Reducing the Burden of Injury Advancing Prevention and Treatment (1999) / Chapter Skim
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Executive Summary
Executive Summary
Pages 1-17
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In this report, the IOM Committee on Injury Prevention and Control characterizes the injury problem in the United States, assesses the current response by the public and private sectors, and presents recommendations for reducing the burden of injury in America.2 1The 1985 cost-of-injury estimates were updated to 1995 separately by type of cost. Direct costs were inflated using the appropriate component of the Consumer Price Index (hospital and related services, physicians' services, prescription drugs, professional medical services, and medical care services)
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The committee decided, unanimously, to reaffirm the views expressed in Injury in America and Injury Control regarding the scope and mission of the injury field. Despite important differences associated with intentionality, the committee strongly endorses the continued integration of all injury prevention activities within a common framework of research and program development.
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The committee believes that an expansion of NEISS data collection to include all injuries treated in emergency departments will increase knowledge of the causes and severity of nonfatal injuries. Furthermore,
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The committee recommends that CPSC expand its NEISS system to gather nationally representative data on all injuries treated in emergency departments, to increase knowledge of the causes and severity of nonfatal injuries. To ensure the success of an expanded NEISS, the CPSC should convene a steering committee (with representation from CPSC, the National Center for Injury Prevention and Control [NCIPC]
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The development of future prevention interventions to address injury and the evaluation of the success of those interventions require a national commitment to expanding the scientific foundation for injury prevention. Support for injury prevention research should be commensurate with the enormous toll of injury on society.
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The committee also recommends intensified research in three promising areas for the injury field, specifically: · the continued development of physical, mathematical, cellular, and biofidelic models of injury, particularly for high-risk populations (such as children and small women) while continuing to use animals and cadavers to validate biomechanical models of inJury; · the pathophysiology and reparative processes necessary to further the understanding of nonfatal injury causes and consequences, in particular, those that result in long-term disability; and · differences in risk perception, Disk taking, and behavioral responses to safety improvements among different segments of the population, particularly among those groups at highest risk of injury.
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The committee recommends the implementation of a comprehensive approach for preventing and reducing firearm injuries that includes firearm surveillance, firearm safety regulation, multidisciplinary research, enforcement of existing restrictions on access by minors and other unlawful purchasers, prevention programs at the state and local levels, and mobilization of public support. A workable political consensus has not yet developed on the balance that should be struck between the prerogatives of firearm ownership and the reduction of firearm-related injuries, especially in a social context in which about 192 million firearms, including 65 million handguns, are in circulation (Cook and Ludwig, 1996~.
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An immediate priority should be a strategic focus on reduction of firearm injuries caused by children and adolescents. To ensure the success of a youth-centered prevention initiative, Congress and relevant federal agencies (e.g., the Departments of Health and Human Services [DHHS]
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About half of the states report having some kind of trauma system, although their nature and extent are not well documented. Some of the most successful statewide trauma systems have flourished with dedicated sources of funding through motor vehicle fees and other creative approaches.
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Consideration should be given by multiple federal agencies to the expansion of training opportunities for state and local injury prevention professionals. The committee recommends the expansion of training opportunities for injury prevention practitioners by the relevant state and federal agencies (e.g., NCIPC, NHTSA, the Maternal and Child Health Bureau [MCHB]
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elevate its existing trauma and burn program to the level of a division. The committee recommends that NIJ continue to give explicit priority to the prevention of violence, especially lethal violence, Within its overall activity in crime prevention research and program evaluation, and that NIJ establish new institutional training grants for violence prevention research at academic institutions.
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The committee believes that the NCIPC should continue to be a focal point for the public health commitment to the injury field (see recommendation in Box 11. However, when Congress enacted the Injury Control Act in 1990, it properly recognized that no single agency could "lead" such a diverse federal effort, and instead authorized the CDC to create a program to "work in cooperation with other Federal agencies, and with public and nonprofit private entities, to promote injury control" (P.L.
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Although there are certainly stellar examples of coordination-for example, between NHTSA and HRSA on the Emergency Medical Services for Children Program, and between CPSC and NCIPC on the expansion of emergency department injury surveillance these examples are more the exception than the rule. An effective federal response to injury requires many agencies to play a leadership role in their areas of strength and jurisdiction.
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Although injury prevention has achieved higher visibility in government at all levels, most of the energy for social action has come from the private sector and through the recruitment of individuals, businesses, foundations, community groups, and other organizations interested in preventing injuries and implementing safety programs. Future advances in the injury field depend on the continued development of the infrastructure of the field through public and private partnerships.
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· Intensify trauma outcomes research, including research on the delivery and financing of acute care services and rehabilitation, through collaboration of HRSA and other appropriate federal agencies (e.g., NCIPC, AHCPR)
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· Support by NIJ for the prevention of violence, especially lethal violence,; and establish new institutional training grants for violence prevention research at academic institutions. ~ · Establish an ongoing and open process for refining NCIPCs research priorities in the areas of biomechanics, residential and recreational Runes, and suicide and violence prevention, in close coordination with its stakeholders~ and federal partners.
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1994. Reflections on a half century of injury control.
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