The Three-Second Choice: Buckle Up or Risk Becoming a Backseat Bullet

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Two days ago, my friend faced a three-second choice he'll regret forever: the choice to buckle his rear seatbelt. Three seconds...that's all it would have taken. While being driven from Delhi to Agra in broad daylight, his driver dozed off and hit the vehicle ahead. In that instant, my friend became a "backseat bullet," ejected through the windshield with devastating force. The result? Severe facial lacerations, broken ribs, and a cervical spine injury that will affect him for life...all because of those three seconds he didn't take to buckle up.

What happened to my friend isn't rare. In front-impact collisions, unrestrained rear passengers are often ejected through the windshield. Worse, if the person being ejected is behind the driver or there's another person in front, even seatbelt-wearers can be killed or injured by the force of this human missile...this "backseat bullet" [1].

The irony: this wasn't an uneducated person making a risky choice. My friend, like many victims of such accidents, is well-educated and aware of safety principles. So why do so many of us…doctors, lawyers, engineers, other educated professionals, smart businessmen…consistently ignore wearing rear seatbelts? There are many reasons.

1. The "it won't happen to me" fallacy: Educated people are particularly susceptible to overconfidence in their judgment.
2. Social awkwardness: Many feel embarrassed to be seen as "overly cautious" in the backseat.
3. False security: The backseat feels safer, leading to a cognitive blind spot.
4. The competence paradox: the more competent someone is professionally, the more they may overestimate their ability to control outcomes in other domains.

Hardly anyone in India wears rear seatbelts. This resistance is particularly lethal on Indian highways. Consider this: 36% of road fatalities occur on highways, despite them constituting just 2% of roads [2], making you 18 times more likely to die on a highway. The data is also clear [3]: in a frontal impact, ejection of the rear passenger due to non-use of a seatbelt is associated with higher mortality than in belted passengers, and the majority of those who die are unbelted. 

Even if you knew these statistics, it probably wouldn’t change behavior. Why? Several systemic and cultural factors contribute to our resistance:

1. Infrastructure Issues:
   1. Most Indian cars have rear seatbelts buried in seats or with non-functional tongues or buckles, creating a perfect excuse for non-compliance.
2. Cultural Norms:
   1. In India, people see rear seatbelt use as "excessive" or "paranoid".
   2. Foreign tourists routinely demand working seatbelts, while locals rarely do.
3. Enforcement Gaps:
   1. Enforcement briefly surges after high-profile accidents (like Cyrus Mistry's death) but quickly fades.
   2. Police focus on urban areas with low speeds, not highways where the risk is 18 times higher.

Breaking these patterns requires more than just knowing the risks. Here are three practical steps that could save your life:

1. Make it a non-negotiable habit: Make those three seconds count every time you get into a car's backseat, whether for work, shopping, or just across town. Make buckling up in the rear seat so automatic that you feel naked without it.
2. Take responsibility for your safety: 
   1. DO NOT hesitate to tell the driver to drive slowly, without jerks, and without tailgating. Your life matters more than social awkwardness.
   2. DO NOT be driven at night, unless you’re in a busy city and can’t drive fast...and NEVER on highways outside the city. Stay overnight and leave at first daylight.
   3. DO NOT think that overnight sleeper buses are safer. They’re equally dangerous...and you have no control over the driver.
3. Vote with your wallet: Many car services provide cars with working rear seatbelts because foreign tourists demand them. Choose these providers and make it clear that working rear seatbelts influenced your choice.

Last year, I posed this question in my Nov 2023 article on road safety in India where I put together a safety guide as well.

What is the point of being physically active, eating sensibly, sleeping well, taking vaccines, not smoking, etc, if you get knocked down while walking or are involved in a car accident while driving or being driven and sustain a grievous injury or die?

This rear seatbelt paradox is perhaps the clearest example of this disconnect…three seconds of inaction could negate all our atmasvasth efforts to live long, healthy.

Rule 138(3) of the Central Motor Vehicle Rules (CMVR) mandates rear seatbelt use, but enforcement is nearly non-existent in India. This may change in the next few years, as with front seatbelt and drunk driving laws and their near-universal enforcement, but you can’t wait for enforcement to catch up. 

Just wear a seatbelt each time you get into a car. Remember: those three seconds could mean the difference between life and death...between health and permanent disability.

Footnotes

1. Mayrose J et al. Influence of the unbelted rear-seat passenger on driver mortality: "the backseat bullet". Acad Emerg Med. 2005 Feb;12(2):130-4. doi: 10.1197/j.aem.2004.09.017. 
2. https://tripc.iitd.ac.in/assets/publication/RSI_2023_web.pdf
3. Pressley JC, Gatollari HJ, Liu C. Rear-seat seatbelt laws and restraint use in rear-seated teen passengers traveling in passenger vehicles involved in a fatal collision on a US roadway. J Trauma Acute Care Surg. 2016 Oct;81(4 Suppl 1):S36-43. doi: 10.1097/TA.0000000000001178.