Although seat belts significantly reduce the extent and severity of injuries sustained by motor vehicle occupants, seat belts are known to be associated with chest and abdominal trauma. Less commonly understood are severe neck injuries caused by the use of two-point automatic shoulder harnesses without concurrent use of a manual lap belt. Such injuries may include cervical spine fractures, craniocervical dislocations and rarely decapitation. Recognizing patterned injuries caused by seat belts and the ability to correlate autopsy findings with the circumstances surrounding the death will allow for correct interpretation of seat-belt related trauma. The four cases described detail fatal neck injuries as a result of improper seat belt use in which an automatic two-point shoulder harness was used without a manual lap restraint. In two of the cases, the victims were decapitated.

The paper examines the data from the William Lehman Injury Research Center (WLIRC) that is a near census of crashes in the Miami-Dade region with occupants that appear to be severely injured. The WLIRC at the University of Miami has investigated more than 200 frontal crashes in which the occupants were protected by air bags. Because the WLIRC cases are a census of cases in the Miami-Dade County rescue area with suspected severe injuries, they may be used to rapidly identify benefits of second generation air bags. The database has no child fatalities due to the air bag. Four cases of 2nd generation air bags with good protection in drivers in crashes well above 35 mph, and for the 2nd generation air bags, unrestrained drivers appear to have better protection in a high-severity barrier-type crash than unrestrained passengers.