injuries16"'.29_VL-3tions from 0.050 to 0.080 second, and magnitude 54.61.-, an attempt was made to duplicate thisfromn 16.5 to 40g. factor .n three runs. While this did appear to

In all cases, transverse linear contusions of the result in more extensive injury in one case atanterior abdominal wall corresponded to the po- 30g. (3372), it was inconclusive for two othersition of the belt at impact (Fig. 2). It is sug- tests at 34g. (3315) and 40g. (2880).gested that a careful examination for such Previous human tests by Lewis and Stapp withbruising be routinely made in human accident healthy, young male subjects resulted in corn-victims as it may serve as a valuable sign of plaints of abdominal pain at 15-20gý" Minimalmore serious intra-abdominal injury. Up to tcotnsi orer the hip are and abdomen as wellappro l 25g., congestion and/or miniml as strain of the anterior abdominal musculature

rm• 2. Typical cnntusiou resulting from Impingement of lap beit in impact.

6

U.,'L.!-

Ff 'tp1- r";Iboon jlrItlon(A Ill o'i l oirynuii-dirfi'e lu SletI dtI jI. to in 0' i l l In~rtend ho !y post IvIl. N.-I~

ph lf[tel. ovlor n lltal-nd aln p rio o wn l7l

dueW to lap lielf iflphlflfýllcflC~t wer, found to occulI V ourt.,e xCIt v. ith Ii :i-l)lf -resitrained stibjet ~at, 10g. (300 g./sec., 0.002 see.). lIi one 26g. iui- imlpacted In I he 901 sidcwird facing body posi-pact (t he highest lap-belý-ouly experimental test tioli (Fig. 3) resulted in injuries surprising ii)run on humans), the subject complI)ainled of severe their extent (Table I-E).,1 In this series, sledopigastric pain persisting for 30 seconds and entrance velocities ranged from 36.4 to 75 ft./see.,thorftei,, pain for 48 hours. Seait belt forces of 15 tn 3 1g., and 1,200 to 3,100 g./sec. onset rates.4,290'pounds, and an average impingement fovc-. Since all animals were terminated post-impact.of 89.3 psi over the belt~ area were calculated. ",,6 survival must be judged f rom the trauma foundSubsequent tests on the Daisy track have not upon autopsy, and it seems probable that without,exceeded 15g., until recent tests of 17g. by thve immediate and extensive medical assistance onlyNationil Bureau of Standards,` -considered to be the 1 ig impact would have. bekn survived. It isthei upper limit of subjective tolerable impact interesting to note that human voluntary lateralwith a lap belt system in forward imp~act. subjective tolerance levels lrmv. been found Wo be

about 9g. (Zfborowski) ,8 much lower than forForwvard, as well as rearward, lap-belt-only either forward- or rearward -facing position-,.

impact for pregnant baboons at 20g. resulted in Five animals received ruptured bladders (whichfetal demise, even when the mnother was not sig- did not occur in forward or rearward lap beltnificantly injured. Death to the fetus occurred impacts). Contusions, tears or lacerations, andin association with placental separation, traii- one complete severance of the uterus also occurt-edmatie hecad injury, and maternal shock.,,, in five cases. In th-ree instances, cervical frac-

WI'io u m 4, St~bdtival bemrrharige III 1,ithooii iinpiicte fxivrwurd f."(11i9, litr ',Oit o.iily, at 32g. raiid 75ffrw e velocity.A hilgh freflueuicy of dlurtil congest ion n 1( beinorriiige was rounti.

tires occiirred with completo Altokto-Occipital being im~pacte~d, and tratvd in till sitino imni~er

iiepatrat iwi. Tntnsecýtion of thu ~;pinal cord o,(- as tlio~ze in H ie, impact ýzerl

curred in one 30g. impact. Again, such cervical with No'-- .',l, was hold at room

tratuma did not occur in eithe-r forw~"- ' ior 1.i5 hour-, and then packed in

wardI lap beclt tests. The mno~ .... ICnctg ice in at shipping container. A temperature probe

was that, of pancreatic 1e1LLorhIagO III ail iuia was inserted inferior to the right lobe of the liver

catses which were autopsied. intra-cranial hcrior- and recordings kept. Body temperature of

Irhago wits again 1ote'd III each case (Fig. 4). 96.80F. dropped to 96.20F. after 1.5 hours, to

Inter-acinar hemorrhage, typical of thiese lateral (4.80F. within 14 hours, and to 480F. within 24

i11IM&cS, is shiown in Figure, 5). Alt houghi such i hours. After 24 hours, gross necropsy and histo-

trauma hias not, been rep~ortedl by previous inve-s- ptooieaiainrvae idpnrai

tigators, even h:. tests with humians exp)osed to necrtosois exainaotio eeldml pancreatic hmrhg.Ti

22g. and a bear to 46g.,13 such tests have been ineicrsis wthout panrt fteai hemroriosrhaed dhisconducte~td with full boyrestraint and mnot iniaelhtpatoahpersi bevddr

body noýlisithstes.Ing necropsy was due to post-mortem changes

To clarif v the role of. post,-mortem pancreatic ',i the pancre~as, but since associated hemorrhagic

(tegeflerat ioi, one baboon was teriniiiated without. fuindings o,-curred only in pancreawe of impactedl

5. ((rr ia(er nclinar livniorrhiwý of p nTICV(s tyIl '1 (Y)Ia f' 1itet , I kb)fnof Iiipicra I at ever.y level teided at '1n)d

9

Own N, ke wereý considleredi 14 he , direct resui t 3JLdi.7icZs of tlie ut ra h ibjlai diictý Nh ilc . a it

of teli trauma11:. forn-ed oiilv DN' the centiroacinous cell-, with tlw1 b ~;~ynficnee 1 tli it et-aeflnr hiiir~ release and1( at-i ivat Xm of pillnercat iCeivi.

riu~gc,ý observed in the paiireait at. 1)cr(Dp, H owever, this mu11st still reiliainl speculat ion Until

following impact is unexpected ntnd has beent proven or (hisproven by clinical studly of siii-c"are(ftlly considered. Prey iouý, descri pt ions of Vi vors.pa -acreat ic injury have been related to dietary Recent work, suiggests that the pancreaticexcess(os, direct traumia resoilting, fromi blows over hemorrhage may be more critical in the, baboon

lie let't' upper quadr~int. of fthe abdomen, surgical thian in matn since rec4 nt, studieS2 indlicate that,tin'0ia,111 and reflux front the. intustine, 17,33,4, the output of serumt ai )Ylaso and lipase is several

,4,5~;,~T475?3R1but we have not found similar foldl highier in the hi boon th'aa in the humnan.reports of pancreatic injury related to sudden, Hence, mechanical (lisr uption of L'he dict, Systelnviolent compression and/or displacement of thie with consequent release of enzyme might W~ ex-viscera such as 'we found in this series of expcri- pected to result -in a far moore fulminating out-nients. Immediately after imipact, we (,')served comle in baboons than inl h1,11Mum.nret ro peritoiieal. and intrallobul ar hemorrhage- Rearward-facing body orientai~ioas (Tmil 1

g(rossly and inter-acir~ar hemorrhage histologic- I-C) at impact were used ia four cases9, -.1l at.ally, It, is clear that, there have been intra. 200 pitch attitude. These, ranged from 122 to(abdominal forces sufficient to ruipture the capil- 4g.59t 88f/sc veeiy,200o 85lary bed. It is not unreasoiiaile to believe that g./sec. onset rates, and 76 to 100 milliFseconldsthiese samne forces could breA' the more delicate time (luration. Seat belt formes of 30-120) pound~

4V,

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Ill pjlj(refjH res itn fr m sbets ilpneyi u ll" ge dnoli h l

Wer'e reC(lorded, upon r-ebound, since the force was trauma. This system not only does not providt.Oistributed upon the subject's back rather than pelvic restraint, which allows the subject's lowerbeing corcentrated at the harness, as in forward- torso to swing forward and rotate out of the beltfacing impacts. All runs were survived without at impact (unless stopped by striking the in3tru-sigmnificant trauma. At 44g., extensive abdominal ment pr.nel, car door, or other structure), but inbruising was the only injury which could be side impact produces an extremely lethal whip-directly attributed to the restraint. Despite ping action in which the body literally rotatesfindings of intra-cranial hemorrhage in three of about and out of the belt. There have been sev-the four cases, these, injuries were considered eral studies of injuries attributed to this type ofreversible (with the exception of the fetal death). belt-including data on chest injuries,4,6,9

,'7',4877

The rearward-facing body orientation offered the as well as ruptured spleen.3 - and sternal frac-

best support in impact for the lfp-belt-only re- thure.21

strained subject. In our series, two forward-facing 30g. tests andB. Diagonal Belt Te8t8. Tests with the single one sideward-fucing 30g. test were run (Table II.,

(liagonal belt only (Fig. 1-B) were made because A and B). As can be readily seen from the severethis restraint system has been reported used in traumiL received in each case, this "restraint"as much as 85% of Swedish automobiles,4 T'iis system certainly does not appear to .ffer manysystem extends across the shoulder and chest on advantages, .nd cannot be considered equal inthe outboard side (left shoulder for driver, right protective capability to the lap belt. In eachshoulder for passenger) diagonally across the case, massive destruction of the thoracie cagechest to the opposite hip, where it is anchored to occurred, with extensive avulsion and rupturethe floor. In our tests, the subjects received fatal of the pectoral muscles, numerous rib fractures,

Vounp 7. Lncerations of liver typical of trauma In Inpm'ted subJet., protected by a single diagonal belt only.

11

andl t raumia to the kid~i,,:,. (,igr. 6) ,fiý el. c (Fig. 7). lated to tile- car(Iiac cycle and co)ft ractilu sutafsp~leen, pericardium, Ilungs,, p'increas (Fig-. 8). of the wi~ocardiuni at thle timie of impact.ad renmk, rlipture or hemorrhage of the signoidl The dlegenerative changes observed in our stiJ(Icolon, and durul hemorrhage. Diagonal linear ini cardiac muscle, of baboons subject,(j to Iiigli-ig.contusions from belt impingement were warked. force,, consist of random areas in which there iý-Amiong other findings, it is interesting to note disruption of the niyofibres by transverse sepa-that myofibrillar degenerittion. was observed in ration and apparent rupture of the sarcolemniatwNO of the rtrimals during mnicroscolpic exainina- permhitt ing separation of the fibrils. NuIcleartion. of nuvocardial tissue (Figs. 9), 10). A similar olm.tu~gs are niarked, some nuelei are swollen andl

o)bservation, was noted in one '22g. side-facing. balloonicd, some are ghostly andt indistinct, and]3-point bel~t impact, oneI -11,g. forward, yoke- some are shrunken, ire-gtilar in shape with (,on-restraint imipact, and (o date, iii four animals d.'nsed chr-omatin and surrouniled by at clear zoneW.subjected to vertical drops in at c-irrent ser~es- by waile others, are frankly pyknotic. Lysis ofSnow.-' 1ragmentatiotA of the 'nYocardial fibres nuclei appoars to have occurred in the more so-and whether it represents decelerative, traumaticI verely affected areas. Vacuioles are p~resent Inl

rupiture of the heart. as de-scribed I)X Nto-itz an(l man11y firsand nuclei are ec-cenitric in posit ion.Atkins,- 0̀ at processing artifitct, or whether the Tihe theory that these are artifacts cauisedi b~y:hei~rt is in systole or dialstohb at th2 time of imi- dull micirotoie, knife is unconvincing beeziust,pact, has been discussed by Nf11SO1. 4

1. It. shou1ld randlo~n areas of frag~iuentai ion usually adjoiinbe noted1 that an experimental stutdy of chiest relatively normal ones. vie overall inipressloliimpact recently completed by Life and PinCe46 is that the changes described are the result of thehas conclus~vely demonstrated thait severity of tissues being subjected to extremne stress. A final]cardliac trauma in canine impact is directly re- interpretation will require further study.

IF[Grry S. Pei.j l iennorrhug-, (if kidlney oevu rinrg in single dia:o em! belt test,,.,

!2)

I

C. 3-Point Sgsem (Diagoud and Lap Belt tion by preventing flexion of the upper torso.CombUnamti). Since the 3-point restraint DiiAdvantages appear to be that it must fit the(American) configuration (Fig. 14') has not ye• occupant correctly to be effective, and that inbeen used extensively in the U'nited States. acci- side impact, the occupant com the side opposite thedent experience is still limited and injuries at- impact may slip out of the harness& while thetributed to this systern have !een infrequently occupant on the near side might receive cervicalreported to date. A rupture of the spleen with injury from neck impingement on the belt- Ner-fracture of five ribs. a fractured 4ernum.-, and ertheIeR. a properly worn 3-point restraint sys-a hyper-flexion hyper-extension cervical injunr-' tern is clearly an improvement over the laphave been reported as attributed to the American bet.t-''3-point system. iIn the American .- point zystem. Table III provides data for three forward-&OIS ends of the diagonal and lap belt are at- facing, one :54,: side-facing. and two 9W: side-ta-bed independently, while in the European facing te-4.z of the Aner'ian :,-point sy.eem. In3-point syi-em. there are only three points, one two forward-facing imnxacts at 21)g. and 22g-. noend of the lap belt cont.nuing upward to form injury w-as found in one case and slight injurythe ,ontiiuouý diagonal attac-hment.j Swedish ipancrratic petechial hemorrhage. adrenal peni-.4udies have reported few injurie- due to this capsular hemorrame. uterus broad ligament

-- Tei" '-' and -imilar result. have teen reported hematoma; in the other. A third test at 30r.from EniJand' and Australia_4:- In a Dutch 69): seat pitch. 74-2 ft. .. c, velocity. &.~XW, g. _e.-4udy. -three times as many chest and leg in- onse rate for *:-, -v%%-. durationu also resultedjuries- were found for diagonal and 3-lpoint users- if minor trauma g eht contu-sions--Fig. 11)-ax for lap Wmet use.• The major advantage of dural conge.4ionl., The diagn.al and lap beltthe :'-point _".sem over either the single dia..omal comnbination appears to provide mudh better in-or the lap belt is that it offers, additional protee- jury. prmtection at this level of impact than the

irg

F`

lap belt only which appears to offer marginal double shoulder harness has been long utilized insurvivability at .3g. military training, and is required at ffight deck

Two rearward-facing tess were run in this crew s-atios of airline transport aircraft. Suchconfiguration. At 2fg. no injury was found. At syaems hare been extensirely te•ed and hare40g. injury was not severe (subdural hernor- been demonstrated to be extremely eectim- •-rhage. subcapsular kidney hemorrhige. and Numerous rersions (5-point. etc.) hare evolvedpetechial hemorrhages). and only the k.dney and from this basic configuratioa. Because of theri petechial hemorrhages are attributable to the previousl proven prowlive value of the full-bdt (in rebound) torso restraint. only one animal was run n this

After om 5( left side impact at 2*.._ rmod- series. and -it g. neither gro nor mXiczoa~oIierate imra-dural hemorrhage was found upon trauma wýas found iTable IV).gro examination, and myofibrillar degeneration IL inered-Y Y&E ma r-upon miciescopir histokoical study-. am An experimental ssm. cailld the in-

Two W sideward-facing impacts iTable III- Yet-ed-Y yoke double-wulder barne. WithD) at -;g. and M0g. wert run. At the lower level, inertia ,,eel. i Fig. I-E was a.s0 tested in a seriessevere dural and urinary adder hemorrhag of three f-warwd- and one 90' side-faciag ;-a-ocmre.- in marked contrast to the 22g. forward pats ,Table V . This -e.- m offes the ad-run where no trauma was found- At waoz- tramna vantuges of full-torso suppon wuhile allowingwas itstazit fatal. due primat]y to disk-ation free and Complete movemen of the oceepant toof the atlanto-oceipital joint a& the neck impinged remch omtrols and change positio.. It is awn-uMPO the &dgOD21 beit. forabse. easy to slip into widhout mssng Ckthes.

L. PWI-Tem Res . The fr-lk-toms re- a•d fits women comfortaly. Ai•ation of moo-aim (Fig- I-D) comusting of lap belt and airrrft reels o-mrs- at but in aut=obiks..

-7-•;_ . T _ +•

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orr--a ~zo 4z'

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7 u It Inuilcar aIzad mccdes isa the, zm-Sobqi- xrwr izidktrd ,- tbpe 3hlzot i4tald a,~ in kr

J 14

0.3 to i.15g. activatiol" is iiecessary because of' and cerebral hemorrhage. Other trauma was not",paniic lrakcing' (ecelorations, not oeccurring in significant and further tests should be conducted.:Ii re ra f t. F. Air-Bag Restraint Tests. Nine tests with

Trests were started iniitiall- at 30gr., due to the seven subjects were run in the forward-facingvst ~intcd restraint cap:ability of this system. At orientation (seat pitch 130) with an experimental

hids level, iin forward impact, trauinna was minor, air-bag restraint system (Fig. 1-F) developedcovsisting- of dutral arid himg congestion and by Eaton, Yale & Towne, Inc.410 Entrance vo-vardiac. micro-hiemorrhlage. At 43g. traumna was locities ranged from 7 1 to 94.1 ft./sec. with onset

"sI Iuilai e-xcep-t that at scapuilar f ractr ccre rates of 3,300 to 6,000 g./sec., and with durationsa11 IL re(sult of belt inmpiiwgeuiet. over the shoulder. fromn 0.040 to 0.060 second. Peak g. forces varieO.

vIt (eOitt~isiofl were also observable. At. 49 from 33 to 57g. (Table VI). Tests were startedpeak sled g.. trautma wits severe and p)robably at 33g., due to the anticipated capability of thisfiltal. Kliat-ral avulsion of the IpectoraliS system. This system consisted of a lap belt -re-IIuIIV:e-, with ;evere contutsimns (lue to b~elt pres- straint and ain air bag, which was folded into aStl Wats mairked, and a partial dlislocation of paniel 10'' in front. of the subject (Fig. 12).lie hiumerus, occurred. lDural conigestion and Upon impact, the bag inflated before the subject

I)eri1cardlial, adrenal, uterine, and abdominal wall began moving forward (Fig. 13). As impacthiemorrhages; were found. Again, myocardial occurred, the gas was vented through two side

frr enta Io aso)ere holes, forming a dynamic system, and graduallydecelerating the subject while distributing the

One left sideward-facing iniplact was run ait load over his body. These were, to our knowi-

P eer Iil mat natfc.ocre edge, the first. experimental tests of a dynamicwhen the subject's head struck the side p~anel air-bag system under controlled simulated crashupon01 relbouind, resulting in fatal craniial fracture conditions with living subjects.

SA

V 4 ,i oII i ) r s . 11,p ig'le i f - m tt r s rt n i 0 . m a t lt C t/ 4 x- e o i y

The patterns 'verxe as close to aircraft or auto- At 3:3g" t).2 ananral terminated and autop-siedmobile crash (leeeleratioris as the D~aisy IDecelera- immediately post-impac-t revealed only Slighttor could be progrrammed. Paired teszs were run, dural congestion. A se-4-ond animal. impacted atwith one animal at each level allowed to survive :36g. and allowed to Eai:-vive for 90 days. sasto permit study of post-impact chronic effects. found -3 have no trauma-One animal was run twice at 46 peak g,. with no A, 47g.. ,injuries to the termirhated animal wereobservable trauma anid then was run a third time dural conzrestion and lung. adrenal. and pan-at 50g.. after which autopsy revealed a ruptured creatic hemorrhage- The paired animal. also runbladder and dural congestion. at 47 g-. but alloweed to survive 30 days. showed

FmGt-U. 1-2 Baboon prior to impact r-an mtthzing Air Rag Riectraint 5Sy~tern. Air hag i-q storea in panel 10 inchesfor-ward of animal and will be inftarpd at impact. The rttsTraint holding ar-ms u-ill be released 00G sec. prior t-,impact-

16

.4

no gros trauma. arid slizht emphysemia upon may indicate that such injuries are ti asient inmn~rc:_kvpic examilnat ion. nat-are. There seems little doubt, on relative

The final -series at 55g., resulted in dural con- and comparative basiss, that the air-bag restraintge-_tion. uterine broad ligament hemorrhage. and system is reatching a stage in developmn nt wherelung sand liver congestion in the terminal animal. it may hav'e p.-actical application.all considered minimal. The paired animal run The baboon's impact tolerance limits w-ith thisat 57 g. and allowed to surviv-e 30 da-s, prior to system appear to be much greater thai the 57g.autopsy. was found to have no gross trauma- tested.Mi~croscopic trauma involved Pulmonar-, edema.vesicular emphysema, and periad-renal hemor-ý IV. Conc!us10flsrhage.. Blood biochemistry studies pre-imnpact. The tests reported in this study di rnonstrate,post-impact. and at 7-day intervals for 1 month that while restraint systems may prot et the oc-on the surviving control animals did not indicate cupant from the very serious trauma that maystress; changes which can be meaningfully inter- be caused by ejection or "secondary collisio,pre-ted at this time. It is interesting to note that they may in themselves act as sources o generallydurl congestion. evident in each animal sacri- less lethal but yet significant injury. 3uch find-fic--d immiediately post-impact. was not found in ings indicate that still a third-order ( f collisionthe 30-day or 90-day post-impact controls. This phenomena ("tertiary- collision-) shoi Id be the

17

FttE1.Ifaino h i-agRsrita oeto mat

subje t uf intensive research. "Tertiary collision demonstrating the lack of correlation betweeninjur: " may 6t defined as the trauma resulting overt trauma and injury potential is the effectfrom he interactioai of the occupant and his re- of impact on the pancreas. In this organ, al-straint system. That such phenomena occur though the actual degree of tissue disruption wasmust. r )t, however, serve as argument against the slight, its consequences ýacute sterile pancreati-utiliza, ion of restraint systems, since these latter tis) would have been extremely serious.2

give .i -nificant needed protection from extreme Another finding is the occurrence of myo-impact. Rather, these phenomena must be viewed fibrillar degeneration. This finding, describedas anal)gous to the untoward side effects of an by others'9,5 as an agonal change of the myo-otherwise lif6-saving drug--effects which may be cardium associated with sudden death, has beeneliminated through further research. dismissed as artifactual by some pathologists.

These experiments also provide cogent and Others have, while cautious, allowed that it mightquantifiable argument for considering the effects represent a subtle but genuine histopathologicalof variation in occupant position in determining change of obscure mechanism. If the latter in-the lethality of a given "dose" of deceleration. terpretation is correct. the changes observedIn general, it may be stated that for the baboon definitely represent pin-point areas of peirhapsrestrained by lap belt alone, rearward-facing im- irreversible myocardial degeneration, and itpacts are in terms of sustained g.-forces. about would be interesting to know what effects suchthree times as tolerable (40-45g. survivable) as lesions may have on myocardial function monthsside-facing impacts (15-20g. survivable). For- or even years after impact. Similarly, in theward-facing impact orientatiow; result in injuries kidney the minute areas of interstitial hemor-intermediate in degree (2 5-35g. survivable). rhage, while not lethal, might ultimately pro-While the quantitative extrapolation of these foundly affect the function of that organ.-findings into deceleration parameters (peak, In these tests, the trauma potential of severalonset rate, and duratUon of g.-forces) for the restraint systems was examined and compoed.human situation may not be simple, the struc- The single diagonal chest restraint resulted intural homologies of the baboon and human pro- immediate fatal injuries at the g.-levels tested.vide much conviction that there is a distinct Simple lap-belt restraints were more effective incorrelation between them for the effects of posi- preventing injury than the single diagonal belt.tion at impact. In other words, in humans, as in but also resulted in serious and fatal injuries atbaboons, a given "dose" of impact appears to be higher g.-forces. The small sample precludesmost tolerable in the rearward-facing position dogmatism. but the available evidence indicatesand least tolerable in the sideward-facing posi- that "loose-high" lap belts contribute to injurytion. From a practical standpoint, this finding severity greater than those snugly fitted andwould argue against the utilization &f side-facing worn low over the abdomen. Lap belts andseats for airline stewardess jump seats where shoulder harness combinations (American 3-incaaciationorofri stewardess jumap diseatrus wpoint or double shoulder) resulted in less injuryincapacitation of a stewardess may disastrously in this series of tests than did any of the coin-affect the controlled and orderly evacuation of monly used restraint systems. The two experi-an entire plane load of passengers. mental devices. Y-yoke with inertia reel and.

These tests demonstrate that abrupt decelera- especially, the air-bag restraint system, gavetion may have potentially grave effects that may maximum protection to the occupant againstnot necessarily be correlated with the degree of tertiary collision injury.tissue disruption or with the magnitude of im- Finally. tests such as these demonstrate thatpact forces. For example, fetal death occurred adequate evaluation of any restraint system mustin all pregnant animals impacted although 'a) include experiments with living animals. Testsirreversiblf, anatomical trauma to the mother or on anthropomorphic dummies, cadavers, and hu-fetus ould not be demonstrated. and (b) poSi- man volunteers can all contribute significantlyfeusosig ant pos- to the development of restraint devices, but thetion at impact, a very s tvariable in final test of their effectiveness lies in. and candetermining the survivability of adult animals. only be determined by. the response of the livinghad no apparent influence on results for the fetus svstem to an impact profile with parameterssince rearward- as well as forward-facing im- simulating as closely as pos-ible those of actualpacts resulted in fetal demise. A second example accident environments.

18

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REFERENCES

1. Axx'. I. W. Intestinal Perforation and Facial 17. Crua J. F.: Complete Ruptue of the PancrfasFractures ;!. Automobile Accident Vimt..s Wearing Brit. J. Surg. 1%: 336-388& 1945.a Seat Belt. J. LouisianO s'tate 4 €edI soc. 115: 18. Di LL P][L-. A. and GoLomnIza. J. W.: alnke2-2X IW.1 . Parameters of the Normal Baboon. The Babom fs

2. ALLZoO. M. A. and Svow. C. C.: Serum Amylawa Medica Research. Prooeedincr. VoL II. p 379-pand Lipae,* Lprels in Normal Savannah Baboons First International Sympoium on the Baboon andtPapio cApoc-phala,,. .4m. J. Yet. Clin, Path. 2' Its Use as an Experimental Animal Harod Vagt-1.V-137. 19IS. borg. Ed.- University of Texas Pre 1967. -

3-t Azx-TaWq.to R.: National Bureau of Standards Tests 19. DiHlAm H. Torwus.. B-. and M:cam. Q.: Alrcraftat Hallonian AFB- Unpublished data- 1967. Safety Belts: Their Injury Effect on the Human

4- BRaKsrrriM. C. " Traffc Injuries in South Sweden Body. Crash Injury Reserch of Cornell Unlwuitywith Special Reference to Medico-eIgal Autopsies Medical College. 1953.of Car A(1ipants and Value of Safety Belts. M DtBots. E. F.: Safety Belts Are Not N'fmmChirurgica Scanodiarieu. SuppL 30& 19&3. Brit. Med. J. 2: W5 1952.

7-- Bnt&..w J. C. and Bomomon. A. A.- Statistical _21. rrs. J, . S.: Seat Belts and Cervical SPoady-Study. Effeeiivene- inofin Seatbelt. Rapport lois. Priitioner 188: 80t'. 19.RAl--TNO. Instituut Voor WepransportMiddelen_ Z Esevac. A.-: Injuries Caumed by Safety BeltL ANetherlands. 19W. Contribution to the Diwumion with Reference toWii. Br Jw.. J. H.: Safety Belts for Motor Vehicles in an Unusual Case. greask. Leakrtidix. 58: 884-886.Victoria. Med. J. Australia 1: 67, 1964. 1961.

7. Bonux. N. I.: A Statistica; Analysis of 2.000 Acci- 23. Federal Aviation Administration. Clkapt. 9. Shoulderdent Cas•. with Emphasis on Occupant Restraint Harness Installations. Seduio 1. Reitrniat 88t=LM.Value. Prorredings. 1lth Stapp Car Crash Confer- Advisory Circular No. 43.13-0- Ca 2. U•cetiveence. Anaheim. California. SAE paper No. 67M.M 5/2G/67. Acceptable Methods. Techique and Prae-1967". tices-Aircraft Alterations.

& Bot-arai G J.: The Efficiency of Car Safety Belts. 24. Flsm. J. and WaGrr. t. IL'. The Seat Belt Syn-J. Irish lied. 4ssoc. 57: 110-117., 1965. drone-Does It Exist? J. Treumo 5 .746-750

9- BIarxi--. U, and Lts, axx. S.- The Effectiveness of 25. lisa P.: Injury ProduceC by Seat Belts; ReportSlafety Belt.. An Analysis of 210 Wilt Ca.s. Nowd of Two Ca.u,. JI Oerupat. lIed. 7: 211-2121lied. W, - 1500-15.M3. 19h61. 26. FtzTr-m. B D. and Bzamox. B. G., Seat-Belt

10. Caiamut. B. J. and Knum&. J. K.: Seat Belt Fractures of the Spine and Sternm. JANA 200:Effectiveness in the Non-Ejection Situation. Pro- 177-175. 1967.ecedixps. Seventh Stapp Car Crash Conference, C. C. 27. FPazncx. IL. J- Ko.. J. M-. Foar. F. A-. and BAKIMThomas. 1964. IL J.: Traumatic Disruption of the Head of the

11. CAum'su.. H. I.: The Automotive Seat Belt and Paw-reas. Arch. Surp. 91: 5-13. 1906.Abdominal Injury. Surgery 119: .01-59'. 1964. 28. Gaaarr. J. W. and B&ArsTwrom. P. W., The Seat

12- CHA..ZDLER. .F." The Da;ty Decelerator. ARL Belt Syndrome. J. TrIuma 2222-238 192.TDL f--s-3. ,571st ARL Hollotnan AFB. New Mexico. 29. Guarramyn. IR. Bmo@Est. A. S.. and PEM P. J.:1967. Unusual Abdmminal Injuries Due to Seat Belts.

12. 't.azx. N.' P.. Wos. I. B. Jr- BHI.uKLy. J. W.. and J. of the AlberH Einsteia Medical Ceuter 14: 63-00TEmPmzE W. K.: Lateral Impact Tolerance Studies 1966.in Support of Apollo. Report I. AMRL Memo 11-29. 30. Gxssa.. W. and BrLi- J.: A Study of Motor-WayWright-Patterson AFB. Ohio. February, 1963. r'atalities, Brit. Met J.1 -,75 1964.

14. Cocxy. W. M. Jr. and M-m. K. K.: Splenic Rup- 31. GOGmE. K.: Road Accidents. Geigy, Basl Switser-ture Due to Improper Placement of Automotive land Unfallopfer im Strenverkeher. Series Chir-Safety Belt, J. Amer. MedL Assoc. 183: 693, 1963. urpre Geiv. No. 5. 1962.

I! Canosy. W. M.. Styma. IL G. Snow, C. C_ and 32. Himsc . 0. M. and RAsn-sswc, P, S.: Traffic Acci-HANsoN. P. G.: Impact Injuries in Pregnancy: I. dent with a Spleen Injury Associated with the UseExperimental Studies. Amer. J. Obst. if Gnmer. of a Safety Belt. Ege'kr. L4eg. 125: 771-773. 1863.101: 100-108 1967. 33. HA. L.: Traumatic Rupture of the Pancreas.

16. CaosaT. W. M.: Impact Injuries in Pregnancy. Med. Bull, of Yet. Admin. 21(1).: 22-7-229,1944.Procredings. Civil Aviation Medical An•oc.. Oklahoma 34. HAir. J. F. and LisA. J. R.: Isolated NonpenetratingCity, 12-14 October. 1967. Injuries of the Pancreas. Ten Year Review of

27

L~iterature and. Report of a Case.NewYork State 55. SiIIU. W.S. ad KArmsaLI.: ANew Patterno

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39. Jo ce, T.K ruatcRpue ftePnces looman AEB. 8e9 Mexico.r SAE Paper ia efa soito-My 97

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41. KrLvsa G2. Rupture of the Pancreas. Brit. J. Sury. Trauma in Lateral (-G,),) Rearward FacingXXI (la6) : 300-30& 99&l4 (+G.). and Forward Facing (-G,) Body Orienta-

42. Krznwsxt. J and RosT. W. B.: Intra-Abdominal tions w-hen lieftrained by Lap Belt Only. AerospaceInjury fromt Safety Belt in Auto Accident: Report W4d 38: 889-S94 !Ws7; FAA Report A31 I&6-3of a Case. Arck 8ury. 73.970-971 195G. OD. Ssvsenm R. 0.. Sxow, C. C.. and Yorsc. J. W.: Ex-

41 LeM-er J_ K_ Eaaszr. D. I, and Hawiar. C.: Intra- pertmental Impact Protection with Advanced Auto-Abdominal Injuries Caused by Automobile Seat motive Restraint Systems: Preliminary PrimateBelts. .AMA 201 , I-lU, 1967. Tests with Air Bag Pad Inertia Reel/I nverted-T

44. Lawla, S. T. and STAsr. J. P.: Hunman Tolerance of Yoke Torso Harnms Proce"4iaga. 11th Stapp CarAireraft Seat Belt Restraint. .1. .4 at. Med. 29: Crash Conference. Anaheim. California- SAZ PaperAis-&-, 1956. 67WlM 1967: FAA Report AM 00--L

4&. Lima J. &. Mc~oD, 1.. F.. B=Azva M. and Pnrcz. 61 Srwa. R 0._ Caosugv. W. ML. Ssow. C.. C_. Yor'no.* B. W.: Comiparative Response of Live Anesthetized J. W., and BAnsoK. P.: Seat Belt Injuries in ImpacL

* and Demd-Ekba~med Organismus Exposed to Imuiax-t Presented. Sesquicentennial Symporian on the Pre-Stressing. Phase Two: The Rhesus Monkey, Space/ reation of Hipk..y Inujry. University of MichiganDefense Corp.. TB To7-W7. May, 1967. Medical School. Highway Saety Institute. Ann Ar-

*466 liam 3. and Prscx B.: Response of the Canine bor. 221 AprilI, 1987: FAA Report AM1 0-&Heart to Thoracic Impact During Ventricular Dias- C2. S-TA?. J. P. -,Tolerance to Abrupt Deceleration.tink and Systole. Space/Defense Corp.. TB 67-121. Collected Papers on Aviation Medicine. Butters-Final Report, October, 1987. worths 'S& Publ. London AGARDograph 'No. 6.

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48. lawus. K D. aid linsmos. B. M.: Car Seat Belts ~ ducted on a Swing Device for Determining HumanAn Analysis of the Injuries Sustained by Car &c Tolerance to Lap Belt Type Dirrelerations. AFMDCcupauts. Practitioner 191 -332-34W. 1963. T.N-57-I. Holloman AFB. New Mexico. 1957.

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Uterus from 'Seat Belt- Injury. Am uer.. 4. 0Ist. A Meeting Aerospace Medicaj A-m-4iatlon, Los Angeles.Grae-. 90(6): 828-829. 1964. 29 April-2 May. 196&.

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54. R-s. k: Personal communication. 1967. Gyssecol. 4Obstetrics 119: 773-778M 1964

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tI70. ToLi.s. S. H.: An Unusual Injury Due to the Seat 77. WLIAMS, J. S., LIm, B. A._ and Bag H. W.: Intra-S~Belt. J. Trauma 4 : 397--M9, 1964. Abdominal Injury from Seat "•elta. J, Tramam 6:

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.1965. W. 1L., Investigations in Human Tolerance to Lateral

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