Are school buses safer with seat-belts? International opinion is divided, writes Eithne Donnellan, Health Correspondent
Given that thousands of children in Ireland and millions around the world travel on school buses every day, the issue of safety on such buses has been a topic of much debate.
Many have asked, particularly following school bus crashes when fatalities are likely to be in multiples, whether the children and adolescents travelling on them would be safer if they wore seat-belts.
Installing seat-belts on school buses is not a new idea, and much research has been conducted into whether they should be made mandatory.
There is a wealth of research in particular from across North America on this subject and surprisingly, according to Canada's Safety Council, no safety benefit has ever been proved.
"In fact, crash tests have shown seat-belts could create more drawbacks than advantages," it says.
In 1984 Transport Canada crash-tested three sizes of school bus, each containing unbelted and belted test dummies. The tests indicated that the use of a lap belt on forward-facing seats could increase the risk of head injuries during a severe frontal collision.
In a head-on collision, the most common type of school bus crash, the occupant's head could hit the seat in front, resulting in severe or fatal head and neck injuries.
Further doubt was cast on the benefits by a 1999 study from the US National Transportation Safety Board which suggested that adding seat-belts to school buses would cause additional head injuries and probably additional deaths in some crashes.
Lap seat-belts, by holding a child's pelvis firmly in place, allowed the torso to crack like a whip, with the head striking a seat back or a hard object with greater force than if the whole body had been thrown, it said.
It found the evidence ambiguous enough to avoid recommending seat-belts on school buses, but was also not persuaded to endorse taking them out of buses where they were already fitted.
On the other hand another study, this time from the US National Research Council in 1999, estimated that if half of all schoolchildren on buses were using seat belts, the number of deaths and injuries could be reduced by 20 per cent.
New York, New Jersey and Florida now require new buses to have seat-belts, but only New Jersey and Florida require students to use them.
In Britain all new buses and coaches carrying three or more children on an organised trip must be fitted with seat-belts, either three-point or lap type.
The debate on whether or not we should have seat-belts on school buses in the Republic has mainly been in the political arena. However, a report published in the Irish Medical Journal in 2003 questioned the use of lap seat-belts by children and adolescents. It said children and adolescents who were restrained in cars by these or by poorly fitted three-point seat-belts were at "excessive" risk of suffering serious back or internal injuries if involved in a road traffic accident.
It said that, on average, 10 per cent of children in a road traffic accident while wearing a lap seat-belt will suffer a fracture to the spine.
Dr Alf Nicholson, a consultant paediatrician at Our Lady of Lourdes Hospital in Drogheda, claims that, just as seat-belts save children's lives in cars, they will save children's lives on buses.
They should be compulsory in all school buses, and children should be encouraged to wear them, he believes.
These should be shoulder belts, not lap belts, he stresses, so that they spread the force of any impact.
"I would have to say from my knowledge of it that there is little doubt that injuries would be lessened if seat-belts were worn on buses. I would say it is a mathematical certainty," Dr Nicholson said.
"It's terrible to think that a huge tragedy of this scale is the reason we are now considering adopting this approach when it should have been done long ago," he said.
His colleague Dr Niall O'Connor, an A&E consultant in Drogheda, said on Monday that the absence of seat-belts on the bus which had crashed outside Navan earlier that day, killing five schoolgirls and injuring many others, might have "potentially contributed to the seriousness of the injuries".
The Irish Medical Organisation, which represents nearly 6,000 doctors in the Republic, called earlier this year for the introduction of legislation to ensure seat-belts were fitted and work in all buses, including minibuses.
The case for seat-belts in school buses is also endorsed by the American Medical Association, the American Academy of Paediatrics and the American College of Emergency Physicians.
Whether children would use them in school buses if they were fitted is another issue. Research by a Florida university found the majority of students riding in belt-equipped buses did not wear them.
Meanwhile, experts point out that seat-belts are designed for adults and that even the seat-belts in cars are not recommended for use by children under 12 years.
Parents carrying children in cars under this age group are advised to use booster seats to make their children tall enough to use the belts which are fitted. Therefore if belts were to be fitted on school buses ferrying primary-school pupils, it appears special belts or special seats would have to be made.
One of the issues which has been raised in the US in the context of this whole debate is the cost of fitting seat-belts to school buses, and the argument seems to be that, given how few lives are lost in school bus crashes every year compared to other modes of transport, the cost may not be worth it.
The one thing that is clear is that there is still no agreement at international level on whether seat-belt use on school buses should be made compulsory.
Doctors in general seem to believe they should be, but agencies which have conducted extensive research into their use have questioned whether or not it is such a good idea.