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Injury prevention is an increasingly important component of healthcare policy in many developed countries, especially where limited resources are an important constraint. It is a stated aim of the United Kingdom government, for example, to reduce trauma deaths among children and young adults by 20% (from 1996 levels) by 2010. 1 The commonest cause of such deaths in the UK is motor vehicle crashes (MVC), and the same is true of the United States of America. 2 In the UK in 1996, 250 000 MVC victims attended hospital and 3000 of them died. 1
In both the UK and USA, the number of car users who have been killed or seriously injured has fallen over the past 30 years despite huge increases in the volume of traffic (R Cuerden, et al, 63rd Road safety conference, 1998). There have been many national programmes over the years to effect this reduction: useful strategies have included rigorous enforcement of speed limits, compulsory seat belt wearing and, more recently, the introduction of airbags into vehicles. Although correctly fitted three point seat belts have been shown to be safer than airbags, 4 there is no doubt that airbags in themselves reduce deaths. 3 If both devices are used together, further reductions in mortality are to be expected.
The first airbag was fitted to a car in the USA in the 1950s. In the mid-1980s Passive Safety Federal Legislation was passed with a resultant increase in airbag use. In 1995, over 70% of new USA cars had airbags installed, and it has been mandatory in law to provide driver and passenger airbags in all new cars in the USA since 1998. At present, there is no law governing the use of airbags in the UK (although there are rules for their storage and fitment).
In 1983, 14% of USA drivers used seat belts; more modern estimates 5 put the figure at up to 60%. Although this figure is improving, USA airbags have had to be designed to protect both the belted and unbelted occupant. To achieve this, airbags inflate rapidly (50 ms) under high pressure to a volume of 70 litres. In contrast, UK (and Western European) fitted airbags are only designed to protect a belted occupant and inflate to...