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Reducing the Burden of Injury: Advancing Prevention and Treatment
Injury researchers and practitioners have suggested the development of a firearm surveillance system (Teret et al., 1992). Firearms are the second leading mechanism, after motor vehicles, of injury deaths; better data on firearm deaths would be helpful in regulating firearm commerce and use. However, limiting a new system to firearms seem unnecessarily restrictive and would preclude a number of useful investigations involving other mechanisms on which surveillance data should be collected. It would also appear limiting because the same sources of information that would be tapped for a firearm surveillance system could provide information on homicides and suicides committed by other means, and they may all be amenable to appropriate and specific prevention interventions. Furthermore, a firearm-only system would preclude investigations into weapon substitution in homicides and suicides and provide an unrepresentative sample for investigations of crosscutting issues such as alcohol and other drug abuse.
In addition to police reports, medical examiner's and coroner's investigations and reports are another source of data about the nature and cause of death. The medical examiner and coroner systems vary among jurisdictions (whether state, county, district, or city). A medical examiner is usually a licensed physician, whereas a coroner need not be a physician and is often an elected official. A medical examiner system exists in 22 states, a coroner system exits in 11 states, and a ''mixed" medical examiner-coroner system exists in 18 states (Combs et al., 1995).
Since the judgment of the medical examiner or coroner ultimately determines whether a death is a homicide, a suicide or an "accident" according to vital statistics, this system could be considered a potential starting point for a fatal intentional injury surveillance system. Medical examiner's and coroner's reports are particularly valuable when they include a full autopsy with blood screens for drugs and alcohol, and information from police reports and forensic scene investigation. However, the completeness of reports varies widely from jurisdiction to jurisdiction, as does the extent to which data are maintained in a centralized data system. Local funding for the medical examiner generally determines the degree of completeness and number of autopsies performed. In 1987, the CDC's National Center for Environmental Health (NCEH) established the Medical Examiner and Coroner Information Sharing Program, to improve the quality of data on death certificates and to increase the availability of those data for scientific research (NCEH, 1998).
The committee recommends the development of a fatal intentional injury surveillance system, modeled after FARS, for all homicides and suicides. The committee urges the CDC (specifically NCIPC, NCHS, and NCEH) in collaboration with the National Institute of Justice (NIJ) and NHTSA to conduct a feasibility study for estab-