Collisions between pedestrians and road vehicles present a major challenge for public health, trauma medicine, and traffic safety professionals. More than a third of the 1.2 million people killed and the 10 million injured annually in road traffic crashes worldwide are pedestrians.1 Compared with injured vehicle occupants, pedestrians sustain more multisystem injuries, with concomitantly higher injury severity scores and mortality.2 Although a disproportionately large number of these crashes occur in developing and transitional countries, pedestrian casualties also represent a huge societal cost in industrialised nations. In Britain pedestrian injuries are more than twice as likely to be fatal as injuries to vehicle occupants3 and result in an average cost to society of £57 400, nearly twice that of injuries to vehicle occupants.4

Despite the size of the pedestrian injury problem, research to reduce traffic related injuries has concentrated almost exclusively on increasing the survival rates for vehicle occupants. Most attempts made to reduce pedestrian injuries have focused solely on isolation techniques such as pedestrian bridges, public education, and traffic regulations and have not included changes to vehicle design. The lack of effort devoted to vehicle modifications for pedestrian safety has stemmed primarily from a societal view that the injury caused by a large, rigid vehicle hitting a small, fragile pedestrian cannot be significantly reduced by alterations to the vehicle structure. Crash engineers, …