Synopsis: Few people are aware that the vehicle occupant most likely to be hurt in a crash is the one in the front passenger seat. Experts discuss why this occurs, the different injuries that can occur there, and many ways car occupants can protect themselves from injury.

Host: Reed Pence. Guests: Meghan Smeenge, injured in auto accident; Dr. David Pedley, consultant, accident and emergency medicine, Dumfries & Galloway Royal Infirmary, Scotland; Dr. Peter Cummings, Emeritus Professor of Epidemiology, University of Washington; Dr. Elisa Braver, Adjunct Association Professor of Epidemiology, University of Maryland School of Medicine

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The Risk of Being a Front Seat Passenger

REED PENCE: On a snowy night in late January, Meghan Smeenge of Elgin, Illinois, was on her way home from a family get together when her car was hit head-on by a large SUV. Her husband was driving, her friend was in the back seat, and Meghan sat in the front passenger side.

MEGHAN SMEENGE: We were going westbound, and all of a sudden I see this very large vehicle that was going eastbound jump over the median, coming right at us.  It happened so fast.  No sooner did I get, “Watch out!” out of my mouth when he hit us.  He hit more towards the driver’s side, ‘cause that’s the side of the car he was coming from.  Our car went flying off to the right, towards the passenger’s side, and into the forest preserve.

PENCE: Sitting in the passenger seat, Meghan received by far the worst injuries –a broken sternum, a hairline fracture to her left knee, and a shattered right ankle and leg.

SMEENGE: I’m still dealing with this, had reconstructive surgery, still non- weight bearing.  It will be close to a year before I’m actually done with everything, once all the healing goes, and the therapy, and everything else.  So, it’ll be almost a year before I’m even walking again.  My husband had a broken arm.  He did have surgery to have a plate put in, because the break was not a clean break.  He’s still doing some physical therapy for that, but he should be fine in a couple weeks.  My friend: her broken sternum and broken rib are healed, so she is ok.

PENCE: But Meghan may never be. Even with physical therapy and time, she fears she may never be able to walk normally. And it turns out that of the 2.3 million people hurt in auto accidents each year, she’s far from alone as a front seat passenger suffering the most severe injuries in a crash. Long before cars had seatbelts, the front passenger seat was often tagged as the “suicide seat” by emergency room doctors. Even today, the name has stuck. Some studies show that it’s the most dangerous place to be in a crash.

DAVID PEDLEY: It used to be thought that the driver was always in the worst position because of the steering wheel causing problems, but actually, when you look at real, live data from actual accidents, it appears that the reverse is true.  The registry data of some 4,000 patients injured in car accidents showed that it was actually the passenger, rather than the driver, who sustained the worse injuries.

PENCE: That’s Dr. David Pedley, a consultant in accident and emergency medicine at the Dumfries & Galloway Royal Infirmary in Scotland.  He’s studied seating position as it relates to crash injuries.

PEDLEY: Really, injuries in car accidents are all about the dissipation of energy.  That can occur with the design of the car.  That can occur because of airbags.  But, the concern is a front seat passenger is thrown forward and the main dissipation of energy takes place when they hit the seatbelt, which pulls sharply across the chest.  So, there’s a concern that perhaps the front seat passenger is a little bit more vulnerable.  Equally, an airbag, if it’s mounted in the steering wheel, is a little bit closer to the body.  We’re talking milliseconds, but the time it takes to deploy and start to dissipate energy is slightly faster than something mounted in the dashboard.

PENCE: Pedley says that in some accidents, drivers also have a brief time to react, and these split seconds can contribute to a higher injury rate for passengers rather than drivers.

PEDLEY: A driver is in control of the vehicle and is able to take evasive action.  Your basic survival instincts kick in, to the extent that you would protect yourself over your passenger.

PENCE: But no matter how the crash occurs, front seat passengers are prone to a few particular types of injuries.

PETER CUMMINGS: You have to realize you can have any kind of facial injury, all kinds of injuries to your neck, injuries to your chest and thorax, injuries to your abdomen -_ depending on just what you hit, and how fast the car was going.

PENCE: That’s Dr. Peter Cummings, Emeritus Professor of Epidemiology at the University of Washington in Seattle.

CUMMINGS: In addition, front seat passengers sometimes break their legs, ‘cause their feet are on the floor, and the floor may be pushing in against them.  It’s an enormous gamut of injuries.

PENCE: Pedley adds that in addition to leg and foot injuries, front seat passengers can face severe trauma to their spine, head, and in rare cases, a rupture of the diaphragm.

PEDLEY: The front-seat passenger: the energy is dissipated more rapidly, rather than the driver, to the extent that you get flex and extension injury too with the cervical spine.  The head is thrown forward to limit the extent of the seatbelt; and therefore, there’s a sudden shock load placed on the cervical spine.  Finding in a large registry that there is around double the incidence of cervical spine injury, a rise from 3.3 to 6% between drivers and front seat passengers. That reaches what we’d call a significant difference between the two.

PENCE: And nowhere is this worse, Cummings says, than in a head-on crash.

CUMMINGS: Most serious crashes, where somebody’s gonna die, are frontal crashes. The car is moving along, and it collides with something in front of it, a tree or another car.  The front-seat passengers then have the problem that they can easily be ejected out the front-seat window, and in addition, even if they remain in the car, the force, the energy, with this frontal crash is transmitted to them.  They can collide with the dashboard, the steering wheel, anywhere in the front of the vehicle.

ELISA BRAVER: Frontal collisions are more common than side collisions, but you don’t want to be in either a front or a side collision.  In some ways, a side collision is actually more dangerous than a frontal collision because with a frontal collision, you have some crush space between yourself and the vehicle.  In a side collision, there’s just you and the door and window.

PENCE: That’s Dr. Elisa Braver, an Adjunct Associate Professor in Epidemiology at the University of Maryland School of Medicine in Baltimore. She says whatever type of collision you’re in, wearing your seatbelt and having side airbags, in addition to frontal airbags, are they key to reducing your chance of injury and death in an accident.

BRAVER: Wearing a seatbelt is so very important.  It keeps people out of the way of the windshield.  It keeps them from being ejected from the vehicle.  It keeps them from flying around the car during the collision and hurting each other.  I can’t state too strongly how important seatbelts are.  They’re the most effective safety measure in any car.  Side airbags make a dramatic difference.  The side airbags with head protection can reduce the risk in crashes by 40 to 50%.

PENCE: However, Braver says it’s important to remember airbags aren’t for everyone.

BRAVER: Right front passenger airbags reduce the risk of death among passengers who are 13 or older by 14%.  Now, for babies and children it’s a different story, because they can be injured or even killed by deploying front airbags.  Changes have been made to the design of front airbags, so they are less risky now.  But even so, it’s best to continue to seat them in the rear.

PENCE: That’s right. A small child who wouldn’t have been otherwise injured in a crash can be killed by an airbag. Cummings says they’re dangerous devices that are incredibly powerful.  

CUMMINGS: In fact, the airbag strikes you a tremendous blow.  If you take an airbag out of a vehicle, put it in a parking lot, and trigger it; you’d just be amazed at the force of the explosion.  Unless the device is heavily anchored, this whole thing will jump, I’ve seen this, several feet in the parking lot.  It’s a walloping blast.  You would hate to be in front of an airbag.  The only reason that it’s ok to be hit by an airbag is it’s much better than the other things you would hit.

PENCE: But what can be done besides airbags and seatbelts? Assuming you’re part of the 85 percent of Americans who do buckle up, Pedley says the main thing you can do to avoid getting hurt is to slow down.

PEDLEY: Speed is the main determinant in terms of the severity of injury when we’re talking about motor vehicle collisions.  I think trauma levels and serious injuries are coming down.  I think that really is a combination of the improvements in vehicle design and the improvements in the design of the network itself.  There’s not much evidence that suggests people are slowing down on major motorways.

PENCE: Braver says you can also shop for a larger vehicle with modern safety features. She says to be sure to check the latest crash test ratings.

BRAVER: There’s been this design revolution in new cars; manufacturers are voluntarily installing technologies that avoid crashes.  These include forward collision warning systems, automatic braking, and adaptive headlights.  So, people, if they’re shopping for cars, really ought to be looking for these features, because they have a strong potential to prevent injuries and death in the event of a crash.  I personally drive mid-sized cars, and I advise my nieces and nephews to buy mid-sized cars rather than small cars.  So, try to buy a bigger car.  The other point is to look up the crash test ratings, both for National Highway Traffic Safety Administration and the Insurance Institute for Highway Safety.  So, look for the cars that have the best crash test ratings.

PENCE: Cummings says cars that get the best crash test ratings are generally those that dissipate energy best during a crash.

CUMMINGS: The big advances have been to create proper crumple zones, so that the front and the back of the car aren’t rigid.  You don’t want them to be made of steel that would not collapse because if it doesn’t, all that energy just comes into the passenger compartment.  You want them to absorb the energy.  Imagine if you were crashing into something, but you had some kind of a big cushion in front of you that could collapse before you hit the object.  Well, that’s what the front and back of modern cars do.

PENCE: But if you want to see how far we might go, Cummings says to look at NASCAR. Drivers typically reach speeds around 200 miles per hour during races, yet are often able to walk away after a crash. One safeguard that protects drivers is the five-point harness.

CUMMINGS: They’re typically restrained with a seat belt that is far more advanced than the ones we have in ordinary passenger cars.  The belt actually holds them down with a strap that’s between their legs that goes off to the side and that goes over both shoulders and that is even attached to their helmet.  They are held in that seat.  I mean, it’s an astonishing bit of technology.  They do not have air bags, as far as I know, in any of these racecars.

PENCE: The five-point harness holds race drivers tightly in their seats during a crash, and spreads out the force over a wider area, resulting in less injury. But Cummings says manufacturers likely haven’t installed the belts in passenger cars because consumers may see them as a nuisance. They take more time to strap in and limit movement. So if we want to be safer, we may have to accept some compromises.

For more information about our guests, as well as archives of our segments, visit our website, You can also find our shows on iTunes and Stitcher.

Our writer-producer this week is Amirah Zaveri.  I’m Reed Pence.

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