Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Why have rear seatbelts not positively impacted on casualty figures?
- Peter W Ward (9 December 2006)
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A partial assessment?
- John Swanson (1 January 2007)
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Caution Over Child Seat Car Safety Laws
- Adam C Frosh, Jonathan Wernick (5 January 2007)
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Peter W Ward, GP Gateshead NE8 1NR
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Rear seatbelts became compulsory for under 14's in September 1989 in Britain. Adams studied statistics for children killed and injured in rear seats using Road Accidents of Great Britain as his source. He compared figures from the year before with the year after the law, 1988 with 1990. These show that fatalities for this group increased by just under 10% and injuries by nearly 12%. These increases are above trend when compared with other road user groups. Why have rear seatbelts for children been such an apparent failure when there is no dispute about their ability in the event of a crash to protect the wearer? Adams, J Risk. Routledge 1995 Competing interests: None declared |
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John Swanson, Written in private capacity 9 Randalls Road, Leatherhead, Surrey, KT22 7TQ
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There may be nothing factually incorrect in this Editorial, but it comes over as an incomplete and one-sided account of the subject. First, by giving the total number of child casualties in cars, it creates an impression that this is the scale of the potential benefits from compulsory child seats. But some of these casualties will be among children not even following the existing requirement to wear adult seat belts, and it is simplistic to assume that parents who ignore the existing law will follow the new law. And correct child seats merely reduce injuries compared to adult seat belts, not eliminate them. So the benefit from this law is likely to be rather less than implied. Second, there is no consideration of cost-benefit. Whether in the work of NICE or in the growing use of Regulatory Impact Assessment in Government, we are increasingly seeing cost-benefit, not as some negative financial hurdle to be overcome, but as a positive tool to help us make the most effective use of societal resources. That sense is missing from this Editorial and from the wider debate of child seats. Thirdly, there is no consideration at all of risk compensation, hinted at by Ward in his Rapid Response. It is delusional to assess one part of the consequence of a measure (the changed incidence of injury when an accident occurs) if there are other consequences we are ignoring (the changed probability of an accident occuring). There are, no doubt, people who oppose this law on libertarian grounds. I am not one of them; I would happily see much stronger legal constraints applied to driving. I, like I assume Hayes and most BMJ readers, want to see fewer injuries on our roads. The challenge is to use the evidence base to find the most effective way of achieving that. Putting high-profile effort into token laws that do not address the causes of accidents and may make very limited difference in practice to the consequences is not the best way forward. Competing interests: None declared |
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Adam C Frosh, Consultant ENT Surgeon Lister Hospital, STevenage, SG3 6ST, Jonathan Wernick
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Dear Sir, We read the article by Michael Hayes on child safety in cars with great interest1. However, we are concerned that the European-compliant law of 18 September 2006 regarding safety regulations for children over 3 years of age may actually contribute towards significant increased numbers of injuries and fatalities. This new legislation has resulted in massive extra sales of children’s car safety seats2. Many car journeys will necessarily be made without child passengers and therefore many safety seats will be left unsecured in the back of the car. It is widely accepted that unsecured projectiles in cars can be lethal in the event of a crash, typically increasing the weight of the item by twenty times3. Indeed, this concern led to the development of legislation in Holland enforcing that all heavy objects within a vehicle be secured4. Our concern is that that the UK legislation will lead to a significant rise in injuries and fatalities arising from increased numbers of unsecured car safety seats acting as potential projectiles when the child is not in the car. Unfortunately, this issue was not factored into the risk assessment when the legislation was made5. Currently, statistics of in-car injuries from unsecured projectiles in the UK is not collected5. While we believe any legislation that improves overall safety is welcome, we would value an urgent risk-assessment to ensure that the new law does not cause overall more death and injury than it is designed to prevent. Reference List (1) Michael Hayes. Child safety in cars. BMJ 2006; 333:1183-1184. (2) Halfords steers steady course. 23-11-2006. http://www.hemscott.com/news/comment-archive/item.do?id=16311 (3) Lethal Weapons. 1-1-2007. http://www.openroad.com.au/motoring_roadsafety_lethalweapons.asp (4) Peijs wil verbod op losse spullen in de auto. 19-7-0005. http://www.elsevier.nl/nieuws/politiek/artikel/asp/artnr/55362/versie/1/index.html (5) Road User Safety Division of Department for Transport. 2007. Competing interests: None declared |
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