The Effect of Nighttime Rental Restrictions on E-Scooter Injuries at a Large Urban Tertiary Care Center.

Safety policy for e-scooters in the United States tends to vary by municipality, and the effects of safety interventions have not been well studied. We reviewed medical records at a large, urban tertiary care and trauma center in Atlanta, Georgia with the goal of identifying trends in e-scooter injury and the effects of Atlanta's nighttime ban on e-scooter rentals on injuries treated in the emergency department (ED). Records from all ED visits occurring between June 2018 through August 2020 were reviewed. To account for ambiguity in medical records, confidence levels of either "certain" or "possible" were assigned using a set of predefined criteria to categorize patient injuries as being associated with an e-scooter. A total of 380 patients categorized as having certain e-scooter related injuries were identified. The average age of these patients was 31 years old, 65% were male, 41% had head injuries, 20% of injuries were associated with the built environment, and approximately 20% were admitted to the hospital. Approximately 19% of patients with injuries associated with e-scooters noted to be clinically intoxicated or have a serum ethanol level exceeding 80 mg/dL. The implementation of a nighttime rental ban on e-scooter rentals reduced the proportion of patients with e-scooter injuries with times of arrival during the hours of the ban from 32% to 22%, however this effect was not significant (p = 0.16). More research is needed to understand how e-scooter use patterns are affected by the nighttime rental ban.

Self-Reported Use of Personal Protective Equipment among Emergency Department Nurses, Physicians and Advanced Practice Providers during the 2020 COVID-19 Pandemic.

BACKGROUND: Emergency departments (EDs) have seen dramatic surges in patients infected with COVID-19 and are high-risk transmission environments. Knowledge, attitudes and practice regarding personal protective equipment (PPE) among ED health care workers (HCWs) during the COVID-19 pandemic have not been studied, thus this study examines this knowledge gap. METHODS: This was a cross-sectional survey of 308 HCWs in two urban EDs in Atlanta, Georgia in April and May of 2020. RESULTS: We surveyed 308 HCWs; 137 responded (44% response rate). All HCWs reported adequate knowledge and 96% reported compliance with PPE guidelines. Reported sources of PPE information: 56.7% charge nurse, 67.3% the institutional COVID-19 website. Frequency of training was positively associated with understanding how to protect themselves and patients (OR = 1.7, 95% CI: 1.0-2.9). CONCLUSIONS: Few HCWs are willing to care for patients without PPE, and therefore we should aim for resiliency in the PPE supply chain. EDs should consider multiple communication strategies, including a website with concise information and enhanced training for key personnel, particularly the charge nurse. Attention to frequency in HCW training may be key to improve confidence in protecting themselves and patients. Findings can be leveraged by EDs to implement effective PPE training.

Whole Body PMHS Response in Injurious Experimental Accelerative Loading Events.

Previous studies involving whole-body post-mortem human surrogates (PHMS) have generated biomechanical response specifications for physically simulated accelerative loading intended to reproduce seat and floor velocity histories occurring in under-body blast (UBB) events (e.g.,. References 10, 11, 21 These previous studies employed loading conditions that only rarely produced injuries to the foot/ankle and pelvis, which are body regions of interest for injury assessment in staged UBB testing using anthropomorphic test devices. To investigate more injurious whole-body conditions, three series of tests were conducted with PMHS that were equipped with military personal protective equipment and seated in an upright posture. These tests used higher velocity and shorter duration floor and seat inputs than were previously used with the goal of producing pelvis and foot/ankle fractures. A total of nine PMHS that were approximately midsize in stature and mass were equally allocated across three loading conditions, including a 15.5 m/s, 2.5 ms time-to-peak (TTP) floor velocity pulse with a 10 m/s, 7.5 ms TTP seat pulse; a 13 m/s, 2.5 ms TTP floor pulse with a 9.0 m/s, 5 ms TTP seat pulse; and a 10 m/s, 2.5 ms TTP floor pulse with a 6.5 m/s, 7.5 ms TTP seat pulse. In the first two conditions, the seat was padded with a ~ 120-mm-thick foam cushion to elongate the pulse experienced by the PMHS. Of the nine PMHS tests, five resulted in pelvic ring fractures, five resulted in a total of eight foot/ankle fractures (i.e., two unilateral and three bilateral fractures), and one produced a femur fracture. Test results were used to develop corridors describing the variability in kinematics and in forces applied to the feet, forces applied to the pelvis and buttocks in rigid seat tests, and in forces applied to the seat foam in padded seat tests. These corridors and the body-region specific injury/no-injury response data can be used to assess the performance and predictive capability of anthropomorphic test devices and computational models used as human surrogates in simulated UBB testing.

Anatomically-based skeletal coordinate systems for use with impact biomechanics data intended for anthropomorphic test device development.

Post-mortem human subjects (PMHS) are frequently used to characterize biomechanical response and injury tolerance of humans to various types of loading by means of instrumentation installed directly on the skeleton. Data extracted from such tests are often used to develop and validate anthropomorphic test devices (ATDs), which function as human surrogates in tests for injury assessment. Given that the location and orientation of installed instrumentation differs between subjects, nominally similar measurements made on different PMHS must be transformed to standardized, skeletal-based local coordinate systems (LCS) before appropriate data comparisons can be made. Standardized PMHS LCS that correspond to ATD instrumentation locations and orientations have not previously been published. This paper introduces anatomically-defined PMHS LCS for body regions in which kinematic measurements are made using ATDs. These LCS include the head, sternum, single vertebrae, pelvis, femurs (distal and proximal), and tibiae (distal and proximal) based upon skeletal landmarks extracted from whole body CT scans. The proposed LCS provide a means to standardize the reporting of PMHS data, and facilitate both the comparison of PMHS impact data across institutions and the application of PMHS data to the development and validation of ATDs.

Kinematic and Biomechanical Response of Post-Mortem Human Subjects Under Various Pre-Impact Postures to High-Rate Vertical Loading Conditions.

Limited data exist on the injury tolerance and biomechanical response of humans to high-rate, under-body blast (UBB) loading conditions that are commonly seen in current military operations, and there are no data examining the influence of occupant posture on response. Additionally, no anthropomorphic test device (ATD) currently exists that can properly assess the response of humans to high-rate UBB loading. Therefore, the purpose of this research was to examine the response of post-mortem human surrogates (PMHS) in various seated postures to high-rate, vertical loading representative of those conditions seen in theater. In total, six PMHS tests were conducted using loading pulses applied directly to the pelvis and feet of the PMHS: three in an acute posture (foot, knee, and pelvis angles of 75°, 75°, and 36°, respectively), and three in an obtuse posture (15° reclined torso, and foot, knee, and pelvis angles of 105°, 105°, and 49.5°, respectively). Tests were conducted with a seat velocity pulse that peaked at ~4 m/s with a 30-40 ms time to peak velocity (TTP) and a floor velocity that peaked at 6.9-8.0 m/s (2-2.75 ms TTP). Posture condition had no influence on skeletal injuries sustained, but did result in altered leg kinematics, with leg entrapment under the seat occurring in the acute posture, and significant forward leg rotations occurring in the obtuse posture. These data will be used to validate a prototype ATD meant for use in high-rate UBB loading scenarios.

Validation of a parametric finite element human femur model.

OBJECTIVE: Finite element (FE) models with geometry and material properties that are parametric with subject descriptors, such as age and body shape/size, are being developed to incorporate population variability into crash simulations. However, the validation methods currently being used with these parametric models do not assess whether model predictions are reasonable in the space over which the model is intended to be used. This study presents a parametric model of the femur and applies a unique validation paradigm to this parametric femur model that characterizes whether model predictions reproduce experimentally observed trends. METHODS: FE models of male and female femurs with geometries that are parametric with age, femur length, and body mass index (BMI) were developed based on existing statistical models that predict femur geometry. These parametric FE femur models were validated by comparing responses from combined loading tests of femoral shafts to simulation results from FE models of the corresponding femoral shafts whose geometry was predicted using the associated age, femur length, and BMI. The effects of subject variables on model responses were also compared with trends in the experimental data set by fitting similarly parameterized statistical models to both the results of the experimental data and the corresponding FE model results and then comparing fitted model coefficients for the experimental and predicted data sets. RESULTS: The average error in impact force at experimental failure for the parametric models was 5%. The coefficients of a statistical model fit to simulation data were within one standard error of the coefficients of a similarly parameterized model of the experimental data except for the age parameter, likely because material properties used in simulations were not varied with specimen age. In simulations to explore the effects of femur length, BMI, and age on impact response, only BMI significantly affected response for both men and women, with increasing BMI producing higher impact forces. CONCLUSIONS: Impactor forces from simulations, on average, matched experimental values at the time of failure. In addition, the simulations were able to match the trends in the experimental data set.

Optimizing Seat Belt and Airbag Designs for Rear Seat Occupant Protection in Frontal Crashes.

Recent field data have shown that the occupant protection in vehicle rear seats failed to keep pace with advances in the front seats likely due to the lack of advanced safety technologies. The objective of this study was to optimize advanced restraint systems for protecting rear seat occupants with a range of body sizes under different frontal crash pulses. Three series of sled tests (baseline tests, advanced restraint trial tests, and final tests), MADYMO model validations against a subset of the sled tests, and design optimizations using the validated models were conducted to investigate rear seat occupant protection with 4 Anthropomorphic Test Devices (ATDs) and 2 crash pulses. The sled tests and computer simulations were conducted with a variety of restraint systems including the baseline rear-seat 3-point belt, 3-point belts with a pre-tensioner, load limiter, dynamic locking tongue, 4-point belts, inflatable belts, Bag in Roof (BiR) concept, and Self Conforming Rear seat Air Bag (SCaRAB) concept. The results of the first two sled series demonstrated that the baseline 3-point belt system are associated with many injury measures exceeding injury assessment reference values (IARVs); showed the significance of crash pulse and occupant size in predicting injury risks; and verified the potential need of advanced restraint features for better protecting the rear-seat occupants. Good correlations between the tests and simulations were achieved through a combination of optimization and manual fine-tuning, as determined by a correlation method. Parametric simulations showed that optimized belt-only designs (3-point belt with pre-tensioner and load limiter) met all of the IARVs under the soft crash pulse but not the severe crash pulse, while the optimized belt and SCaRAB design met all the IARVs under both the soft and severe crash pulses. Two physical prototype restraint systems, namely an "advanced-belt only" design and an "advanced-belt and SCaRAB" design, were then tested in the final sled series. With the soft crash pulse, both advanced restraint systems were able to reduce all the injury measures below the IARVs for all four ATDs. Both advanced restraint systems also effectively reduced almost all the injury measures for all ATDs under the severe crash pulse, except for the THOR. The design with the advanced-belt and SCaRAB generally provided lower injury measures than those using the advanced belt-only design. This study highlighted the potential benefit of using advanced seatbelt and airbag systems for rear-seat occupant protection in frontal crashes.

Development, Evaluation, and Sensitivity Analysis of Parametric Finite Element Whole-Body Human Models in Side Impacts.

Occupant stature and body shape may have significant effects on injury risks in motor vehicle crashes, but the current finite element (FE) human body models (HBMs) only represent occupants with a few sizes and shapes. Our recent studies have demonstrated that, by using a mesh morphing method, parametric FE HBMs can be rapidly developed for representing a diverse population. However, the biofidelity of those models across a wide range of human attributes has not been established. Therefore, the objectives of this study are 1) to evaluate the accuracy of HBMs considering subject-specific geometry information, and 2) to apply the parametric HBMs in a sensitivity analysis for identifying the specific parameters affecting body responses in side impact conditions. Four side-impact tests with two male post-mortem human subjects (PMHSs) were selected to evaluate the accuracy of the geometry and impact responses of the morphed HBMs. For each PMHS test, three HBMs were simulated to compare with the test results: the original Total Human Model for Safety (THUMS) v4.01 (O-THUMS), a parametric THUMS (P-THUMS), and a subject-specific THUMS (S-THUMS). The P-THUMS geometry was predicted from only age, sex, stature, and BMI using our statistical geometry models of skeleton and body shape, while the S-THUMS geometry was based on each PMHS's CT data. The simulation results showed a preliminary trend that the correlations between the PTHUMS- predicted impact responses and the four PMHS tests (mean-CORA: 0.84, 0.78, 0.69, 0.70) were better than those between the O-THUMS and the normalized PMHS responses (mean-CORA: 0.74, 0.72, 0.55, 0.63), while they are similar to the correlations between S-THUMS and the PMHS tests (mean-CORA: 0.85, 0.85, 0.67, 0.72). The sensitivity analysis using the PTHUMS showed that, in side impact conditions, the HBM skeleton and body shape geometries as well as the body posture were more important in modeling the occupant impact responses than the bone and soft tissue material properties and the padding stiffness with the given parameter ranges. More investigations are needed to further support these findings.

A parametric ribcage geometry model accounting for variations among the adult population.

The objective of this study is to develop a parametric ribcage model that can account for morphological variations among the adult population. Ribcage geometries, including 12 pair of ribs, sternum, and thoracic spine, were collected from CT scans of 101 adult subjects through image segmentation, landmark identification (1016 for each subject), symmetry adjustment, and template mesh mapping (26,180 elements for each subject). Generalized procrustes analysis (GPA), principal component analysis (PCA), and regression analysis were used to develop a parametric ribcage model, which can predict nodal locations of the template mesh according to age, sex, height, and body mass index (BMI). Two regression models, a quadratic model for estimating the ribcage size and a linear model for estimating the ribcage shape, were developed. The results showed that the ribcage size was dominated by the height (p=0.000) and age-sex-interaction (p=0.007) and the ribcage shape was significantly affected by the age (p=0.0005), sex (p=0.0002), height (p=0.0064) and BMI (p=0.0000). Along with proper assignment of cortical bone thickness, material properties and failure properties, this parametric ribcage model can directly serve as the mesh of finite element ribcage models for quantifying effects of human characteristics on thoracic injury risks.

Development and Validation of an Older Occupant Finite Element Model of a Mid-Sized Male for Investigation of Age-related Injury Risk.

The aging population is a growing concern as the increased fragility and frailty of the elderly results in an elevated incidence of injury as well as an increased risk of mortality and morbidity. To assess elderly injury risk, age-specific computational models can be developed to directly calculate biomechanical metrics for injury. The first objective was to develop an older occupant Global Human Body Models Consortium (GHBMC) average male model (M50) representative of a 65 year old (YO) and to perform regional validation tests to investigate predicted fractures and injury severity with age. Development of the GHBMC M50 65 YO model involved implementing geometric, cortical thickness, and material property changes with age. Regional validation tests included a chest impact, a lateral impact, a shoulder impact, a thoracoabdominal impact, an abdominal bar impact, a pelvic impact, and a lateral sled test. The second objective was to investigate age-related injury risks by performing a frontal US NCAP simulation test with the GHBMC M50 65 YO and the GHBMC M50 v4.2 models. Simulation results were compared to the GHBMC M50 v4.2 to evaluate the effect of age on occupant response and risk for head injury, neck injury, thoracic injury, and lower extremity injury. Overall, the GHBMC M50 65 YO model predicted higher probabilities of AIS 3+ injury for the head and thorax.

A statistical skull geometry model for children 0-3 years old.

Head injury is the leading cause of fatality and long-term disability for children. Pediatric heads change rapidly in both size and shape during growth, especially for children under 3 years old (YO). To accurately assess the head injury risks for children, it is necessary to understand the geometry of the pediatric head and how morphologic features influence injury causation within the 0-3 YO population. In this study, head CT scans from fifty-six 0-3 YO children were used to develop a statistical model of pediatric skull geometry. Geometric features important for injury prediction, including skull size and shape, skull thickness and suture width, along with their variations among the sample population, were quantified through a series of image and statistical analyses. The size and shape of the pediatric skull change significantly with age and head circumference. The skull thickness and suture width vary with age, head circumference and location, which will have important effects on skull stiffness and injury prediction. The statistical geometry model developed in this study can provide a geometrical basis for future development of child anthropomorphic test devices and pediatric head finite element models.

Development and Validation of Statistical Models of Femur Geometry for Use with Parametric Finite Element Models.

Statistical models were developed that predict male and female femur geometry as functions of age, body mass index (BMI), and femur length as part of an effort to develop lower-extremity finite element models with geometries that are parametric with subject characteristics. The process for developing these models involved extracting femur geometry from clinical CT scans of 62 men and 36 women, fitting a template finite element femur mesh to the surface geometry of each patient, and then programmatically determining thickness at each nodal location. Principal component analysis was then performed on the thickness and geometry nodal coordinates, and linear regression models were developed to predict principal component scores as functions of age, BMI, and femur length. The average absolute errors in male and female external surface geometry model predictions were 4.57 and 4.23 mm, and the average absolute errors in male and female thickness model predictions were 1.67 and 1.74 mm. The average error in midshaft cortical bone areas between the predicted geometries and the patient geometries was 4.4%. The average error in cortical bone area between the predicted geometries and a validation set of cadaver femur geometries across 5 shaft locations was 2.9%.

Modeling the injury prevention impact of mandatory alcohol ignition interlock installation in all new US vehicles.

OBJECTIVES: We estimated the injury prevention impact and cost savings associated with alcohol interlock installation in all new US vehicles. METHODS: We identified fatal and nonfatal injuries associated with drinking driver vehicle crashes from the Fatality Analysis Reporting System and National Automotive Sampling System's General Estimates System data sets (2006-2010). We derived the estimated impact of universal interlock installation using an estimate of the proportion of alcohol-related crashes that were preventable in vehicles < 1 year-old. We repeated this analysis for each subsequent year, assuming a 15-year implementation. We applied existing crash-induced injury cost metrics to approximate economic savings, and we used a sensitivity analysis to examine results with varying device effectiveness. RESULTS: Over 15 years, 85% of crash fatalities (> 59 000) and 84% to 88% of nonfatal injuries (> 1.25 million) attributed to drinking drivers would be prevented, saving an estimated $342 billion in injury-related costs, with the greatest injury and cost benefit realized among recently legal drinking drivers. Cost savings outweighed installation costs after 3 years, with the policy remaining cost effective provided device effectiveness remained above approximately 25%. CONCLUSIONS: Alcohol interlock installation in all new vehicles is likely a cost-effective primary prevention policy that will substantially reduce alcohol-involved crash fatalities and injuries, especially among young vulnerable drivers.

Effects of obesity on occupant responses in frontal crashes: a simulation analysis using human body models.

The objective of this study is to investigate the effects of obesity on occupant responses in frontal crashes using whole-body human finite element (FE) models representing occupants with different obesity levels. In this study, the geometry of THUMS 4 midsize male model was varied using mesh morphing techniques with target geometries defined by statistical models of external body contour and exterior ribcage geometry. Models with different body mass indices (BMIs) were calibrated against cadaver test data under high-speed abdomen loading and frontal crash conditions. A parametric analysis was performed to investigate the effects of BMI on occupant injuries in frontal crashes based on the Taguchi method while controlling for several vehicle design parameters. Simulations of obese occupants predicted significantly higher risks of injuries to the thorax and lower extremities in frontal crashes compared with non-obese occupants, which is consistent with previous field data analyses. These higher injury risks are mainly due to the increased body mass and relatively poor belt fit caused by soft tissues for obese occupants. This study demonstrated the feasibility of using a parametric human FE model to investigate the obesity effects on occupant responses in frontal crashes.

Comparing the effects of age, BMI and gender on severe injury (AIS 3+) in motor-vehicle crashes.

BACKGROUND: The effects of age, body mass index (BMI) and gender on motor vehicle crash (MVC) injuries are not well understood and current prevention efforts do not effectively address variability in occupant characteristics. OBJECTIVES: (1) Characterize the effects of age, BMI and gender on serious-to-fatal MVC injury. (2) Identify the crash modes and body regions where the effects of occupant characteristics on the numbers of occupants with injury is largest, and thereby aid in prioritizing the need for human surrogates that represent different types of occupant characteristics and adaptive restraint systems that consider these characteristics. METHODS: Multivariate logistic regression was used to model the effects of occupant characteristics (age, BMI, gender), vehicle and crash characteristics on serious-to-fatal injuries (AIS 3+) by body region and crash mode using the 2000-2010 National Automotive Sampling System (NASS-CDS) dataset. Logistic regression models were applied to weighted crash data to estimate the change in the number of annual injured occupants with AIS 3+ injury that would occur if occupant characteristics were limited to their 5th percentiles (age≤17 years old, BMI≤19kg/m(2)) or male gender. RESULTS: Limiting age was associated with a decrease in the total number of occupants with head [8396, 95% CI 6871-9070] and thorax injuries [17,961, 95% CI 15,960-18,859] across all crash modes, decreased occupants with spine [3843, 95% CI 3065-4242] and upper extremity [3578, 95% CI 1402-4439] injuries in frontal and rollover crashes and decreased abdominal [1368, 95% CI 1062-1417] and lower extremity [4584, 95% CI 4012-4995] injuries in frontal impacts. The age effect was modulated by gender with older females more likely to have thorax and upper extremity injuries than older males. Limiting BMI was associated with 2069 [95% CI 1107-2775] fewer thorax injuries in nearside crashes, and 5304 [95% CI 4279-5688] fewer lower extremity injuries in frontal crashes. Setting gender to male resulted in fewer occupants with head injuries in farside crashes [1999, 95% CI 844-2685] and fewer thorax [5618, 95% CI 4212-6272], upper [3804, 95% CI 1781-4803] and lower extremity [2791, 95% CI 2216-3256] injuries in frontal crashes. Results indicate that age provides the greater relative contribution to injury when compared to gender and BMI, especially for thorax and head injuries. CONCLUSIONS: Restraint systems that account for the differential injury risks associated with age, BMI and gender could have a meaningful effect on injury in motor-vehicle crashes. Computational models of humans that represent older, high BMI, and female occupants are needed for use in simulations of particular types of crashes to develop these restraint systems.

Kinematics of pediatric crash dummies seated on vehicle seats with realistic belt geometry.

OBJECTIVE: A series of sled tests was performed using vehicle seats and Hybrid-III 6-year-old (6YO) and 10YO anthropomorphic test devices (ATDs) to explore possibilities for improving occupant protection for children who are not using belt-positioning booster seats. METHODS: Cushion length was varied from production length of 450 mm to a shorter length of 350 mm. Lap belt geometry was set to rear, mid, and forward anchorage locations that span the range of lap belt angles found in vehicles. Six tests each were performed with the 6YO and 10YO Hybrid III ATDs. One additional test was performed using a booster seat with the 6YO. The ATDs were positioned using an updated version of the University of Michigan Transportation Research Institute (UMTRI) seating procedure that positions the ATD hips further forward with longer seat cushions to reflect the effect of cushion length on posture that has been measured with child volunteers. ATD kinematics were evaluated using peak head excursion, peak knee excursion, the difference between peak head and peak knee excursion, and the maximum torso angle. RESULTS: Shortening the seat cushion improved kinematic outcomes, particularly for the 10YO. Lap belt geometry had a greater effect on kinematics with the longer cushion length, with mid or forward belt geometries producing better kinematics than the rearward belt geometry. The worst kinematics for both ATDs occurred with the long cushion length and rearward lap belt geometry. The improvements in kinematics from shorter cushion length or more forward belt geometry are smaller than those provided by a booster seat. CONCLUSIONS: The results show potential benefits in occupant protection from shortening cushion length and increasing lap belt angles, particularly for children the size of the 10YO ATD.

A statistical human rib cage geometry model accounting for variations by age, sex, stature and body mass index.

In this study, we developed a statistical rib cage geometry model accounting for variations by age, sex, stature and body mass index (BMI). Thorax CT scans were obtained from 89 subjects approximately evenly distributed among 8 age groups and both sexes. Threshold-based CT image segmentation was performed to extract the rib geometries, and a total of 464 landmarks on the left side of each subject׳s ribcage were collected to describe the size and shape of the rib cage as well as the cross-sectional geometry of each rib. Principal component analysis and multivariate regression analysis were conducted to predict rib cage geometry as a function of age, sex, stature, and BMI, all of which showed strong effects on rib cage geometry. Except for BMI, all parameters also showed significant effects on rib cross-sectional area using a linear mixed model. This statistical rib cage geometry model can serve as a geometric basis for developing a parametric human thorax finite element model for quantifying effects from different human attributes on thoracic injury risks.

Modeling the impact of rescinding Michigan's primary and secondary seat belt laws on death and injury from passenger vehicle crashes.

BACKGROUND: Seat belts are the most effective method of decreasing fatal and nonfatal motor vehicle crash injury. Advocacy groups have recently been successful in enacting repeals of mandatory motorcycle helmet laws in several states. In some states, this has prompted renewed efforts aimed at repealing mandatory seat belt laws. PURPOSE: To evaluate and quantify the potential impact of rescinding seat belt laws on annual crash-related fatalities, nonfatal injuries, and associated economic costs, using Michigan as a model, to inform the national debate. METHODS: Proportional injury rates were calculated utilizing police-reported statewide passenger vehicle crash data from 1999 and 2002, where belt use rates approximate estimates associated with repeal of primary and secondary seat belt laws. Proportional rates were applied to the most recent year of crash data (2011) to estimate changes in statewide fatalities and nonfatal injuries. National cost estimates were applied to injury data to calculate associated economic costs. RESULTS: Full repeal of the seat belt law is estimated to result in an additional 163 fatalities, 13,722 nonfatal injuries, and an associated societal cost of $1.6 billion annually. Repeal of the primary seat belt law only is estimated to result in an additional 95 fatalities, 9156 nonfatal injuries, and an associated societal cost of $1.0 billion annually. CONCLUSIONS: This analysis suggests that repealing the either the primary or full seat belt law would have a substantial and negative impact on public health, increasing motor vehicle crash related fatality, nonfatal injury, and associated economic costs.