Section 24

Seat belts, airbags, and child restraints

All provinces and territories have legislation that requires every occupant of a vehicle to wear a seat belt. All children (including infants) must be secured in appropriate child seats.

Airbags are safety devices that supplement the protection provided by seat belts. They are installed in the steering wheel and front passenger console of most newer-model cars, although there are still vehicles without them. If airbags are present in a vehicle, infants and children age 12 years and younger should sit only in the back seat. In cars without airbags, the back seat is still safest in the event of a crash, as it is likely to be furthest from the point of impact.

A consumer can choose to have the airbag(s) in a vehicle deactivated if the consumer, or a user of the vehicle, is in one of the circumstances listed in Section 24.3, Airbags, or 24.4, Child restraints. Physician documentation of the circumstance is not required. The applicant must indicate on the form that they have read the airbag deactivation brochure and understand the benefits and risks of deactivating the airbag. An application form for deactivation of airbag(s) is available from Transport Canada (see “How to obtain a ‘Declaration of Requirement for Air Bag Deactivation’ Form” at https://tc.canada.ca/en/road-transportation/motor-vehicle-safety/air-bag-deactivation-how-obtain-declaration-requirement-air-bag-deactivation-form). However, depending upon the jurisdiction, there may be a requirement to obtain permission from the local licensing authority rather than from Transport Canada.

Some provincial/territorial legislation allows for medical exemptions from using a seat belt. However, there are no medical circumstances that justify exemption from wearing a seat belt.

Drivers who are uncomfortable wearing a seat belt should be encouraged to use devices such as belt extenders, adjustable seats, adjustable seat belts, and padding to make the seat belt more comfortable.

Correct positioning of the seat belts, techniques such as the “pregnant woman technique” (positioning the seat belt across the hips and below the abdomen), and coaching by occupational therapists and other interveners may facilitate the wearing of seat belts. Medical and paramedical personnel should consider seat belt pressure points when implanting invasive medical devices (e.g., medication pumps, cardiac pacemakers, vagal nerve stimulators, and intravenous entries).

The one factor that is common to those seriously injured as a result of airbag deployment is not their height, weight, sex, or age. Rather, it is their proximity to the airbag when it started to deploy. In particular, infants and children age 12 years or younger are vulnerable to serious injury when an airbag deploys. Hence, children should be placed in the back seat, with an appropriate child seat or restraint.

Deactivating the airbag(s) may be reasonable in the following circumstances.

Drivers:

• A safe sitting distance (25 cm between sternum and the steering wheel) or position cannot be maintained because of scoliosis, achondroplasia, short legs, or an unusual medical condition that has led the physician to inform the person that airbags pose a special risk.

Passengers:

• A safe sitting distance (25 cm between sternum and console) or position cannot be maintained because of scoliosis, Down syndrome with atlantoaxial instability, or an unusual medical condition that has led the physician to inform the person that airbags pose a special risk.
• The passenger is an infant or child with a medical condition that necessitates riding in the front seat for monitoring (see also Section 24.4, Child restraints).
• The passenger is an infant or child and the vehicle does not have back seats.

All Canadian jurisdictions have laws or regulations rendering the use of child restraints obligatory for all children under a given age or height, although the specific age or height may vary from one jurisdiction to another. Proper installation of any child restraint is imperative; unfortunately, however, verification of child seat installation has shown that many parents simply place the restraint system on the back seat without attaching it to the vehicle’s hard points. For example, not attaching the top strap is a frequent error.

Child restraint systems are designed for installation in the rear of the vehicle but in certain circumstances, they may be installed in the front passenger seat. For example, a child may have special needs that require monitoring by the driver. In this situation, the child’s seat should never be placed on the front passenger seat without deactivation of the airbag, which usually requires an exemption granted by the licensing agency (see Section 24.1, Overview, for information about applying for an exemption to allow deactivation). The requirement for deactivation of the airbag should be discussed during parent counselling (e.g., before a child is discharged after a hospital stay).

If a child with special needs requires a customized child restraint system and the prescribed system does not conform to federal safety testing standards, the jurisdiction’s licensing bureau should be consulted to determine whether a formal waiver is required. If such a waiver is required, the treating physician will typically be asked to provide pertinent medical documentation supporting the waiver request.

The literature on the use of seat belts and airbags is vast. Research establishing the beneficial effects of seat belts was conducted mainly over the period 1970–1985. Airbag research is more recent but has followed the same progression. The benefits of restraint systems for vehicle occupants are now taken for granted, and current research is oriented toward improving the restraints and persuading non-users to buckle up (“click it or ticket” initiatives). For further information, consult information on “Road Safety in Canada” provided by Transport Canada (https://tc.canada.ca/en/road-transportation/road-safety-canada).