A time comparison study of motor vehicle crashes in Monroe County, New York, from 1983 to 1986 was completed. Using a database of police accident reports, hospital logs, and autopsy reports from the county coroner, the hospital and autopsy reports of 91 unrestrained and 27 restrained fatally injured victims were reviewed. The hypothesis was that safety belts do not change patterns of injury in fatally injured victims. Patient data, seating position, and direction of impact were the same for both groups, while ejections occurred only in the unrestrained group (19.8%). Injury Severity Score (ISS), major injuries in AIS-85 categories for the Head, Thorax, Abdomen, and in AIS-85 Code 5 or 6 categories for the Head, Thorax, Abdomen were the same in unrestrained and restrained victims, except for the greater incidence of cerebral contusions in the unrestrained group (71% vs. 37%, p = 0.002). Cranial injuries were the most likely cause of death in nearly two thirds of the victims in both groups. The incidence of major head (other than cerebral contusion), thoracic, and abdominal injuries in unrestrained and restrained fatally injured victims was the same. This suggests that severe collisions with crushing, intrusion, or significant deceleration exceed the ability of restraints to prevent many fatal injuries.