I was pleased to see the article in the recent OT Practice entitled "School Buses + Safety = Good Idea." (Loveland, 2009). I think it is important for OTs to have a good discussion about ways to promote safety and prevention of child injuries.
There are some additional facts to consider so I wanted to list them here:
1. In the studies cited in the Loveland article, there was an annual average of 17,000 children seen for emergency treatment for school-bus related injuries. However, that number is a little misleading. The study reports that only 42% of those injuries were crash related, so by extrapolation, it is arguable that seat belts would not have made a difference in many of those injuries. In fact, the 17,000 number includes slips and falls outside of the bus, getting on/off the bus, etc (McGeehan, 2006).
3. Study after study shows that compartmentalization works - but it is true that studies also tend to measure the impact of front impact crashes. There is a reason for this - and that is because there has to be some standard for determining safety. It is not reasonable to study every possible rear and side impact configuration because it is impossible to reliably report the result of those impacts. There are just too many variables - size of other vehicle, point of impact, speed of collision, locations of children related to injury distribution within the bus, and many others. People don't like to say it out loud - but the issue may very well relate to diminishing safety benefit in relation to dollars spent, which leads me to the next point.
4. Of course any child injury or any child fatality is one too many - BUT - if we are going to expend resources (money, time, energy, etc.) into injury prevention will our efforts be better served by focusing on causes where there is a MUCH GREATER NEED and where our efforts will HAVE A GREATER IMPACT on reducing injury and fatality? This is a very difficult conversation, and I expect people might get upset about discussing it this way - but it is just a reality. If we spend millions of dollars to save 20 lives a year, could we have saved hundreds of lives by distributing those resources and efforts in a different direction? This is not to diminish the importance of school bus transportation safety - but rather is an important policy question about allocation of resources.