American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Statement on Safety Belt Laws and Enforcement

The American College of Surgeons' Committee on Trauma, through its Subcommittee on Injury Prevention and Control, prepared the following Statement on Safety Belt Laws and Enforcement in order to educate surgeons about the important differences between primary and secondary laws and to encourage surgeons to support primary restraint legislation in their respective states.

The statement was approved by the Board of Regents at their June 2003 meeting.

Over 42,000 deaths occur each year on roadways in the U.S., and an estimated 3 million people are injured. Seatbelts have been shown to significantly reduce morbidity and mortality following motor vehicle crashes, but in 2002, only 75 percent of motor vehicle occupants were restrained. Increasing the national seat belt use rate to 90 percent would prevent an estimated 5,536 fatalities, 132,670 injuries, and save the nation $8.8 billion annually. Currently, every state but New Hampshire has seat belt legislation, but only 19 jurisdictions have primary seat belt laws. Primary seat belt laws have been shown to significantly increase seat belt usage.


  • Safety belts are the single most effective safety device in preventing serious injury and death in motor vehicle crashes.
  • Safety belts, when used properly, reduce the risk of fatal injury to front seat passengers by 45 percent and the risk of moderate to severe injury by 50 percent.
  • "Primary" safety belt laws allow a citation to be issued whenever a law enforcement officer observes an unbelted driver or passenger. "Secondary" safety belt laws require the officer to stop a violator for another traffic infraction before being able to issue a citation for not using a safety belt.
  • "Primary" safety belt laws have been shown to increase safety belt use up to 24 percentage points in the year following implementation.
  • Strong legislation and effective enforcement are crucially important to the success of safety belt laws.


The American College of Surgeons supports legislation enacting standards for "primary" safety belt laws and their effective enforcement.


  1. The Presidential Initiative for Increasing Seat Belt Use Nationwide. November 2001. DOT HS 809 349. NHTSA Web site: Accessed 5/6/2003.
  2. Viano DC: Restraint effectiveness, availability and use in fatal crashes: Implications for injury control. J Trauma, 38:538-546, 1995.
  3. Zador PL, Ciccone MA: Automobile driver fatalities in frontal impacts: Air bags compared with manual belts. Am J Pub Hlth, 83:661-666, 1993.
  4. Mitchell JL, Remington PL: Research shows effectiveness of safety belts. WMJ, 100(3):4, 2001.
  5. Evans L: The effectiveness of safety belts in preventing fatalities. Accident Anal Prev, 18:229-241, 1986.
  6. Campbell BJ: Highway Safety in 2010: Compromising among values. In: Stammer ME (ed.): Highway Safety at the Crossroads. New York, NY: American Society of Civil Engineers, p. 279-289, 1988.
  7. National Highway Traffic Safety Administration: The Case for Primary Enforcement of Safety Belt Use Laws. Washington, DC: NHTSA. DOT/HS 808, 32, 1995.
  8. Ulmer RG, Preusser CW, Preusser DF, Cosgrove LA: 1995. Evaluation of California's safety belt law change from secondary to primary enforcement. J Safety Res, 26(4):213-220, 1995.

Reprinted from Bulletin of the American College of Surgeons
Vol.88, No. 9, September 2003