Traffic accidents are one of the major causes of serious injury and death in America. Every day, orthopaedic surgeons see the tragic aftermath of people who choose to drive while under the influence of alcohol or drugs, or do not wear safety belts.

You can reduce this tragic toll: obey traffic safety rules, drive defensively, keep your vehicle in good mechanical condition, and wear safety belts. Don't drink and drive.

• About 3 in every 10 Americans will be involved in an alcohol-related crash sometime in their lives.
• More than 40,000 people die each year in traffic crashes.
• More Americans between the ages of 4 and 33 die from motor vehicle injuries than from any other cause.
• Traffic accidents account for more fatalities each year than homicides, deaths from work-related accidents or airplane crashes.
• More than half of all road-related fatalities are automobile passengers who might have lived if they had used safety belts.

There are two collisions in every motor vehicle crash. The first occurs when a vehicle strikes an object, but death or injury is most often the result of the second collision. That's when the occupant collides with the interior of the vehicle or collides with the ground as the occupant is thrown out of the vehicle. Ejection from a vehicle occurs 10 times more often to occupants who are unprotected and unrestrained. The best protection for occupants involved in a collision is lap belts and shoulder restraints. In a frontal collision, safety restraints can cut the chance of injury to the head or face by 60 percent.

Virtually every study ever conducted indicates that lap and shoulder belts cut the risk of serious or fatal injury between 40 and 55 percent. Safety belts saved 12,144 lives in 2001. Canada's highway death toll dropped 15 percent in 1988 and 1989, following implementation of a national program that emphasizes the use of safety belts and child safety seats.

Air bags are not a substitute for safety belts. Air bags are designed to inflate only during frontal collisions and are useful only as a supplement to safety belts. They offer no protection during multiple crashes, rollovers or side contact. That's why safety belts must always be worn, even in cars equipped with air bags.

The most common reasons for not using safety belts are based on false assumptions.

• Myth. Safety belts trap occupants in their vehicles, especially in cases of fire and submersion. I'd be better off if I'm thrown clear.
• Fact. Death by incineration or drowning accounts for less than one-tenth of 1 percent of motor-vehicle-related trauma. Most passengers who are ejected from cars die and the majority of them are thrown out through the windshield.
• Myth. Safety belts can cause injuries.
• Fact. It is true that injuries due to safety belts have been reported. But in these infrequent cases, the belt was worn incorrectly or the crash was so severe that the occupant would have been more seriously or fatally injured without a safety belt.
• Myth. Safety belts are important only for long trips and high-speed expressway driving.
• Fact. Three out of every four traffic crashes happen within 25 miles of home and at speeds under 40 miles per hour. Unbelted occupants have been killed at speeds of less than 12 mph-parking-lot speed.

The leading cause of fetal death in a motor vehicle is the death of the mother. The best protection you can offer your unborn child is to wear a lap and shoulder belt whenever you're on the road. Position the lap belt as low as you can under the abdominal bulge, and let the shoulder strap rest between your breasts. Wearing both belts in the right position will not increase the chances of damage to the fetus and can keep you both safe.

Head restraints have cut by half the frequency of neck injuries. Fixed head restraints are nearly twice as effective as adjustable restraints because adjustable head restraints are often left in the down position, where they can't protect someone of average height.

• Traffic crashes are the leading cause of death of children over the age of four years.
• Motor vehicle crashes kill more children in the 1 to 4 years age group than any disease.
• From 1975 through 2001, an estimated 5,085 lives were saved by use of child restraints.
• Restraining children in child safety seats saves lives as well as millions of dollars in treating injuries.

During a crash, a child unrestrained by a safety seat is like a rocket out of control. The child can crash into or through the windshield or violently strike other occupants. Even minor mishaps put children at risk. A recent study showed that 25 percent of the children treated in an emergency room were injured, not in crashes, but in swerves, stops, and turns in cars. Remember, the safety seat must be secured to the vehicle's seat the way the manufacturer has suggested. Otherwise the safety seat also will become a rocket out of control in a collision.

A child held on an adult's lap has a much greater risk of being injured or killed than a child who is secured in a safety seat. Experts refer to the "on-lap" position as the "child-crusher" position. That's because, in a crash, a child is likely to be crushed between the occupant and the dashboard or the windshield.

Being a safe driver yourself is no excuse for you or your child to be unprotected. The careless act of another driver could injure or kill your children. You increase that chance if you hold your children or allow them to move about in the car unrestrained.

Passenger side air bags alone will not protect children in a crash. Children who are standing or kneeling unrestrained in the front compartment of a vehicle are at risk of injury from the inflating air bag.

The law in most states requires that infants and young children be belted into crash-tested safety seats that are appropriate to the child's age and size.

Even the best restraints will not help if they are not properly used. Common mistakes are improper attachment of the restraint to the car or improperly securing the belt around the child.

A child who is accustomed to a safety device from infancy will continue to accept this restriction as a matter of course in later years. As part of their education, children should be permitted to "buckle up" on school buses. The educational and safety benefits of making safety belts available outweigh their costs.

As people age, their reaction time slows; eyesight, particularly at night, decreases; and it is more difficult to deal with distractions. These changes increase the risk of being in a crash. Courses such as the American Association of Retired Persons' (AARP) "55 Alive/ Mature Driving Program" or American Automobile Association's (AAA) "Safe Driving for Mature Operators" can help the experienced driver adapt, maintain, and improve safe driving habits.

• 41 percent of all fatal traffic crashes in 2001 involved someone who was drinking alcohol.
• In 2001, alcohol-related crashes killed 17,448 people. That's an average of one alcohol-related fatality every 30 minutes.
• More than 1.5 million drivers were arrested in 2000 for driving under the influence of alcohol or drugs. That's an arrest rate of 1 for every 130 licensed drivers in the U.S. (2001 figures not yet available.)
• An estimated 30 percent of all people can expect to be involved in an alcohol-related traffic crash some time during their lives.

Alcohol slows reflexes, impairs coordination, and interferes with concentration. That's why many responsible people use the designated-driver method of road safety. It's simple: one person in your party has only non-alcoholic drinks and is the driver for the night. Don't let intoxicated guests drive. Send them home with a friend, in a taxi or invite them to spend the night.

Remember: Don't drink and drive. The least destructive result is that you could lose your driver's license. The most serious outcome is that you can kill yourself-or someone else.

The next time you get behind the wheel, buckle up. Whenever you plan to drive, don't drink. Observe all the rules of safe driving. The best way to stay safe on any road is to Drive It Safe.