The habit many passengers have of not belting up when seated in the back of a vehicle could have more serious consequences than they imagined. Records from two public hospitals obtained by The Straits Times showed that those who did not do so had more severe injuries in accidents. This finding echoes a recently reported local study, which found that passengers seated in the vehicle's rear, and those travelling during the morning rush hour, may have a higher risk of sustaining severe injuries in an accident.

"Our data showed that in similar accident types, the rear-seat passengers tended to have more severe and more varied injuries when unbuckled," said Dr. Victor Ong, a Senior Consultant at the Emergency Medicine Department at the National University Hospital (NUH). These injuries include thoracic and lumbar spinal injuries, chest and abdominal trauma, and limb fractures, going by the hospital's trauma registry of about 2,600 patients from 2014 to last year. It was a similar story at Khoo Teck Puat Hospital (KTPH).

"Looking at the KTPH trauma registry data of 1^st April 2016 to 31^st March 2017, we found that... none of the back-seat passengers who had severe injuries and a higher risk of death wore seat belts," said Dr. Jerry Goo, a Consultant at the hospital's Department of General Surgery. The more serious injuries suffered by unbuckled rear-seat passengers can be due to a few reasons. Dr. Ong of NUH said that in a head-on collision, unrestrained passengers 'tend to be thrown in the car and become projectiles'.

Sitting in the back can also be a disadvantage in terms of reaction time during an accident. "The front passenger and driver may also react instinctively in a crash and hence may take evasive actions to reduce injury," said Associate Professor Chin Hoong Chor from the National University of Singapore's department of Civil and Environmental Engineering. "Rear passengers are less likely to be aware of the road environment."

Drivers and passengers are required by law to belt up. Motorists found driving without the use of a seat belt can face a fine of $120 and three demerit points. Passengers caught without wearing their seat belts can be fined the same amount. Taxi driver Khairul Azman, 48, knows a seat belt can keep him safe when he is in the driver's seat, but is less concerned about belting up in the back of the car. "It's more comfortable without (a seat belt)." Seat-belt violations here rose from 8,162 cases in 2015 to 9,833 last year, according to the Traffic Police.