Medical Exemptions from Safety Belt Use
| Exemptions to Iowa's
safety belt law are allowed for certain medical reasons. The medical conditions
which may warrant an exemption from safety belt use, recommendations for the issuance of
such medical exemptions, and requirements of the law or regulations concerning medical
exemptions are discussed in the following guidelines issued by the Iowa Department of
Transportation. |
Guidelines
for Exemption
Section 321.445 of the
Code of Iowa, which went into effect July 1, 1986, requires drivers and front seat
occupants of motor vehicles to wear property fastened safety belts. However,
exemptions can be granted to a person possessing a written form signed by a
physician/chiropractor stating that the person is unable to wear a safety belt or harness
due to physical or medical reasons.
The physicians/chiropractors of Iowa have strongly supported
the use of safety belts for many years, recognizing the fact that the mortality and
morbidity incurred by unrestrained drivers and passengers in motor vehicle crashes are
greater than by those properly restrained. Two decades of real world experience have
proven belts prevent or mitigate serious or fatal injuries by about 50 percent. In
Iowa, the use of safety belts could prevent an estimated 100-150 deaths each year.
Experience in countries where belt use is required has shown
that less than one percent of all motor vehicle related injures are caused by the belt per
se. Such injures predominantly occur under conditions where an unrestrained
occupant would be much more seriously injured.
The safety belt law provides no categorical, specific or
routine medical grounds for granting a medical exemption. Each case should be
decided on its own merit. If a medical exemption is granted, it should be issued for
a valid medical reason.
Because of the benefits of using a safety belt,
physicians/chiropractors should weigh very carefully the advantages of reducing the risk
of injury or death to the patient who drives against any medical reason the patient may
give for seeking an exemption from using a safety belt. If a person is fit to be in
control of a vehicle, the evidence indicates he or she is fit to wear a safety belt.
Furthermore, physicians/chiropractors should be extremely reticent in granting
medical exemptions to patients who are primarily passengers. If such patients are
genuinely unable to use a safety belt, or decline to use it, they should be advised, and
strongly urged, to ride in the back seat of the motor vehicle where it may be relatively
safer to ride without a belt.
Safety belt use or nonuse may become evidence in court.
Physicians/chiropractors are encouraged to keep a record of any medical exemption
granted, the reason for it, the date it was granted, and its expiration date.
Medical
Reasons for Exemption
Some of the medical reasons that may be presented by patients
for obtaining a medical exemption include certain musculoskeletal conditions and
deformities, pregnancy, scars, pacemakers, ileostomies or colostomies, conditions of the
breast, disabling conditions, unusual body size or shape, or psychological
conditions. Many of the reasons presented result from lack of knowledge of the
purpose and correct adjustment of the safety belt itself.
- Musculoskeletal
Conditions & Deformities
A correctly applied safety belt should not restrict the motion of patients with
arthritis of the neck and shoulders while driving. If the rotation of the neck is
limited and the trunk cannot be rotated while backing up the motor vehicle because of the
safety belt, the patient may be informed that is is legal to remove the safety belt when
backing up.
Certain severe abdominal skeletal conditions such as rheumatoid spondylitis, ankylosed
major joints, deformity or fusion of the spine or major joints, other gross
musculoskeletal deformities, or orthopedic devices such as body casts, may make it
impossible for the patient to fasten a safety belt properly. In such conditions, a
medical exemption may be considered.
- Ileostomies
& Colostomies
Ileostomies and colostomies in persons of average size and build do not interfere
with the use of a correctly applied safety belt. Persons with ileostomies and
colostomies who have been involved in major vehicle crashes while wearing a safety belt
have occasionally suffered irritation of the exposed mucosa, with some bleeding and even
tearing of the mucosa from the stoma wall caused by sudden constriction by the safety
belt. Such injuries are relatively minor in comparison to what could be expected
from not wearing a safety belt.
- Pregnancy
Based on research to date and experience from countries with compulsory safety
belt use law, pregnancy - no matter at what stage - is not a valid reason for exempting
safety belt use. In studies of belted pregnant women involved in motor vehicle
crashes, it has been shown that there has been no increase in injuries to the fetus, or in
fetal loss or abortion as a result of proper use of a safety belt.
Pregnant women should be instructed to position the belts correctly; the lap part should
lie comfortably below the anterior superior ilac spines and the diagonal part across the
costal margin, the sternum and clavicle. Thus, no part of the harness is allowed to
compress the uterus.
- Pacemakers
Pacemakers are commonly implanted in the right upper part if the anterior chest just below
the clavicle in about 85 percent of the patients, and on the left side in about 15
percent. In general, safety belts do not cause discomfort to the pacemaker wearer or
damage to the pacemaker itself.
If the pacemaker has been recently implanted and the surgical wound is still painful, a
foam pad may be taped to the skin overlying the pacemaker to prevent any irritation while
the safety belt is being used.
Should the wearer of a pacemaker be involved in a motor vehicle crash and the pacemaker
receive a direct blow by the safety belt, the wearer should, as a precaution, have the
pacemaker checked by his or her physician/chiropractor for any malfunction. Such
malfunctions, however, have not been observed clinically or experimentally.
- Scars
Well-healed scars present on the chest or abdominal wall are not harmed by a
correctly positioned safety belt. Occasional irritation and pain have resulted from
prolonged wearing of a safety belt, often too loosely positioned which allows a certain
amount of friction and movement over parts of a scar.
Recent tender or painful scars may require a foam pad taped to the skin to prevent
irritation and pain to the area over which the safety belt lies.
- Disabling Conditions
Physically disabled persons permitted to drive with a restricted driver's license
will benefit from the use of safety belts because of the stabilization provided by the
restraints. The guidelines for musculoskeletal conditions and deformities also apply
to physically disabled persons.
- Conditions of the
Breast
Breast irritation (mastitis) is rarely caused by belt use. When the safety
belt is repositioned or the tension of the safety belt is reduced by use of a comfort clip
or the"window shade" feature, the condition usually is resolved within a short
time.
- Special
Height or Weight Conditions
Persons five feet tall or less may complain that the shoulder harness safety belt
crosses their neck, causing them discomfort. These persons should be referred to
their car dealers for possible adjustment of the height of the seat, installation of a
power seat, or the repositioning of the upper seat belt mounting point using a drop link.
Adjustment of the position or tension of the safety belt with a comfort clip or the
"window shade" feature may also help to alleviate the problem. Persons who
are extremely obese and complain the safety belt does not reach across their abdomen
should be referred to their automobile dealers for medication of the existing belt, a
safety belt extender, or for the belt's replacement with a more appropriate one. If
none of these alternatives are feasible, an exemption may be considered.
- Psychological
Conditions
Patients manifesting severe claustrophobia can often be helped to accept safety
belts by an explanation of the need and reasons for their use. A demonstration of
the use of safety belts as part of the operation of a motor vehicle could serve to
overcome such phobias.
Recommendations
for Exemption
- A medical exemption should only be granted for a sound medical
reason.
- A request for medical exemption must be carefully reviewed and
the patient should be given all possible encouragement to adapt the restraint system to
the patient's conditions (i.e., adjusting the position and height of the car seat, and
adjusting and positioning the safety belt) before making a decision.
- If a medical exemption is granted, a record should be kept by
the physician/chiropractor of the medical reason given by the patient for the exemption,
the documentation of the basis for which the medical exemption was granted, the date it
was granted, and the expiration date.
- For temporary conditions, a medical exemption should be
granted for periods of no more than six months, and renewed as necessary.
- A patient who is primarily a passenger and who is unable or
who categorically refuses to use a safety belt should be advised to ride in the back seat
of motor vehicles.
How
to Obtain an Exemption
- A medical exemption may be granted only by a licensed
physician/chiropractor.
- An
Iowa Medical Safety Belt
Exemption Form #432017, provided by the Iowa
Department of Transportation, must be completed by a physician or chiropractor. The
exemption shall not exceed 12 months, but may be renewed if necessary.
- The patient's name, date of birth and address, the date of
issuance of the exemption, a clear statement of medical exemption from belt use, and the
physician/chiropractor's signature must appear on the certification.
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