national conference on medical indications for air bag ....doc
Published on: Mar 3, 2016
Transcripts - national conference on medical indications for air bag ....doc
National Conference on Medical Indications for Air Bag Disconnection
The Ronald Reagan Institute of Emergency Medicine
Department of Emergency Medicine
The National Crash Analysis Center
The George Washington University Medical Center
July 16-18, 1997
At the request of the National Highway Traffic Safety Administration, The Ronald Reagan
Institute of Emergency Medicine, with the assistance of the National Crash Analysis Center (NCAC),
both of The George Washington University (GW), convened an expert panel of physicians to formulate
recommendations on specific medical indications for air bag disconnection. The panel consisted of 17
physicians, each nominated by a professional society or organization. The medical societies were
selected because their members were either the most likely to see air bag-related injuries or to be
questioned about air bag risks by their patients. The medical conditions considered were provided by
NHTSA as the most common concerns expressed by members of the public in disconnection requests to
the agency. One additional condition for discussion was added by panel members.
The Reagan Institute was responsible for coordination of the conference, including methods of
discussion and consensus development. This report represents a summary of the results of the
conference. While the report has been reviewed by the participants, any endorsement of the
recommendations by the specialty societies will be subject to the bylaws of the respective groups.
Air bags have been proven effective at saving lives in frontal crashes. Air bags have also been
shown to present a risk of death or injury in certain situations. Currently, there are proposals to allow
disconnection of air bags at the request of consumers. While disconnection removes the risk of injury
from air bag deployment, disconnection also risks the loss of lifesaving benefits in the event of a
potentially fatal crash. The panel approach was to determine those specific situations in which risks of
air bag deployment might weigh heavily enough to mitigate the benefits.
The panel generated a number of general needs regarding the subject area. These needs focus on
improved data collection about air bag performance, support for dissemination of conference results to
physicians and the public, and improved consumer awareness about the risks of air bag deactivation.
The panel addressed a list of issues which are detailed in this report. Many of the issues relate to
specific situations such as pacemakers and previous surgery. In most of these areas, the best information
available indicates that the benefits of air bags clearly outweigh the risks. More general issues, such as
short stature, were less clear. The available data, particularly regarding lives saved and nonlethal injuries
suffered and averted is not clear enough to make specific recommendations about what specific height
places an individual at risk from a deploying air bag. Proximity to the initially deploying air bag appears
to be the central issue, not necessarily height. The panel recommends that the vast majority of
automobile owners keep their air bags connected. The clinical experiences of the panelists and their
colleagues confirm the dramatic change in injury patterns and outcomes since the advent of air bag
technology. Improved research and data collection is vital to future decision-making by policymakers
The purpose of the conference was to discuss specific medical indications for air bag
disconnection and to formulate recommendations in these areas. During the course of these discussions,
the panel developed a list of general recommendations related to air bag safety data and public
1. The benefits of air bags are well-known to physicians who care for patients who have been in
crashes. These benefits should be preserved and improved. Air bags may be considered as analogous to
other medical therapies, all of which have known risks and benefits. Physicians make decisions about
risks and benefits of various forms of therapy every day. As larger populations are exposed to these
therapies, both risks and benefits can become more apparent. For example, we have accepted
thrombolysis as effective therapy for myocardial infarction, despite known serious risks. The use of air
bags to lessen the risk of death and injury in frontal crashes must be considered in a similar fashion.
2. There is a paucity of population-based data on a number of the areas of interest related to air bag
injury patterns. Improved injury surveillance might be able to address some of the areas of concern in a
directed way. For example, emergency departments, trauma centers, and primary care providers could
participate in data collection systems that could be adapted to search for persons of certain heights,
pregnant women, or patients with pacemakers in order to determine true incidences of injury with
adequate estimation of exposure risk. These systems could complement existing systems such as the
National Automotive Sampling System (NASS) and the Fatal Analysis Reporting System (FARS).
3. There is a significant need for improved data collection on air bag safety specifically and traffic
safety in general. The panel recommends improved detail about specific injuries and medical risk factors
to improve current data collection systems for air bag-related injuries specifically and traffic-related
injuries in general.
4. While the panel was not asked to consider specific air bag systems, the participants recognize
that engineering improvements are an important component of injury control. There is a significant need
for increased research on occupant sensing systems and the effects of increases in air bag deployment
thresholds. Research and development on occupant sensing systems has the potential to remove many of
the issues in question addressed by the panel. The panel recognizes that the issue of air bag deployment
thresholds is complex. Changes in deployment thresholds have been suggested by others as a method of
injury reduction. The panel recommends increases in biomechanics research in this area in order to
establish a proper risk-benefit analysis.
5. Consumers should be provided with improved information about the specifications and efficacy
of the air bag systems in their vehicles. Not all air bags or air bag systems are identical. Air bag system
designs vary widely and continue to evolve. Recognizing that certain information is proprietary, the
panel suggests that consumers be provided with more extensive information about specific air bag
systems in order to make more informed decisions.
6. The panel recommends that NHTSA provide assistance to disseminate the conference
information to various specialty groups. Most effective dissemination of the panel’s recommendations
will be to a wide range of health care providers, including the membership of the organizations
represented, nurses, physician assistants, and others. The panel suggests an approach incorporating
elements of the early cardiac care notification program of the National Heart, Lung, and Blood Institute.
The panel feels strongly that the recommendations should be provided to practitioners as directly and
simply as possible. Numerous stakeholders should also be incorporated into this cooperative education
effort. These stakeholders include, but are not limited to, local, state, and federal governments,
manufacturers, auto dealers, managed care organizations, and medical societies and organizations.
7. Air bag disconnection may decrease the effectiveness of certain seat belt restraints; therefore,
consultation by the vehicle owner with the car manufacturer is recommended before any air bag system is
disconnected. The popular press has reported to the public that newer seat belt designs may not restrain
occupants adequately in frontal crashes without the accompanying deployment of air bags. Auto
manufacturers and dealers have an important role to play in educating consumers. Information regarding
the increased potential for injury and death in frontal crashes after air bag disconnection should be
disseminated to the public as clearly as possible by manufacturers and governments.
8. Any automobile owner who elects to have an air bag disconnected should be aware of the risk of
injury to other persons who may ride in the affected seat at a later date. This concern clearly applies to
both driver and passenger-side air bags.
The panel consisted of 17 physicians, each nominated by a professional society or organization.
The medical societies were selected because their members were either the most likely to see air bag-
related injuries or to be questioned about air bag risks by their patients. During the month prior to the
conference, the Reagan Institute communicated with each panel member regarding content and any
information needs for the conference. During this month, each panel member extensively reviewed the
available medical and engineering literature about air bag technology and injury risk and prevention in
preparation for the conference.
The opening general session consisted of a didactic presentation by the NCAC with an
opportunity for discussion. This session served to update and clarify engineering and data issues and to
familiarize panel members with the format of the conference. Following this general session, the panel
was divided into three groups for discussion of specific issues.
Each group consisted of five or six physicians, and was assisted by a moderator and a scribe.
Each group also had access to ongoing technical assistance from the NCAC, the course director, and
NHTSA. Each group was assigned specific areas of discussion with some duplication among the groups
on more general areas.
Each group discussed each topic area in order to address seven specific results: known data,
unknown data, recommendations, level of confidence in recommendation, rationale for recommendation,
specific issues affecting recommendation, and stakeholders. Each group presented their findings to the
overall panel for discussion and formulation of final recommendations. The panel’s final
recommendations constitute the major findings of this report.
What follows is a summary of the panel’s specific recommendations. For each specific
condition, we list potential issues, recommendations, and discussion. Potential Issues Previously Raised
are those areas in which a member of the public might have concerns or questions before receiving a
medical opinion. Recommendations are those specific statements generated by the panel and intended to
be communicated to the public and the medical community. Discussion includes explanatory
information concerning the recommendation. It is important to emphasize that all issues were discussed
in the context of risk of injury in relation to the overall lifesaving benefits of air bags.
Potential Issues Previously Raised - Air bag deployment might cause failure of a pacemaker or failure or
discharge of an implantable defibrillator.
Recommendation - There is no evidence to support disconnecting airbags for occupants who have
pacemakers, implantable defibrillators, or similar devices.
Discussion - Pacemakers and similar hardware are specifically designed to withstand impact. The forces
associated with air bag deployment are typically distributed throughout the chest and are not directed at
one specific area. The impact suffered without an air bag may in fact be more severe and more localized
than that with an air bag. Clinical experience does not demonstrate any significant concern about the
effects of air bag deployment on this type of hardware when properly installed. As forces to the chest in
areas directly contacted by seatbelts may exceed forces from air bags, it is important the belts be placed
properly and not directly over these devices.
Potential Issues Previously Raised - Air bag deployment might be associated with increased risk of fire in
the presence of supplemental oxygen. The equipment necessary for supplemental oxygen delivery might
be associated with an increased risk of injury during air bag deployment
Recommendation - There is no evidence to support disconnecting air bags for reason of fire hazard or
equipment risk for persons who require supplemental oxygen. All equipment such as tanks and
regulators should be properly secured away from the air bag.
Discussion - There have been no reported fires after air bag deployment, and there is no reason to
suspect that an environment enriched with only personal supplemental oxygen would create a fire hazard.
While occupants frequently report the presence of “smoke“ after air bag deployment, this substance is
more likely residual powder used to create smooth air bag deployment. The presence of any stray object
in the front seat of a vehicle, particularly in a position between the module and the occupant, creates the
potential for injury during deployment. Standard oxygen delivery devices such as canulae, tubing, and
masks are soft and flexible and present a minimal hazard. Equipment such as regulators and tanks should
be kept in a position away from the air bag so as not to be between the occupant and the module.
Devices for securing tanks in vehicles might be an area for improvement.
Potential Issues Previously Raised - During air bag deployment, eyeglasses might place the vehicle
occupant at increased risk of eye injury specifically caused by the interaction of the air bag and the
Recommendation - There is no reason to recommend disconnection of air bags for persons wearing
Discussion - There are a number of anecdotal cases of eye injuries after air bag deployment, both with
and without eyeglasses. Eyeglasses may, in fact, be protective during air bag deployment. There is no
obvious increased risk of injuries in the presence of eyeglasses; moreover, impact with the steering
column or dashboard may be more dangerous to someone wearing eyeglasses than impact with an air
bag. Persons who need eyeglasses should wear them to drive and should not have air bags disconnected
solely because of the eyeglasses.
Potential Issues Previously Raised - Decreased stability of the sternum after median sternotomy might
create an increased risk of intrathoracic injury due to the force of air bag deployment.
Recommendation - We recommend that persons who have undergone median sternotomy not disconnect
Discussion - Uneven pressure on the chest can harm a patient with a recent median sternotomy because
the external wound may be opened. An air bag does not cause this uneven force; seatbelts or striking an
object like a dashboard can cause this uneven force. Although there have been no cadaver tests in this
specific area, in general the forces across the chest are less with an air bag during impact than without.
The combination of air bag and seatbelt remains the best solution in a frontal crash. Most surgeons
recommend that patients wait two to three weeks before driving after a median sternotomy, irrespective
of the presence of an air bag.
Potential Issues Previously Raised - An episode of angina or dysrhythmia might be precipitated by the
force and sudden nature of air bag deployment in someone with ischemic heart disease.
Recommendation - We recommend not to disconnect air bags for persons with angina.
Discussion - It is known that emotional or physical triggers can cause sudden death in patients with
cardiac disease. It is also known that certain blows to the chest can cause sudden death in persons with or
without cardiac disease. However, there is no evidence to suggest that this phenomenon is occurring with
any greater frequency in the presence of air bags. In general the force of an air bag is distributed across
the chest and not localized directly over the heart. Deployment of an air bag may produce anxiety;
however it occurs at the same time as a crash, another anxiety-producing event.
Potential Issues Previously Raised - The byproducts of the propellant might precipitate severe
bronchospasm in persons with lung disease.
Recommendation - We recommend not to disconnect air bags for patients with these chronic lung
Discussion - There is no risk of oxygen deprivation during air bag deployment because of the quick
deflation of the device. There is some equivocal evidence to suggest that the chemical irritants produced
may precipitate bronchospasm in persons with asthma. However, there is no evidence to suggest that this
phenomenon is occurring with any greater frequency in the presence of air bags. There is no reason to
suspect that persons with any type of chronic lung disease will be adversely affected by an air bag
deployment sufficiently enough to justify disconnection of the device. As with other conditions, the
benefits of air bags in these situations outweigh the risks.
Potential Issues Previously Raised - Women who have undergone mastectomy and/or breast
reconstruction may suffer injury to those previous surgical sites during air bag deployment.
Recommendation - We recommend not to disconnect air bags on the basis of previous breast
reconstruction in its various forms or on the basis of previous mastectomy.
Discussion - As with other conditions related to chest anatomy, crash forces are distributed more evenly
in the presence of an air bag than with only a seatbelt or with no restraint. The low risk of implant
rupture exists with allogenic or gel-filled implants, not flap procedures. While rupture has been reported
anecdotally with seatbelt use, this phenomenon has not been noted to occur due to air bags. If a rupture
occurs, a repair can be done. Flap reconstruction with native tissue is no more likely to be damaged than
native breast tissue. The exact forces required to rupture an implant are not known, and might be an area
for future research.
Potential Issues Previously Raised - Persons with severe scoliosis may be at increased risk of injury
during air bag deployment because of positioning problems.
Recommendation - If capable of being positioned properly, persons with scoliosis should keep air bags
connected in their vehicles.
Discussion - This specific condition might make it impossible for a person to sit upright and away from
the air bag. This very small portion of the population of persons with scoliosis might be candidates for
disconnection. It must be remembered that a person sitting far forward in either the driver or passenger
seat is also at increased risk of injury from other structures (steering column, dashboard) in front of them.
Previous back or neck surgery:
Potential Issues Previously Raised - Persons with previous back or neck injuries or surgery might be
reinjured by a deploying air bag.
Recommendation - We recommend not to disconnect air bags in cases of persons with previous back or
Discussion - Air bags are known to be protective against spinal injuries overall in frontal crashes. This
protective effect would be expected to include patients with previous surgery. Sites of fusion within the
spinal column likely provide increased protection from injury because of increased strength. In general,
most surgeons recommend that postoperative spinal patients not drive for six to twelve weeks. This
recommendation should not change in the presence of an air bag.
Previous facial reconstructive surgery or facial injury:
Potential Issues Previously Raised - Persons with previous facial injuries or surgery might be reinjured by
a deploying air bag.
Recommendations - We recommend not to disconnect air bags for persons with previous facial
reconstructive surgery or facial injury.
Discussion - While there is concern about damage to rigid prosthetic implants from the force of an air
bag, the likelihood of facial injury is higher after contact with a firm object such as a steering wheel.
This risk-benefit analysis is likely to hold true for any person with previous facial surgery or injury. The
effect of changing deployment thresholds and depowering bags is a potential area for investigation in this
and other conditions.
Hyperacusis or tinnitus:
Potential Issues Previously Raised - The noise of a deploying air bag might exacerbate the symptoms of
persons with hyperacusis or tinnitus.
Recommendations - We recommend not to disconnect air bags for persons with hyperacusis or tinnitus.
Discussion - Airbag deployment is known to create sound that approaches 170 decibels. The risk of
damage to hearing is present at 140 decibels. However, the phenomenon of hearing loss has not been
noted to occur due to air bags. The specific conditions of hyperacusis and tinnitus are not associated with
hearing loss, and persons with these conditions would have no greater likelihood of hearing loss from air
bag deployment than any other persons. Some persons with tinnitus report that noise triggers attacks of
tinnitus; however, it is difficult to separate the noise of an air bag from the noise of a crash in many
situations. Given the potential general risk from air bag noise, muffling the noise of deployment might
be an area for future study.
Potential Issues Previously Raised - Persons of advanced age might be at increased risk of injury from air
bag deployment compared to their risk of injury without an air bag.
Recommendation - Advanced age by itself does not suggest the need for air bag disconnection.
Discussion - There is a large spectrum of fitness in the elderly, and physiologic age may not necessarily
coincide with chronologic age. It is known that older persons are at greater general risk of injury in all
types of crashes. The data suggests that air bags may be less effective in the older population although
the cause of this finding is unclear. There is no evidence to suggest that advanced age by itself, in the
absence of other potential risk factors examined here, warrants air bag disconnection. More study on age
as an independent risk factor for injury, and in association with other factors, is needed.
Potential Issues Previously Raised - The fragility of the bones of persons with osteogenesis imperfecta
places them at increased risk of injury from air bag deployment.
Recommendation - The panel recommends air bags not be disconnected for persons with osteogenesis
Discussion - While there is little population-based data in the crash experience of this group, it is
anticipated that the injury risk to these persons is higher without an air bag and proper restraint than with
an air bag.
Potential Concerns Previously Raised - Persons with osteoporosis and various types of arthritis may be at
increased risk of injury from air bag deployment.
Recommendation - For persons with osteoporosis, arthritis, and other skeletal conditions air bags should
not be disconnected unless the person cannot sit back at a safe distance from the air bag.
Discussion - Persons with specific conditions, such as ankylosing spondylitis, may have a relatively stiff
spine and thus may be unable to place themselves an acceptable distance from the steering wheel while
driving. Other than in this specific circumstance, persons with osteoporosis and types of arthritis are
generally benefitted by the presence of an air bag. In general, the distribution of loads across bony
surfaces in the presence of air bags is less than with belts alone.
Potential Concerns Previously Raised - It may be impossible to place certain wheelchairs in certain air
bag-equipped vehicles. Persons in wheelchairs may be at increased risk of injury from a deploying air
Recommendation - For persons in wheelchairs the decision to allow disconnection of the air bag should
be handled on a case-by-case basis. Disconnection may be needed if installation of special equipment
requires removal of the air bag. If wheelchair installation or steering column configuration does not
necessitate air bag removal, we recommend not to disconnect air bags.
Discussion - In certain situations, the air bag must be removed from a steering column in order to install a
specially-designed steering wheel for the driver. This is particularly true in a person with upper
extremity weakness after a spinal cord injury. In these situations, handles are installed on smaller
steering wheels in order to make steering more feasible. In the absence of circumstances requiring
reconfiguration of the steering mechanism, there is no reason to suggest that those in wheelchairs are at
increased risk of injury from air bag deployment. In all cases the occupant should be belted and the
wheelchair secured to reduce the risk of injury.
Potential Concerns Previously Raised - Persons with achondroplasia and other syndromes associated with
short limbs may be at increased risk of air bag-related injury because of proximity to the module.
Recommendation - In persons with achondroplasia we recommend allowing disconnection of driver-side
air bag only if the person is unable to sit back from the air bag.
Discussion - Persons with significantly congenitally shortened limbs may be required to sit very close to
the steering wheel in order to operate a vehicle. In this situation, pedal-extenders will offer limited
assistance as the arms are also affected. However, there is no reason to disconnect the passenger-side air
bag for an occupant with achondroplasia.
Previous ophthalmologic surgery:
Potential Concerns Previously Raised - Persons with various types of ophthalmologic surgery may be at
unreasonable risk of injury because of the fragility of their ocular structures.
Recommendation - For patients who are binocular, air bags should remain connected for overall safety
and protection of eyes. For patients who are monocular with or without prior surgery the known benefits
of air bags overall outweigh risks. While the monocular patient may perceive a threat to vision
exceeding the benefit of airbag protection, we recommend that airbags remain connected. We
understand that the data in this specific area is limited at this time.
Discussion - There is little population-based data on which to base a clear recommendation that applies to
all persons in this category. There are a number of anecdotal reports of serious eye injuries after air bag
deployment. Most of these reports lacked long-term followup, and most were unilateral. Corneal
surgery may lead to longer postoperative globe weakness than cataract surgery because of the location
and size of the incision. It is not clear in these types of postoperative conditions whether the risk of
ocular injury is greater with or without an air bag. The panel recognizes that most eye injuries that occur
after air bag deployment are minor and lead to full recovery. The recommendation of the panel is based
on an analysis of the relative risks of injury using the best data available. The panel suggests review of
eye registry data and further review of this issue in order to formulate future recommendations.
Down syndrome and Atlantoaxial instability:
Potential Concerns Previously Raised - Persons with Down syndrome and severe developmental delay
may be incapable of reliably sitting back from an air bag. Persons with Down syndrome and
antlantoaxial instability may be at unreasonable risk of severe neck injury during air bag deployment.
Recommendation - Disconnection of the passenger air bag is warranted if a person with this specific
condition cannot reliably sit properly aligned in the front seat, such as in those with developmental delay.
Discussion - Children and adults with severe developmental delay, including some with Down syndrome,
may be incapable of consistently maintaining a position away from a passenger-side air bag. If these
individuals cannot ride in a back seat, air bag disconnection may be warranted.
While there is no known data on this specific situation in relation to air bags, atlantoaxial
instability is present in 20% of persons with Down syndrome. This instability creates the clear risk of
atlantoaxial subluxation. Persons with this condition should clearly sit properly restrained in the back
seat of a vehicle. In situations in which they must sit in the front seat, air bag disconnection may be
warranted because of the risk of cervical injury, particularly if these individuals have developmental
delay which prevents them from consistently maintaining proper positioning.
Monitoring of infants and children:
Potential Concerns Previously Raised - Certain infants must be monitored and cannot be in the back seat
when the only adult in the vehicle is the driver.
Recommendation - The panel recognizes that there are a few specific medical conditions in which infants
and young children must be in the front seat for monitoring by the adult driving. In such situations, the
passenger side air bag may need to be disconnected.
Discussion - Parents are frequently concerned that they will be unable to properly monitor their infants if
the infants are in the back seat without an adult. The American Academy of Pediatrics has clearly
recommended that infants without underlying medical conditions can safely ride alone in the back seat
properly restrained in a rear-facing restraint. The data shows that in the absence of an air bag, the injury
risk in the back seat is 30% less than the risk in the front seat. The panel recognizes that certain vehicles
do not have back seats. In these vehicles the option of on-off switches is already available. Monitoring
of certain infants may require placement of the car seat in the front passenger seat when the only adult in
the vehicle is the driver. These situations may warrant air bag disconnection or an on-off option. Parents
should clearly recognize that distraction while driving significantly increases the risk of a crash. Ideally,
if a child needs attendance in a vehicle, someone other than the driver should be available. It is
anticipated that the American Academy of Pediatrics will make recommendations regarding which
specific conditions warrant close monitoring while driving.
Potential Concerns Previously Raised - The proximity of the gravid uterus to the deploying air bag
creates an increased risk of fetal death.
Recommendation - Assuming proper positioning (sitting as far away as possible) and proper seat belt
restraint, the benefits of air bags appear to outweigh risks in pregnant women by the limited data
available. The panel recommends that air bags not be disconnected for pregnant women at this time.
Further research is needed in this important area.
Discussion - The panel feels that there is no reason to recommend disconnection of passenger-side air
bags in the case of pregnant women. There is a clear concern on the part of the public about the safety of
the fetus in the presence of a driver-side air bag. What is clearly known is that the leading cause of fetal
death is maternal death. Protection of the pregnant female with proper lap and shoulder restraint is vital.
However, pregnancy places the gravid uterus closer to the steering wheel as pregnancy develops. While
there is a risk of fetal death from air bag deployment, there is also a clear and well-documented risk of
placental abruption and fetal death from low-velocity impact, such as contact with a steering wheel.
Based on the current data, the panel recommends that the benefits of air bags outweigh the risks for
pregnant women. This recommendation is made with the recommendation that further study be done on
the biomechanics of injury to the gravid uterus and the fetus during crashes and air bag deployment.
Potential Concerns Previously Raised - Persons of short stature cannot place themselves a safe distance
from the air bag module and thus are at increased risk of injury.
Recommendation - We are not able to determine an absolute cut-off height and weight for disconnection
of air bags. Given proper positioning and seat belt use, at a maximum distance from the air bag the
benefits of air bags appear to outweigh the risk for patients of small stature given the current data.
Further study is warranted given the potential risks and the large population involved.
Discussion - Short stature is a common area of concern for the public in regard to air bag deployment.
As proximity to the air bag is the major issue, the passenger-side air bag should not be disconnected for a
passenger of short stature. Beyond just short stature, weight, arm length, and leg length also play
important roles in driver positioning. We know that a disproportionate number of the deaths attributed to
air bag deployment have occurred in persons of short stature. However, of the 150,000 estimated air bag
deployments involving persons of short stature, only 14 are known to have been fatal. In all cases,
however, for both tall and short-statured individuals, close proximity to the deploying air bag was the
overriding factor in the death. As with some other categories, there is somewhat limited population-
based data on this specific population in order to formulate an exact risk-benefit ratio. The panel feels
strongly that while the vast majority of persons of short stature benefit from the presence of an air bag,
this area should be studied using improved database systems and injury surveillance.
There are a number of potential confounders that are not specifically addressed in this report.
Unless otherwise specified, we refer to driver-side air bags in making specific recommendations and
pointing out areas of concern. Under most circumstances, with the notable exception of infants in rear-
facing infant seats, the person in the passenger position can be made safe from inadvertent injury by the
use of proper restraint and placement of the seat in the most rear position. Certain vehicles with bench
seats may complicate this issue and may need to be considered carefully on a case-by-case basis.
We have not addressed the issue of multiple children in a vehicle without enough acceptable
seats. This is a clear concern on the part of some parents. This situation, however, does not result from
any specific medical condition but is merely dependent on the number of occupants in a vehicle at a
particular time. Drivers should carefully consider the risks and benefits of certain seating positions
before placing occupants in a vehicle.
The combination of surveillance data and clinical experience suggests that the overall effects of
the presence of air bags in the vehicle fleet have been positive. Reliable data using injury surveillance
and information on crash dynamics points out that over 2500 lives have been saved by air bags. Many
thousands more injuries have been averted. The clinical experiences of the panelists and their colleagues
confirm the dramatic change in injury patterns and outcomes since the advent of air bag technology.
This panel of 17 physicians of diverse specialties has used the best data available combined with
clinical experience in order to develop recommendations for physicians and their patients to consult when
considering the option of air bag disconnection. It is clear from our analysis of the facts that the vast
majority of persons, especially if properly restrained, are likely to benefit from the presence of an air bag
as a supplemental restraint. Air bags are one important component of protection for front seat occupants
in frontal crashes. We cannot overemphasize the importance of proper seat belt restraint for all vehicle
occupants. In conclusion, we choose to emphasize several points:
• Air bags are proven effective in both saving lives and preventing injuries.
• Virtually all persons are more likely to avoid injury and death when protected by an air bag in a
• Persons who choose to disconnect air bags because of a specific concern should carefully consider
the increased injury risk to themselves and other potential occupants after that disconnection
from loss of air bag protection.
• Future owners of vehicles with disconnected air bags should be clearly notified of the disconnection.
• The panel urges increased support for crash injury surveillance, particularly for less severe injuries,
improved research on tolerance of human tissue to injury, research and development of
improved occupant sensing systems, and research on crash effects on pregnant women.
• Children and infants should ride in the back seat.
• All occupants of motor vehicles should be properly restrained by seat belts.
Director: B. Tilman Jolly, MD
The George Washington University Medical Center
James M. Atkins, MD
American College of Cardiology
Jeffrey Augenstein, MD, PhD
American College of Surgeons
James Benedict, MD, PhD
Association for the Advancement of Automotive Medicine
Marilyn J. Bull, MD
American Academy of Pediatrics
Andrew Burgess, MD
American Academy of Orthopaedic Surgeons
Elizabeth Cobbs, MD
American Geriatrics Society
Linda Cocchiarella, MD
American Medical Association
Gregory Luke Larkin, MD
American College of Emergency Physicians
Leah Raye Mabry, MD
American Academy of Family Physicians
Ayub Ommaya, MD
Congress of Neurological Surgeons
Dante Pieramici, MD
American Academy of Ophthalmology
Bradley Robertson, MD
American Academy of Plastic and Reconstructive Surgery
Jeffrey W. Runge, MD
Society for Academic Emergency Medicine
David Shessel, MD
American Academy of Otolaryngology, Inc.
Michael Shefferman MD
American College of Physicians
Jim Van Hook, MD
American College of Obstetrics and Gynecology
Ross Zafonte, DO
American Academy of Physical and Rehabilitative Medicine