Mis-use of appropriate child restraints and use of inappropriate child restraints are important issues that are overlooked.

The Ontario Provincial Police posted the above photo on their Twitter account showing how a case of beer was being used as a booster cushion for a 2-year-old child seated in the front seat. The photo is eye-catching and garners some publicity of what would appear to be a rare and unusual occurrence. However this provides an opportunity to point out that mis-use of appropriate restraints¬† and use of inappropriate restraints is not rare or unusual. But when it causes unnecessary injury there are many reasons why its consequences are kept from the public’s knowledge.

Even use of the beer case is not the worst that adults have done to their innocent children. Without the availability of a child seat anything that can elevate the child and increase the angle of the lap belt as it leaves its floor anchorage is better than simply placing a 2-year-old child in an adult-fitting seat-belt. There is no way that the anatomy of a 2-year-old child will allow the lap belt to be placed appropriately below the illiac crests of the child’s pelvis. In the event of crash of any significance the child’s abdomen will move against the webbing potentially causing major organ ruptures. This would need immediate emergency treatment in an operating room. Sadly such immediate treatment will not take place in a large number of cases when a collision occurs some distance from a major medical facility.

What is also misunderstood is that seat-belt abdominal injuries do not exhibit themselves in open wounds that provide an immediate indication of a problem. Minor head wounds will produce much bleeding and obvious signs to witnesses at a collision site that an injury has occurred.

But even paramedics can be misled by the lack of obvious signs of injury when abdominal organs sustain seat-belt injuries and the patient progresses into shock without a clearly identifiable reason. In those instances paramedics could be trained, not only to look for signs of injury on the patient but to look at the seat-belt and vehicle interior for additional vital clues.

It has been over 30 years since Zygmunt Gorski presented a research paper at the American Academy of Forensic Sciences in Philadelphia entitled “Examination and Analysis of Seat-belt Loading Marks”, which was subsequently pubished in their journal in 1990. In that paper it was demonstrated how investigators could examine the physical evidence left on restraint systems to determine if, and how they have been used in a crash. Physical evidence is created at the tongue (latch plate) and D-ring of the system and tranferred onto the seat-belt webbing. That evidence provides an indication of the length of the lap and shoulder (torso) belt used in the crash. Not only this, but specific characteristics of those markings can be used to determine how the system was used, whether it was misused and/or whether it performed improperly during a crash.

An example of seat-belt markings documented during an investigation by Zygmunt Gorski in the 1980s.

Thus this data has been available for at least 3 decades. Yet very little attention has been paid to its existence. Paramedics could easily gain valuable information about possible injuries to a patient even without taking any vital signs by simply looking at the physical evidence on a restraint system. Similarly evidence of occupant contact with the vehicle interior can provide further clues as to possible restraint problems. Paramedics could be taught to recognize certain telltale signs of occupant contact that would not exist if a restraint was used or performed properly. Unfortunately this is the kind of evidence and training that remains unexplored.