Fighters, which identified four critical factors for prevention, was distributed to every fire department in the nation (NIOSH, 1994). Other influential Alerts were Preventing Homicide in the Workplace and Preventing Deaths and Injuries of Adolescent Workers (NIOSH, 1993, 1995). NIOSH received a special, $5 million earmarked appropriation in FY 1996, a major portion of which was devoted to the establishment of a research and education center to prevent child agricultural injuries at the National Farm Medicine Center in Wisconsin.

NATIONAL INSTITUTES OF HEALTH

The National Institutes of Health ranks as the world's leading institution for biomedical research and training. Originating as a one-room Laboratory of Hygiene in 1887, the 21 institutes and centers that today comprise NIH started to take shape after World War II, under the authority of the Public Health Service Act. Many NIH institutes and centers are organized around specific diseases, such as cancer, neurological diseases, and alcoholism. The monumental scope and reach of NIH is captured in its budget of about $13 billion in FY 1997 (NIH, 1998). This budget is estimated to support 50,000 researchers at 1,700 institutions nationwide (NIH, 1993). NIH's mission is "science in pursuit of fundamental knowledge about the nature and behavior of living systems and the application of that knowledge to extend healthy life and reduce the burdens of illness and disability" (NIH, 1997). The mission is accomplished through a profusion of research, training, public and professional education, and technology transfer activities.

Injury is not the primary focus of any single institute at NIH; rather, there are several discrete programs on injury located within a few institutes, and individual projects are funded across virtually all NIH institutes and centers. The collective effort, totaling less than $200 million, is relatively small by NIH standards (see below). More than 30 years ago, the NRC report Accidental Death and Disability recommended the creation of a separate institute, a proposed "National Institute of Trauma," but it never materialized (NRC, 1966). In 1985, the Institute of Medicine (IOM) considered, but rejected, placement of an injury center or institute at NIH; this report noted that the establishment of a sizable injury center or institute would not be accorded high priority because NIH is generally disinclined to establish new institutes (NRC, 1985). Instead, the 1985 report turned to the CDC for an administrative location in which to place an injury center. However, in light of CDC's resource constraints, and a host of unmet needs in basic and clinical research that only NIH can fulfill, many continue to advocate a stronger role for NIH in injury research and training (Mickel, 1990). By the early 1990s, Congress foresaw the need for a larger commitment by NIH in trauma research by authorizing a new research program, but funds were not allocated.



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