The field performance of frontal air bags: a review of the literature.

This article presents a broad review of the literature on frontal air bag field performance, starting with the initial government and industry projections of effectiveness and concluding with the most recent assessments of depowered systems. This review includes as many relevant metrics as practicable, interprets the findings, and provides references so the interested reader can further evaluate the limitations, confounders, and utility of each metric. The evaluations presented here range from the very specific (individual case studies) to the general (statistical analyses of large databases). The metrics used to evaluate air bag performance include fatality reduction or increase; serious, moderate, and minor injury reduction or increase; harm reduction or increase; and cost analyses, including insurance costs and the cost of life years saved for various air bag systems and design philosophies. The review begins with the benefits of air bags. Fatality and injury reductions attributable to the air bag are presented. Next, the negative consequences of air bag deployment are described. Injuries to adults and children and the current trends in air bag injury rates are discussed, as are the few documented instances of inadvertent deployments or non-deployment in severe crashes. In the third section, an attempt is made to quantify the influence of the many confounding factors that affect air bag performance. The negative and positive characteristics of air bags are then put into perspective within the context of societal costs and benefits. Finally, some special topics, including risk homeostasis and the performance of face bags, are discussed.

Benefits of Australian Design Rule 69 (full frontal crash protection) and airbags in frontal crashes in Australia.

In-depth data at MUARC was used to evaluate the Australian Design Rule 69 (ADR69) - Full frontal dynamic crash requirement, as well as the effectiveness of frontal airbag deployment on injury risk and associated cost of injury. ADR69 was introduced in Australia in mid-1995 and was based largely on the US equivalent FMVSS-208. The results indicate reductions in excess of 90% in the likelihood of sustaining AIS 2+ injuries in body regions where frontal airbags would be expected to benefit. The average injury cost savings for drivers of post-ADR69 manufactured vehicles was found to be up to AUD19,000 dollars depending on body region considered. Limitations and implications of these findings are discussed.

Validating benefit and cost estimates: the case of airbag regulation.

Preregulation estimates of benefits and costs are rarely validated after regulations are implemented. This article performs such a validation for the mandatory automobile airbag requirement. We found that the original 1984 model used to estimate benefits became invalid when 1997 values were input into that 1984 model. However, using a published 1997 cost-effectiveness model, we demonstrate, by replacing the model inputs with the values from 1984, that the 1997 cost-effectiveness ratios, based on real-world crash data and tear-down cost data, are less attractive than what would have been originally anticipated. The three most important errors in the 1984 input values are identified: the overestimation of airbag effectiveness, the overestimation of baseline fatality/injury rates, and the underestimation of manual safety belt use. This case study, which suggests that airbags are a reasonable investment in safety, shows that the regulatory analysis tools do not always produce findings that are biased against health, safety, and environmental regulation. Future validation studies of health, safety, and environmental regulation should focus on validation of benefit and risk estimates, areas where we found significant error, as well as on cost estimates.

Reducing risks to children in vehicles with passenger airbags.

This review examines the risk that passenger airbags pose for children and discusses behavioral and technologic measures aimed at protecting children from airbag deployment. Although airbags reduce fatal crash injuries among adult drivers and passengers, this safety technology increases mortality risk among children younger than age 12. The magnitude of the risk is multiplied when children are unrestrained or restrained improperly. As new vehicles are resold to buyers who tend to be less safety-conscious than new car owners, the number of children endangered by passenger airbag deployment may increase. For vehicles already in the fleet, strong measures are required to secure children in the rear seat and increase the proper use of appropriate restraint systems through police enforcement of laws. One promising strategy is to amend child passenger safety laws to require that parents secure children in the rear seats. For future vehicles, a mandatory performance standard should be adopted that suppresses airbag deployment automatically if a child is located in the front passenger seat. Other promising improvements in airbag design also are discussed. Major changes in passenger airbag design must be evaluated in a broad analytical framework that considers the welfare of adults as well as children.

The cost-effectiveness of air bags by seating position.

CONTEXT: Motor vehicle crashes continue to cause significant mortality and morbidity in the United States. Installation of air bags in new passenger vehicles is a major initiative in the field of injury prevention. OBJECTIVE: To assess the net health consequences and cost-effectiveness of driver's side and front passenger air bags from a societal perspective, taking into account the increased risk to children who occupy the front passenger seat and the diminished effectiveness for older adults. DESIGN: A deterministic state transition model tracked a hypothetical cohort of new vehicles over a 20-year period for 3 strategies: (1) installation of safety belts, (2) installation of driver's side air bags in addition to safety belts, and (3) installation of front passenger air bags in addition to safety belts and driver's side air bags. Changes in health outcomes, valued in terms of quality-adjusted life-years (QALYs) and costs (in 1993 dollars), were projected following the recommendations of the Panel on Cost-effectiveness in Health and Medicine. PARTICIPANTS: US population-based and convenience sample data were used. MAIN OUTCOME MEASURE: Incremental cost-effectiveness ratios. RESULTS: Safety belts are cost saving, even at 50% use. The addition of driver's side air bags to safety belts results in net health benefits at an incremental cost of $24000 per QALY saved. The further addition of front passenger air bags results in an incremental net benefit at a higher incremental cost of $61000 per QALY saved. Results were sensitive to the unit cost of air bag systems, their effectiveness, baseline fatality rates, the ratio of injuries to fatalities, and the real discount rate. CONCLUSIONS: Both air bag systems save life-years at costs that are comparable to many medical and public health practices. Immediate steps can be taken to enhance the cost-effectiveness of front passenger air bags, such as moving children to the rear seat.

Airbag and facebag benefits and costs.

There is debate about the appropriate design of supplementary airbags for passenger car occupants with high levels of seatbelt use. A theoretical analysis was performed to demonstrate the likely costs and benefits of U.S. fullsize driver airbags and the smaller European-style facebag. This study, undertaken for the Federal Office of Road Safety in Australia, builds upon previous work in this area. Benefits were determined using Harm Reductions for front-seat occupants involved in frontal crashes. A sensitivity analysis was undertaken for different benefit scenarios for the facebag, given the lack of available performance data. Likely costs of the components were derived from information provided by the local automobile manufacturers, part suppliers, and vehicle importers, with adjustments made for fitting to Australian vehicles. The results demonstrate the advantage of fullsize airbags over facebags, even when seatbelt wearing rates are high.