DR. (COL.) DAVID ROMINE
Command Surgeon
U.S. Army Combat Readiness Center
Fort Rucker, Alabama

It was a spectacular, mid-winter morning. The weather was cool with a light breeze curling down the western slope of the Tiefort Mountains in “the box” at Fort Irwin, California. Three junior enlisted Soldiers and their sergeant maneuvered their Bradley Fighting Vehicle along a sandy track to their training evolution. It was the first time the junior Soldiers had been in such an intensely realistic training situation, and their squad leader was proud of their progress and enthusiasm for the mission.

The young NCO reflected on the quality of their training and the robust support they were receiving from the National Training Center observer controllers and the leaders from their own armored brigade combat team. These warriors were getting the chance of a lifetime to learn how to improve their skills under the most demanding conditions with maximum repetitions as well as increase their confidence in preparation for an upcoming overseas combat tour.

Then, in what at seemed like an eternity, but in reality was just a few seconds, the metal-grinding din of a still-running and badly damaged engine filled the air and everything went black. As the sergeant slowly regained consciousness, he found himself inverted, in pain and disoriented — the smell of fuel and his own blood permeating his nostrils. Six inches from his face was one of his specialists, contorted in a grotesque position with his head at a 90-degree angle to his neck and bleeding from the mouth, nose and ears. The young Soldier made a few faint gurgling sounds as his body took its last breath. Groans followed from the other two junior Soldiers somewhere in the dark space.

They’d later learn their vehicle had veered from its track, careened over a 30-foot wadi, landed hard on its roof and rolled before coming to a creaking halt. The Bradley’s cabin held its shape and provided occupiable space required for a survivable crash. Unfortunately, there was one fatal flaw — none of the Soldiers wore seat belts and, as a result, became projectiles inside the vehicle. Had they chosen to buckle up, the crew likely would have suffered just some aches and scrapes. Sadly, that wasn’t the case, and the end result was one Soldier dead, three others injured and numerous lives shattered.

The story above is frustratingly repetitive. In the first three months of 2019, six Soldiers died from injuries sustained in on-duty tactical motor vehicles mishaps. All six were unrestrained. Data overwhelming supports the reality that seat belt use is the single most important element to surviving a motor vehicle accident. It’s the law in most states and mandated by Army regulations. So why do Soldiers choose to ride unrestrained?

When traveling in a vehicle, occupants have kinetic energy (e.g., the energy possessed by moving along). Normally, when you want to stop a vehicle, you have to get rid of that kinetic energy, preferably by applying the brakes. In a crash, this can’t happen due to the deadly combination of sudden impulse, sustained momentum and a compressed time frame. Modern automobiles are engineered to include crumple zones, which absorb the deceleration force experienced during a crash and prevent it from being transmitted to the vehicle occupants. Those who wear seat belts participate with this technology and ultimately benefit from it. An unrestrained occupant, however, defeats much of this lifesaving design.

In every crash where passengers are not wearing a seat belt, there are three collisions. The first collision causes the car to buckle and bend as it hits an object and comes to an abrupt stop. The second collision occurs between the occupant and something in the vehicle’s interior. For example, the driver’s chest striking the steering wheel. The third collision happens when the body’s internal organs hit the chest wall or skeleton. And, in the case of coup-contrecoup, there are aftershock collisions after the third strike, where the brain sustains injuries at both the impact site and its opposite side when it rebounds.¹ Even when wearing a seat belt properly, depending on the impact of the crash, you can probably expect a broken collar bone. However, a broken collar bone beats a dead body every single time.

Higher-speed crashes may result in occupants breaking ribs. The more energy absorbed by the ribs, the more that break. Once enough are broken, the chest loses its structure and the ribs become sharp objects that can pierce the lungs and other vital organs. The carnage worsens if the space between the lungs and the ribcage gets punctured. The chest will expand as normal, but the lungs won’t go with it, which is known as a pneumothorax. It’s one of the most common injuries in high-speed frontal crashes.

Side impacts have their own gruesome results. While the front ends of most automobiles are built to crumple in a controlled manner, side-impact crashes are much more damaging due to less protection in that area of the vehicle. Side impacts often result in more severe injuries to the thorax and upper body. There are also a lot more rib fractures and damage to the lungs and internal organs. Pelvic fractures are a particular problem because of the height of the bumper of the car that strikes another vehicle. And don’t forget your bowels and other internal organs, which, when ruptured, spill digestive juices and other fluids into and around the rest of your body. When the bowel is busted, waste products pour around the inside of the body, and the damage continues.

The earliest — and still some of the best — research into crash tolerance limits was conducted in the 1940s and 50s in the field of aviation medicine. These studies investigated how to protect pilots and astronauts from ejection forces of high-speed travel. Dr. (Col.) John Stapp used himself as a test subject to assess the limits of human tolerance in a high-G environment.²

From Stapp’s work, we know that a mere 10 percent increase in the speed of your car, say from 50 to 55 mph, results in an increase of 20 percent in energy absorbed and a similar increase in crash forces. So, the injuries aren’t just 10 percent worse; they’re more like 20 percent worse. Likewise, for a 10 percent decrease in speed, crash injuries don’t decrease just by 10 percent. They actually decrease by 20 percent.
 
Conclusion
One of the safest choices drivers and passengers can make is to buckle up. Most Americans understand the lifesaving value of the seat belt; the national use rate was 89.6 percent in 2018. Of the 37,133 people killed in motor vehicle crashes in 2017, 47 percent were not wearing seat belts. In 2017 alone, seat belts saved an estimated 14,955 lives and could have saved an additional 2,549 people had they simply buckled up.³ Every life is precious and worth protecting on duty, off duty, in garrison and in combat. Understand the potentially fatal consequences of not wearing a seat belt and make sure you and your family are properly buckled up before starting your engines.

Leaders, you should:

1. Reaffirm at every opportunity just how valuable beyond measure your troops are — to themselves, their families and their country.
2. Lead with your own example and talk about the need to slow down and buckle up at every formation, especially before holiday weekends and other key times. Don’t rely on check-the-box programs that simply give lip service to seat belt use.
3. Emphasize the vital importance of seat belt use just as you would weapon safety or any other high-visibility threat to our formations.

Like so many other good habits, instilling a healthy routine of buckling up before the ignition switch is engaged costs nothing; however, it is the critical component to enabling the myriad other safety measures to work for saving lives.


¹ https://www.researchgate.net/publication/7588858_The_contrecoup-coup_phenomenon

² https://www.businessinsider.com/john-stapp-human-crash-test-dummy-usaf-2016-5 and https://www.popsci.com/blog-network/vintage-space/john-paul-stapp-real-life-rocket-sled-man#page-2

³ https://www.ncbi.nlm.nih.gov/pubmed/16174940