Learning How Cars Kill Us

The man on the operating table is close to death. He had slammed his 1990 Honda into the brick wall of a pizza parlor near Manassas, Va., collapsing the building and crunching his car like a tin can. Now, as doctors at Washington Hospital Center labor to repair a severed artery in his chest, three unusual visitors look on with sober, professional interest: Dr. Ricardo Martinez, administrator of the National Highway Traffic Safety Administration; Lou Brown, a mechanical engineer in NHTSA's research-and-development unit; and P.L. Moore, a NHTSA automobile safety standards engineer. They've come to the hospital's trauma center this cold Friday night to find out what happens when the safety rules that they write run head on into reality.

Every six weeks for the past two years, Martinez has taken NHTSA engineers, lawyers, and other agency bureaucrats through this grim ritual. They want to know if victims were wearing seat belts, whether bumpers absorbed shock as they were supposed to, and if windows shattered properly, or, instead, sent shards of glass flying. "We come here out of necessity," Martinez says. "Somewhere along the way, we quit talking about people and started talking about injuries to test dummies. This is an effort to turn that around." They are seeing a drama that is played out daily in hundreds of emergency rooms across the nation. More than 40,000 people die on U.S. roads and highways every year.

These visits aren't easy for NHTSA employees, who've seen doctors treat victims of collisions, pedestrians who had been mowed down by trucks, and drivers whose brakes failed. One group recently watched as a young medical student's leg was amputated after it was pinned against her bumper by another car. Noble N. Bowie, a NHTSA program manager who publishes data on the safety performance of vehicles in the U.S., spent eight hours in the trauma unit at the University of Maryland in Baltimore--and thinks about the experience every day. "So much time has been spent trying to influence behavior, such as discouraging drinking and driving, and encouraging seat-belt use," Bowie says. "I saw how important it is for people to buy safer vehicles."

That's why the visits lead to changes in auto regulations. Shocked at the number of lower-extremity injuries they saw, safety engineers last year wrote new rules to improve frontal crash protection in autos. Another group visited a Baltimore trauma center where they saw a crash victim--who had been cushioned by an air bag but had no lap belt--leave the hospital, apparently healthy, only to return a few hours later because of a lacerated liver. Because doctors had missed the problem, critical treatment time was lost. As a result, NHTSA now distributes information on occult, or hidden, injuries to medical-emergency workers and police departments. They advise personnel to examine auto wrecks for such things as deformed steering wheels, which could indicate the crash victim has internal injuries. "Time is tissue," Martinez says.

While the visits have galvanized NHTSA staffers, they haven't done much to silence critics of Martinez and his agency. Auto manufacturers say the tours are just part of Martinez' touchy-feely, New Age managerial style. And safety advocates, who charge that Martinez fails to mandate costly recalls to correct auto defects, say the department ought to resolve the lingering issue of air bags, which have killed 38 children since 1993 and 24 adults since 1990.

"A DISAPPOINTMENT." One critic, Ralph Hoar, president of Ralph Hoar & Associates, an Arlington (Va.) auto-safety consulting firm, says the trauma-center visits underscore Martinez' emphasis "on changing people rather than changing vehicles. This is why Martinez has been such a disappointment." Among the changes that Hoar wants are rollover, or stability, standards on sport-utility vehicles.

Martinez shrugs off the criticisms. Standing before an array of X-rays of knee caps and craniums strung along a bank of fluorescent screens, he says the visits, such as this one to Washington Hospital Center, address many of the issues his critics complain about.

He turns his attention back to the operating table. The victim had been driving his car at least 75 mph over the crest of a hill when he lost control of the car, hit a truck, then flew into the air, crashing into the pizza parlor. The 32-year-old man had buckled up, but he had no air bag. The tightly woven nylon seat belt has left an angry red welt from his left shoulder to his right hip, and doctors suspect the safety device may have severed his aorta. The man also has facial cuts, broken bones, fractured ribs, and a collapsed lung. The injuries, Martinez says, underscore the benefits of air bags and the limitations of seat belts, which need more give in high-speed crashes.

DAILY DISASTER. As the two safety engineers study the victim's X-rays, Martinez explains with passion that diagnosing trauma is like detective work. Injuries have subtle signatures, and cuts, bruises, and fractures are clues to safety changes needed in automobiles. Since the injuries in rollover accidents are even worse when victims are thrown from their cars, the agency is looking for ways to keep passengers inside, perhaps with rules requiring specialized glazing to fortify car windows.

Martinez leaves the hospital at midnight, but the engineers remain. At 2 a.m., there's a radio alert to prepare for four "code yellows"--victims of a "T-bone," or side-impact, crash. According to the police report, a 1979 Oldsmobile has run a red light, colliding with a 1991 Chevy Blazer carrying four persons. When the victims arrive by ambulance, doctors take X-rays, make abdominal exams, give reflex tests.

NHTSA mechanical engineer Lou Brown, who has stayed on, watches doctors gently lift one of the bloodied victims onto a cold steel examining table. He shakes his head and says wearily that with traffic accidents, "we have the equivalent of one Valujet accident [which killed 110] in this country every day." It's now 4:30 a.m. Time to drive home--time to test the fates of the road.

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