European cars are built to conform to performance requirements that are intended to limit the hostility of various interior car components. However head injuries are frequently sustained by car occupants despite these regulations. This paper examines the circumstances that result in these head injuries to both the survivors and the fatalities. Restrained front seat occupants are analysed separately from unrestrained rear seat occupants. All directions of impact are included.

AIS 3+ head injuries are frequent amongst fatalities although other body areas often have injuries that are equally severe. Survivors sustain AIS 3+ injuries more often to other body areas than the head although they are less likely to have several AIS 3+ injuries.

Glazing materials are highlighted as a very common source of AIS 1 injuries while the roof, steering wheel and pillars account for many of the more severe injuries. Intruding structures are found to be commonly associated with the most severe injuries as are contacts outside the vehicle. Head injuries are found to become more severe when the striking object supports the intruding structure. The value of restraint use by rear seat occupants is raised. The need for a better understanding of the role of intrusion and support from the striking object is stressed.