cation, 1998). The stature of the profession has also improved with the ascension of emergency medicine to full department status in many academic medical centers.

Finally, the profession of emergency nursing has grown and flourished. The field emerged as a nursing specialty around 1970, when the Emergency Nurses Association was formed. By 1997, membership in this organization rose to about 24,000, as did membership in related organizations such as the Society of Trauma Nurses. Emergency nurses practice mostly in the prehospital and acute care setting. They typically are responsible for assessing and initiating care to stabilize and resuscitate patients and for care during transport of critical care patients. The role of the emergency nurse in the prehospital arena is continuing to evolve (Adams and Trimble, 1994).

ROLE OF TRAUMA SYSTEMS IN PRIMARY PREVENTION, SURVEILLANCE, AND RESEARCH

Community-based primary prevention programs have been demonstrated to avert injury-related morbidity and mortality and to reduce health care costs. Trauma care systems have traditionally focused on secondary and tertiary prevention (i.e., efforts to reduce re-injury and to curtail the impact of an injury once it has occurred). Yet consensus has emerged that health professionals who manage trauma patients also should engage in primary prevention to keep an injury from occurring in the first place (U.S. DHHS, 1992; NCIPC, 1993; U.S. DOT, 1996a; Garrison et al., 1997). The rationale for broadening the role of trauma providers to include primary prevention is that these health professionals have unique and direct experience with, and knowledge of, the consequences of injury, as well as a professional obligation to improve health and safety and to control health care costs. After reviewing the biomedical literature on existing and recommended primary prevention activities for out-of-hospital providers (Kinnane et al., 1997), a consensus statement on prevention by the EMS community was prepared under the aegis of the National Association of EMS Physicians. The statement recommended leadership activities and knowledge areas that are either essential or desirable. Some of the leadership activities deemed to be essential were the provision of education to EMS providers on primary injury prevention, the protection of individual EMS providers from injury, and the collection and use of injury data (Garrison et al., 1997). Although a number of primary prevention programs by prehospital. and acute care providers have been implemented in various states or regions, none has been evaluated as yet (Kinnane et al., 1997). The committee suggests that enhanced emphasis be placed on the development and evaluation of prevention programs by these providers, as well as by rehabilitation providers to prevent secondary complications of injuries. Further, the committee believes that primary injury prevention should be incorporated into training curricula and continuing medical education pro-



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