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Remarks Before the Education, Health and Environmental Matters Committee, Maryland General Assembly, on House Bill 564, Primary Enforcement Seat Belt for All Occupants, Annapolis, Maryland
Earl F. Weener, PhD
Annapolis, Maryland

The National Transportation Safety Board (NTSB) offers this statement regarding the NTSB's occupant protection safety recommendations. The NTSB is an independent federal agency charged by Congress to investigate transportation accidents, determine their probable cause, and make recommendations to prevent their recurrence. The recommendations that arise from our investigations and safety studies are our most important tool for effectuating life-saving changes.

The NTSB has recognized for many years that motor vehicle crashes are responsible for more deaths than crashes in all other transportation modes combined. Almost 95 percent of all transportation-related deaths each year result from highway crashes. The single greatest defense against highway fatalities is a vehicle's seat belt.

Unfortunately, seat belt use in the United States remains considerably lower than seat belt use in other industrialized nations. Australia and Canada, for example, have use rates well over 90 percent, while seat belt use in the United States is approximately 85 percent. According to the 2010 National Occupant Protection Use Survey, the average belt use was 88 percent in states authorizing primary enforcement, 12 percentage points higher than in states authorizing only secondary enforcement.

Maryland has been a leader for many years with its primary enforcement law, and accordingly, its observed belt use rate has been over 90 percent for several years. However, Maryland's primary seat belt law only applies to the front seat. A study released by the National Highway Traffic Safety Administration (NHTSA) examining 2009 seat belt use data revealed that belt use in rear seats was only 70 percent, compared to 84 percent in the front seat. Additionally, average seat belt use was higher among states with laws requiring seat belt use in all seating positions compared to states requiring seat belt use only in the front seat.

Seat Belts Are Effective

Seat belts are the number one defense against motor vehicle injuries and fatalities. Seat belts restrain vehicle occupants from the extreme forces experienced during motor vehicle crashes. Unbelted vehicle occupants frequently injure other occupants, and unbelted drivers are less likely than belted drivers to be able to control their vehicles. Also, seat belts prevent occupant ejections. In 2009, only 1 percent of vehicle occupants using seat belts were ejected, while 30 percent of unrestrained vehicle occupants were ejected. Among those occupants totally ejected from their passenger vehicles, 77 percent were killed.

NHTSA estimates that from 1975 through 2009, seat belts saved more than 267,890 lives nationwide. According to NHTSA, had all passenger vehicle occupants over age 4 used seat belts in 2009, an additional 3,688 deaths would have been prevented. Unfortunately, some motor vehicle occupants mistakenly believe that they are safer without a seat belt, that their vehicle and/or their air bag provides sufficient occupant protection, or that they will not be in a motor vehicle crash where seat belts would make a difference.

Unrestrained Vehicle Occupants More Frequently Engage in High-Risk Behavior

According to daytime observational surveys, approximately 15 percent of motor vehicle occupants nationwide do not use seat belts. These drivers, who choose not to buckle up, tend to exhibit multiple high-risk behaviors and are more frequently involved in crashes. According to the National Automotive Sampling System (crash data composed of representative, randomly selected cases from police reports), belt use among motorists is lowest in the most severe crashes.

Fatal crashes are the most violent motor vehicle crashes and can result from high-risk behaviors such as speeding and impaired driving. While observational surveys have identified an 85 percent seat belt use rate, use by occupants involved in fatal crashes in 2009 (the last year for which we have fatality data) was significantly lower, approximately 70 percent. And among those occupants fatally injured in traffic crashes, only 47 percent were restrained.

Among special populations, such as impaired drivers and teen drivers, seat belt use is also substantially lower than the national observed belt use rate. In 2009, only 28 percent of fatally injured drivers who were violating their state's per se impaired driving statute (had a blood alcohol concentration at or above 0.08 percent), and for whom restraint use was known, were using seat belts. Among fatally injured teen drivers age 15 through 20, only about 47 percent were restrained.

Economic Costs from the Failure to Use Seat Belts Are Significant

Although opponents to strong seat belt laws claim that nonuse is a personal choice and affects only the individual, the fact is that motor vehicle injuries and fatalities have a significant societal cost. For example, NHTSA calculated that the lifetime cost to society for each fatality is over $977,000, over 80 percent of which is attributed to lost workplace and household productivity. In 2009, more than 3,600 lives and billions of dollars might have been saved if everyone had used a seat belt.

NHTSA estimates that each critically injured survivor of a motor vehicle crash costs an average of $1.1 million. Medical expenses and lost productivity account for 84 percent of the cost of the most serious level of non-fatal injury. In a 1996 study, NHTSA found that the average inpatient cost for unbelted crash victims was 55 percent higher than for belted crash victims. In 2000 alone, seat belts might have prevented more than 142,000 injuries.

While the affected individual covers some of these costs, those not directly involved in crashes pay for nearly three-quarters of all crash costs, primarily through insurance premiums, taxes, and travel delay. In 2000, those not directly involved in crashes paid an estimated $170 billion for crashes that occurred that year; $21 billion, or 9 percent of total economic costs, were borne by public sources (federal and state government). Motor vehicle injuries and deaths experienced by unbelted vehicle occupants cost the Nation's taxpayers an estimated $26 billion just for medical care, lost productivity, and other injury related costs.

The emotional and financial costs to Maryland are just as staggering. In 2009, 189 vehicle occupants died; at least 66 percent were not using seat belts. NHTSA estimates that if everyone in Maryland used a seat belt, Maryland would prevent an additional 27 fatalities and almost 750 injuries, saving the state's taxpayers more than $100 million.

Strong Seat Belt Laws Do Increase Seat Belt Use

Primary enforcement seat belt laws remain the best way to raise and maintain high seat belt use rates, but the laws need to apply to all vehicle occupants. As noted above, belt use in rear seats is higher in states that require rear seat occupants to use these safety devices.

The numbers in Maryland demonstrate the discrepancy in belt use between those required to use seat belts and those not covered by the law. According to 10 years of NHTSA fatality data, 21 percent of front seat vehicle occupants involved in fatal crashes were unrestrained; that rises to 41 percent for vehicle occupants riding in the rear. Looking at fatally injured occupants, almost 40 percent of front seat fatally injured occupants were unrestrained, but more than 65 percent of rear seat fatally injured occupants were unrestrained.

Unrestrained rear seat occupants can also pose a risk to other individuals in the vehicle. An article in the Academy of Emergency Medicine noted that the odds of dying for restrained drivers are higher when the passenger behind the driver is unrestrained; the odds increase more in head-on collisions. A separate study in The Journal of the American Medical Association stated that an occupant's risk of death in a crash is associated with the restraint use of other occupants, and the risk is lowest when all vehicle occupants are restrained.

It is also important to note there is a correlation between adult belt use and restraint use by children. In a 2009 NHTSA study, it was shown that when adults were wearing their seat belts, 92 percent of children were also restrained; but when adults were not wearing their seat belts, only 54 percent of children were restrained. As the NTSB has chosen 2011 to place special emphasis on child and youth transportation safety, we are pleased to see that Maryland is considering legislation that will make children safer.


The NTSB believes that a significant number of lives can be saved and injuries avoided if Maryland closes the loopholes in its occupant restraint law. A comprehensive primary enforcement seat belt law should include coverage of all vehicle occupants in all seating positions with sufficient penalties to promote compliance with the law.

The NTSB believes that House Bill 564 will save lives and reduce injuries. Thank you again for considering the NTSB's statement on this important issue.