The Department of Emergency Medicine at the University of Louisville and the Kentucky medical Examiner's Office are conducting an on-going study to identify and describe injuries and injury patterns associated with air bag deployment. Over 10 years of clinical experience and study has irrefutably indicated not only that an occupant in close proximity to a deploying air bag can sustain severe injuries or death, but also that proximity of an occupant's upper extremity to the deploying air bag or module cover can result in traumatic amputation of fingers, hands and forearms, pulverized compound fractures of the forearms and fractures of the upper arms, no matter what the speed of the vehicle.

A survey of 184 cars in the model year 1999 revealed that 85% have the horn activation button located in the airbag module cover. No warning appears to inform drivers of the risk associated with placement of the hand or forearm on the hub of the steering wheel or the dashboard. Passengers have also sustained very severe injuries when they attempted to brace themselves by placing their hand on the dashboard. But today, no warning labels inform the driver or passenger of these risks from placing hands or forearms on driver or passenger side air bag module covers. As long ago as 1972, Ford Motor Company recommended a warning placard be affixed to the crash pad directly in front of the right front passenger to warn of hazards associated with the air bag.. . (including) . . .out of position occupants. . .and warning against right front seat occupancy by those of small stature, the aged or the infirm.

Three cases of injuries from airbag module covers to drivers heights 5'3" and under are reviewed and discussed. Injuries ranged from tearing away of a thumb from the driver's hand, pulverizing fractures of the upper arm, to bleeding and swelling of brain tissue inside the skull resulting in respiratory arrest. A vehicle operator should be aware that although airbags can significantly reduce the severity of injuries sustained in frontal collisions, the module cover has the potential to inflict serious, even fatal injuries.

Serious and fatal injuries can be sustained when anatomic structures are in close proximity to an airbag module cover at the moment of airbag deployment.

Automotive and insurance industries have promoted airbags as life-saving, injury-reducing saying that individuals in vehicles equipped with airbags sustain less injuries than in vehicles without them. However, while airbags were still in the research and development phase, the automotive industry conducted tests that clearly demonstrated the potential for fatal injuries associated with airbag deployment, and the industry itself concluded that the life-saving airbag could also be life-threatening.

The driver's side airbag module is located within the center of the vehicle's steering wheel and may be covered by a variety of materials, including thermoplastic, rigid urethane foam covered with polyvinyl or rigid metal plates covered with foam and vinyl. At the moment of deployment the cover splits along seams intentionally weakened in manufacture and rapidly opens outward to allow the airbag to inflate, averaging between 144 mph and 211 mph.

Case Reports

Case 1. A 25 year old woman, 5 feet and 3 inches tall and 115 pounds, was the driver of a 1991 Ford Taurus when the vehicle left the roadway and traveled down the highway median until it struck the leading edge of a concrete barrier in a head-on collision. The woman was wearing the lap-shoulder belt. She gripped the steering wheel in a bracing maneuver which resulted in the placement of her thumb over the right edge of the airbag module cover. Along with scratches and bruises to her chest and arms she sustained a 75% tearing away of her thumb at the MCP joint. Her thumb remained connected to her hand only by a small piece of connective tissue. The car sustained moderate front-end damage.

Case 2. A 52 year old woman, 5 feet 1 inch tall and 125 pounds, was the operator of a 1990 Ford Taurus that was attempting to make a left turn when it was struck by an on-coming vehicle. The speed was 5 mph. The driver was wearing a lap-shoulder seat belt. Her right forearm was across the airbag module cover as she was turning the steering wheel when the airbag deployed. She sustained multiple fractures of the upper arm including severely pulverized fractures of both upper arm bones, dislocation of elbow, and fracture of upper arm bone connected to the shoulder. Damage to the front bumper was minor.

Case 3. A 35 year old woman, 5 feet 2 inches tall and 110 pounds, was the driver of a 1991 Ford Taurus when the vehicle=s front bumper grazed a guard rail for about 24 feet. She was wearing the lap-shoulder belt. When the vehicle came to rest, her husband who had been asleep, restrained in the front seat, got out and came around to the driver=s side. He found his wife unconscious, her seat belt on, with blood coming from her nose and left ear. As she was being transported to the local hospital by a passing motorist, the unconscious woman suffered respiratory arrest. A CT scan at the hospital revealed the presence of bleeding and severe swelling of the brain inside the skull. She was pronounced brain dead. Abnormally low blood pressure led to cardiac arrest. She had extensive bruises and scratches over the left side of her face. There were 5 other occupants in the car, 3 suffered no injuries, one suffered a nose bleed and the other a small cut. A tear on the lower portion of the module cover from contact with her face was found. The only damage to the car was to the front bumper from sliding along the guard rail.

When a body region is in direct contact with the airbag module at the moment of deployment, the amount of concentrated force is more than six times the established human tolerance level. The numbers of serious and fatal injuries in humans in real-world accidents from airbags, such as cardiac rupture, cardiac perforations, the tearing off of fingers and thumbs, bleeding inside the skull, eye trauma, and fractures of the upper arms, are increasing. (Although doctors and patients report these injuries to the national highway traffic safety administration, they do not show up in any of NHTSA's literature or on its website and in fact appear to be unobtainable.)

The injuries reported in the cases examined in this article all resulted from contact with the deploying airbag module cover. Each woman was wearing a seatbelt and was a height of 5 feet 3 inches or less. Their height necessitated advancing the driver's seat to the full forward position, placing them at a disadvantage in regard to their proximity to the airbag module. In September, 1992, NHTSA reported that Aa large proportion of the reported injuries are to smaller occupants who tend to be seated closer to the steering wheel than most other occupants.  In a report by D. F. Huelke, published by the Society of Automotive Engineers, 9 cases of severely pulverized fractures of the upper extremities were the result of contact with a design similar to ones found in this article's three cases. It can be described as a large polyvinyl flap which measures approximately 5" x 8" and flips outward at greater than 160 mph upon deployment.

If injuries associated with the module cover are to be prevented then anatomic structures must not be in proximity to the cover at the time of deployment. This may not be possible if the driver's height necessitates a full forward position of the seat, or when his or her hands are touching the module such as when honking the horn or setting the cruise control. Forearms may be in front of the module cover while turning the steering wheel. These three cases vividly demonstrate that the airbag has the potential for serious or fatal injuries when the driver is too close, and that the potential for injury is increased when occupants of short stature operate airbag equipped vehicles.

For Dr. Smock's research Article, click here