In 1966, the National Research Council (NRC) report Accidental Death and Disability: The Neglected Disease of Modern Society recommended creation of a National Institute of Trauma to sponsor a program of injury treatment research at the National Institutes of Health (NIH); this recommendation has never been implemented. What is needed at this time is a mechanism for coordinating, rationalizing, and strengthening these diverse activities. The most sensible step in this direction is to create a new division within the National Institute of General Medical Sciences and to assign this division the responsibility for conducting trauma care and treatment research. Primary responsibility for trauma systems, development and for outcomes research should be assumed by the Health Resources and Services Administration.

For injury prevention practice and research, spheres of responsibility emerge rather clearly from statutory arrangements and historical practices. The National Highway Traffic Safety Administration (NHTSA) bears primary responsibility for program support and regulation in highway safety, but responsibility for researchin this area has been shared by NHTSA and the National Center for Injury Prevention and Control (NCIPC) in order to take advantage of the stronger scientific tradition of the Centers for Disease Control and Prevention (CDC). In the committee's view, NHTSA's role in supporting safety research should be strengthened through the introduction of peer-reviewed research, while the NCIPC continues to evaluate community safety interventions unaddressed by NHTSA and supports research in biomechanics as one of its highest priorities. Coordination of activities and cooperation between these two agencies is imperative.

The federal role in occupational safety and the responsibilities of the Occupational Safety and Health Administration (OSHA) and the National Institute for Occupational Safety and Health (NIOSH) are well defined by the Occupational Safety and Health Act of 1970. There is little overlap between the missions of these agencies and other federal agencies; however, opportunities to translate knowledge from the occupational setting to other settings, and vice versa, should be improved (e.g., the work of NIOSH and OSHA in violence prevention).

The statutory relationship between NIOSH and OSHA provides a useful model for enhancing cooperation between the NCIPC and the Consumer Product Safety Commission (CPSC). Although CPSC needs the capability provided by its National Electronic Injury Surveillance System (NEISS) to identify, and respond to, product hazards within its regulatory jurisdiction, the agencies should continue their collaborative efforts to study the feasibility of expanding the NEISS system into an all-injury emergency department surveillance system.

The federal investment in preventing lethal violence and suicide should be strengthened through cooperative arrangements between the agencies involved in these areas. Specifically, the National Institute of Justice (NIJ) and NCIPC should coordinate their efforts in violence prevention research, identifying the areas in which each has a comparative advantage. NIJ should be assigned primary responsibility for evaluating the violence prevention initiatives supported by multiple



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