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alcohol and drugs, an opportunity exists to study effectively the specific causes and mechanisms of injury of all magnitudes and to establish base lines against which to measure the efficacy of control measures. RECOMMENDATIONS 1. Judicial application of the principle of seeking impartial medical advice in the determination of disability. 2. Replacement, on a national scale, of lay coroners by medical examiners who are not only physicians but also qualified pathologists experienced in medicolegal problems. AUTOPSY OF THE VICTIM The exact cause of death in many of the injured can be learned only from complete autopsy examination. Especially in multiple injuries, priority of treatment may have been directed toward obvious, or overt, injuries, but covert injuries, such as laceration of major vessels, retroperitoneal hemorrhage, or fat embolism may have been the primary cause of death. Although it is the responsibility of the coroner to direct autopsy examination, this is not routinely performed. If this opportunity to ascertain the spe- cific cause of death is to be grasped, complete autopsies must be performed routinely on those who have died as the result of injury. Furthermore, the findings in large numbers of autopsies must be critically analyzed in order to point the way to necessary changes in treatment. One such study, of 950 consecutive autopsies of accident cases, revealed an unexpected finding: in 38 percent of those who died in the hospital or after returning home following fracture of the hip, the primary cause was pulmonary embolism. Yet in a large number of similar patients who had not been autop- sied, pulmonary embolism was the recorded cause of death in only 2 percent. This is but one example of the value of careful autopsy examination. Such findings are important to alert emer- gency department staffs to the incidence of covert injuries that might well dictate first priority care, as well as the care and pro- phylactic measures that must be observed during definitive care and rehabilitation. RECOMMENDATION Routine performance and analysis of complete autopsies of accident . . . victims. 27
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