I studied for my Masters in orthopaedics in India and then went to Great Britain for further studies in 1991. During my first few weeks into the job, I started seeing a rash on the  side of the neck of patients involved in a vehicular accident. See the figure below.

I had not seen this in India. My senior in training educated me on this. This he said was termed “seat belt sign”. Seat belts are known to prevent 50 to 80 % of deaths in high velocity traffic accidents. However, if this sign is seen on a patient the doctor examining the patient first should be more careful. This sign indicates that the accident was very high velocity and the restraint can cause serious intra abdominal and neck injuries. One should be more aggressive in investigating these patients for internal organ injuries he taught me.

When I returned to India I had this ingrained habit of looking for this sign and never ever found one in last 20 years of my practice. Did I see a lot of high velocity accidents in India? Sure I did, but then realized that hardly anyone wore a seat belt.

Few months ago, I treated a 38 year old guy whose entire family was killed in a highway accident. His wife, only son, brother in law were all killed instantaneously. This guy broke both his thigh bones, pelvis, one elbow and one shoulder. He also had a tear in his liver. He had no seat belt sign. He recovered very slowly from his injuries but went into a severe mental depression for obvious reasons. I discussed the whole accident issue with him. None of the family members were wearing a seat belt! When I quizzed him a bit more he came out with an alarming statement “seat belt is meant only for the driver, isn’t it doctor?” He was aghast when I explained why a seat belt is mandatory for everyone in the car. Today he is back to work but still get nightmares and is under a psychiatrist’s care for his depression.

I then started observing people whenever my car was stationary at a signal. I found an amazing fact. Even the back seat occupants of a 7 series BMW were not wearing a seat belt! Surprisingly most of the drivers of Mercs and BMWs were seen to have their seat belt on, though their owners seating behind had no protection! Most of our cabs do not have a functional seat belt. One of the cab drivers had pulled the belt across the chest and was sitting on the buckle instead of putting it in the clip, answer was typical “police se bachne ke liye hai”!

The last surprise came a week ago. I offered to drop a few of my resident doctors home after a lecture series. Three of the future orthopaedic consultants got into my car but not a single one attempted to put a seat belt on!

India not surprisingly has a very high mortality rate in road traffic accidents…come on guys have you put on your seat belt?