This paper examines 176 passenger car occupants killed in frontal impacts during the first two years of the seat belt use law in the United Kingdom. The analysis concentrates on the 118 belted front seat occupants who were killed describing by body area the pattern of fatal injuries, the injury sources, the continued appropriateness of current crash test procedures, and potential countermeasures to reduce fatalities given high belt use. In fatal frontal crashes the most frequently struck objects were found to be cars and trucks, and in 24 percent of the impacts there was significant underrun of the struck vehicle. Belted drivers had a higher incidence of fatal head and neck injury than belted front seat passengers, and direct contact with the striking vehicle was the leading source of injury. For belted front seat passengers, chest injury as a result of contact with structures within their vehicle was the most frequent fatal injury. About 70 percent of the deaths were judged to be preventable by application of existing technology. Air bags and belt pretensioners were judged to be the countermeasure most likely to reduce deaths of both belted and unbelted occupants in frontal impacts. Undenide guards for the fronts, sides, and rears of trucks are a key to further reducing the deaths of belted front seat occupants.