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by Dr. Ahmed Abdullah, Centre for Sight, General Hospital, Kandy.

"I am not scared of dying" you say. And do not buckle your seat belts. You think you are smart and clever. Death has nothing to do with your cleverness. What you have forgotten is the grey zone between health and death which is scarier than death itself.

Among the very many reasons for wearing your seat belt the most important one may be that of protecting your eye and avoiding the ever prolonging visits to eye units for repeated surgeries. During a sudden jolt the head will shoot forward and collide with the windscreen. Out of the hundreds of glass fragments, just a small splinter is enough to make you go blind for the rest of your life.

The eye is a delicate organ which cannot tolerate even a small particle of dust inside. Remember the other day when you were walking along the road something went into your eyelids? You were scratching and squeezing your eyes till it came out with tears. To understand the value of safety belt use, it's important to understand some of the dynamics of a crash. Every motor vehicle crash is actually comprised of three collisions.

The vehicle's collision - The first collision known as the vehicle's collision, causes the car to buckle and bend as it hits something and comes to an abrupt stop. This occurs in approximately one-tenth of a second, or the blink of an eye. The crushing of the front end absorbs some of the force of the crash and cushions the rest of the car. As a result, the passenger compartment comes to a more gradual stop than the front of the car.

The human collision - The second collision occurs as the car's occupants hit some part of the vehicle. At the moment of impact, unbelted occupants are still travelling at the vehicle's original speed. Just after the vehicle comes to a complete stop, these unbelted occupants will slam into the steering wheel, the windshield, or some other part of the vehicle's interior. This is the human collision. Another form of human collision is the person-to-person impact. Many serious injuries are caused by unbelted occupants colliding with each other. In a crash, occupants tend to move toward the points of impact, not away from it. People in the front seat are often struck by unbelted rear-seat passengers who have become high-speed projectiles.

The internal collision - Even after the occupant's body comes to a complete stop, the internal organs are still moving forward. Suddenly, these organs hit other organs or the skeletal system. This third collision is the internal collision and often causes serious or fatal injuries.

Properly fastened safety belts distribute the forces of rapid deceleration over the larger and stronger parts of the person's body, such as the chest, hips and shoulders. The safety belt stretches slightly to slow your body down safely and to decrease how far the body travels before coming to a halt. The difference between the belted person's stopping distance and the unbelted person's stopping distance is significant. It's often the difference between life and death!

Do you know what happens in the first fatal second after a car going at 80 KmPH hits a solid object?

* In the first 10th of a second, the front bumper collapses.

* The second 10th finds the hood crumbling, rising and striking the windshield as the spinning rear wheels lift from the ground. Simultaneously, fenders begin wrapping themselves around the solid object. Although the car's frame has been halted, the rest of the car is still going 80 KMPH. Instinct causes the driver to stiffen his legs against the crash, and they snap at the knee joint.

* During the third 10th of the second, the steering wheel starts to disintegrate and the steering column aims for the driver's chest.

* The fourth 10th of the second finds two feet of the car's front end wrecked, while the rear end still moves at 80 KMPH. The driver's body is still travelling at 80 KMPH.

* In the fifth 10th of a second, the driver is impaled on the steering column, and blood rushes into his lungs.

* The sixth 10th of a second, the impact has built up to the point that the driver's feet are ripped out of the tightly laced shoes. The brake pedal breaks off. The car frame buckles in the middle. The driver's head smashes into the windshield as the rear wheels, still spinning, fall back to earth.

* In the Seventh 10th of the second, hinges rip loose, doors fly open and the seats break free, striking the driver from behind. The seat striking the driver does not bother him because he is already dead.

* The last three 10ths of the second mean nothing to the driver.

Strangely there is an astonishing reluctance to wear one's seat belt in Asian countries. Sometimes even if one wishes to wear the driver looks at you offended and says "Why am I not a good driver?" It is not the lack of trust in him but the truth that there is no turning back when one suffers an eye injury. It is not like your teeth that you can replace. It is not like your skin you can do away with a graft from another area in your body. The damage to the eye rarely if at all reverses. One has to live with it for life.

The other day a famous actor was admitted to Centre for Sight Kandy with a horribly lacerated left eye lid and eye brow following a road traffic accident. He had to go through a three hour long surgery needing more than 25 stitches to repair his upper eye lid alone.

Fortunately for him God has decided to save his eye ball. It was a miracle. But had he worn his seat belts he could have saved himself and his surgeon from all that agony.

When a piece of glass enters the eye it perforates the delicate transparent membrane lying over the pupil. This will cause the fluid in the frontal part of the eye to leak. You need stitches to seal it and once it heals it will leave permanent scars on the eye obstructing your vision like a ghost. A few millimetre injury can change the course of your life permanently. It will comfortably decide where you are going to spend a good portion of your future life. One single splinter, if it touches your lens will make it cloudy (cataractous) warranting its removal and replacement by an artificial lens. If this piece penetrates further, after traversing through a jelly like liquid (vitreous) will touch and damage the light sensitive membrane of the inner eye ball (Retina) making you permanently blind.

According to the latest publication from WHO. Five million people have died worldwide due to injuries in year 2000. Out of these approximately 1.2 million people have died of road traffic accidents. Many would have been saved had they put their seat belts.

According to the National Highways Traffic Safety Administration, USA every 12 minutes somebody in the United States dies in a traffic collision. This year, approximately 8,000 Americans, adults and children, will die in crashes simply because they failed to buckle their seat belts. Many who drive vehicles with air bags. ABS and other safety measures have a misconception that these would substitute the need for seat belts. Nothing is far from truth. Without seat belts the passenger will be thrown forward on to a rapidly exploding air bag.

Air bags are designed for frontal impact crashes, the kind of crashes which account for more than half of all passenger vehicle occupant deaths. Air bags are designed to limit head and chest injuries. But they only supplement safety belts, they do not replace them.

During pre-crash braking, an unrestrained passenger may be thrown against the dashboard area, in immediate proximity to an air bag. The airbags inflate at something like 200 miles an hour, and its an explosive event. The closer you are to the steering column, the more impact you'll receive from the inflating airbag. Air bags inflate in less than 1/25th of a second, faster than the blink of an eye, drivers and passengers who are unrestrained or are wearing only the lap portion of their safety belt can receive serious or even fatal injuries from deploying air bags.

Airbags can also cause the loss of fingers or parts of limbs if the driver or passenger is resting his or her hands on the airbag cover - usually in the center of the steering wheel or the right-hand side of the dashboard - at the moment the bag deploys.

Airbags save lives, but they can be hard on the eyes - literally. During a collision, older-model auto airbags can deploy with such force that they can cause serious injuries to the eyes or even, in rare cases, blindness, say eye trauma specialists.

The most common eye injuries seen with airbag deployment are superficial scratches, and burns from the propellant used to inflate the bag. There have been patients with injuries to the retina (the delicate tissue lining the inside of the eye that serves as a screen for transmitting images to the brain), bleeding within the eye, cataracts (clouding of the lens due to trauma), temporary loss of consciousness and visual acuity, rupture of the eyeball itself, and even one case of a young woman who went blind from her injuries. One study found that people most at risk for injury from airbags are those of short-stature, who sit close to the steering wheel.

Therefore if you have airbags, they're only effective if you're wearing a shoulder restraint or a seat belt. The lap portion alone may not protect you sufficiently. The combination of an air bag in addition to a lap and shoulder belt reduces the risk of serious head injury by 81 per cent, compared with 60 per cent reduction for belts alone.

A study published by the American Academy of Ophthalmology concludes that serious eye injuries in children may result from automotive air bag deployment and further puts forth the notion that infants and children are best transported in the rear seats of vehicles in order to minimize their risk of injury. Unrestrained children are at great risk of harm. A child unrestrained in a 50 Km-per-hour crash is like a child dropped from a third story window.

In infants the increased mortality risk results from the use of rear-facing infant car seats in the front passenger seat. This places the infant's head too near the deploying air bag. In older children who are unbelted or who use lap-only seat belts, the head may move forward during impact, resulting in head and neck injuries.

Infants should NEVER ride in the front seat of a vehicle with a passenger air bag. The practice of sitting younger children on the lap of a parent on one of the front seats should not be allowed. Children aged 12 and under should always be properly restrained in a child safety seat or safety belt and ride in the back seat. Even if there isn't a passenger air bag in the motor vehicle, the safest place for infants and children is properly secured and buckled up in the back seat.

For some death is nothing. Somebody else's death is even less than nothing. But everyone will agree that injury, disability and morbidity are something. It is not a supposedly painless state of lifelessness. Rather you are very much alive to the pain, to the suffering and to the discomfort.

It has been found out that nearly 50% of fatal accidents occur within a couple of miles of the victim's home or work place. Therefore it is wiser and safer, whether you are going on a long vacation drive or around the corner to the grocery store to wear your seat belts.

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