Within the overall framework, initial priority should be given to measures that reduce the risk of harm to the most vulnerable segments of the population, particularly children and adolescents and that curtail the risk of firearm injury caused by children and adolescents. Even in the absence of a broad consensus about the aims of national policy, few people are likely to contest the ethical legitimacy of aggressive measures designed to reduce gun-related injuries to and by youths.

A youth-centered injury prevention strategy is needed that would have several components: reducing the number of locations in which youth have access to guns; restricting their ability to gain access to the guns and ammunition in these settings; building features into guns that will reduce the risk of accidental or unauthorized use if the gun does get into the hands of youth; and building community coalitions to make youth environments safer.

The committee recommends the development of a national policy on the prevention of firearm injuries directed toward the reduction of morbidity and mortality associated with unintended or unlawful uses of firearms. An immediate priority should be a strategic focus on reduction of firearm injuries caused by children and adolescents.

To ensure the success of a youth-centered prevention initiative, Congress and relevant federal agencies (e.g., the Departments of Health and Human Services [DHHS] and Justice) should set national goals for reducing assaultive injuries, suicide, and unintentional injuries by young people using firearms. As a long-term commitment to this goal, consideration should be given to appointing a high-level task force for implementing and evaluating such an initiative.


Great strides have been made over the past decades in developing trauma systems covering a continuum of prehospital, acute care, and rehabilitation services. Public health organizations and providers have embraced the need for a broader, more inclusive philosophy that shifts the focus from the trauma center to a system of trauma care that attends to the needs of all trauma patients over the full course of treatment.

A focal point at the federal level has to be reinstated to support research and to cultivate the growth of state and regional trauma systems. A federal program had been in place until 1995, when budget pressures led to the program's demise. Consequently, there is no longer a focal point at the federal level to cultivate trauma systems development.

The committee supports a greater national commitment to, and support of, trauma care systems at the federal, state, and local lev-

The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement