that countermeasures involving the third approach are the most effective because individual behavior is minimally affected. Indeed, groups at highest risk of injury are often the least likely to alter their behavior in response to education or legislative mandate.

The potential success of programs and policies aimed at changing risky behavior should not be underestimated. Research is needed on behavioral risk factors related to injury in order to develop and improve effective interventions.

Another conclusion that can be drawn from the literature is that comparatively little is known about the risk factors associated with falls; possible countermeasures are rarely researched (National Research Council, 1985). Falls rank highest among all nonfatal injuries in both incidence and cost, and constitute a leading cause of disabling conditions in the United States; nevertheless, there is limited information about the risk factors associated with falls (National Research Council, 1985).

More research is needed to identify and improve our understanding of risk factors associated with falls and to develop effective countermeasures that would reduce the number and severity of falls. Necessary elements of such an approach include research, regulatory change, and public education.

Finally, the abuse of alcohol and drugs is known to be a major contributor to injuries of all etiology. As will be discussed in later sections, alcohol and drug use can also play an important role in recovery from major trauma in the acute and rehabilitation phases.

Research is needed to develop and implement a comprehensive, coordinated approach to reducing the number of injuries resulting from alcohol and drug abuse. A coordinated approach should involve new legislation, regulatory change, and public education.

A SYSTEMS APPROACH TO ACUTE CARE AND REHABILITATION

Although primary prevention efforts should be given highest priority, there is also a need to ensure that people who survive potentially disabling injury receive adequate acute care and rehabilitation. Meeting this need is particularly important because of the growing number of survivors who sustain severe injuries that result in significant physical and cognitive impairment, and for whom the prevention of secondary conditions is important.



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