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SPECIFIC RECOMMENDATIONS ACCIDENT PREVENTION Formation of a National Council on Accident Prevention at the Executive level for coordination of information and advice on implementation of measures and regulations now vested in scattered private, industrial, and federal agencies, and for research, public education, and develop- ment of improved standards in accident prevention. EMERGENCY FIRST AID AND l\/IEDICAL CARE First Aid Extension of basic and advanced first aid training to greater numbers of the lay population. Preparation of nationally acceptable texts, training aids, and courses of instruction for rescue squad personnel, policemen, firemen, and ambulance attendants. Ambulance Services Implementation of recent traffic safety legislation to ensure completely adequate standards for ambulance design, and construction, for ambu- lance equipment and supplies, and for the qualifications and supervision of ambulance personnel. Adoption at the state level of general policies and regulations pertaining to ambulance services. Adoption at district, county, and municipal levels of ways and means of providing ambulance services applicable to the conditions of the locality, control and surveillance of ambulance services, and coordination of ambulance services with health departments, hospitals, traffic authori- ties, and communication services. Pilot programs to determine the efficacy of providing physician-staffed ambulances for care at the site of injury and during transportation. Initiation of pilot programs to evaluate automotive and helicopter ambulance services in sparsely populated areas and in regions where many communities lack hospital facilities adequate to care for seriously Injured persons. Communication Delineation of radiofrequency channels and of equipment suitable to provide voice communication between ambulances, emergency depart- ments, and other health-related agences at community, regional, and national levels. Pilot studies across the nation for evaluation of models of radio and telephone installations to ensure effectiveness of communication facilities. Day-to-day use of voice communication facilities by the agencies serving emergency medical needs. 35

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Active exploration of the feasibility of designating a single nationwide telephone number to summon an ambulance. Emergency Departments Initiation of surveys and pilot programs to establish patterns of and the numbers and types of emergency departments necessary for optimal care of emergency surgical and medical casualties in a selected number of cities, groups of small communities, and sparsely populated areas. Development of a mechanism for inspection, categorization, and accreditation of emergency rooms on a continuing basis. Federal fund support to design, construct, and, in part, operate model emergency facilities of each type. Interrelationships between the Emergency Department and the Intensive Care Unit Expansion of intensive care programs to ensure uninterrupted care beyond the immediate measures rendered in emergency departments. THE DEVELOPMENT OF TRAUMA REGISTRIES Establishment of trauma registries in selected hospitals as a mechanism for the continuing description of the natural history of the various forms Ot Injuries. Subsequent consideration of establishment of a national computerized central registry. Studies on the feasibility of designating selected injuries to be incor- porated with reportable diseases under Public Health Service control. HOSPITAL TRAUMA COMMITTEES Formation of hospital trauma committees, on a pilot basis, in selected hospitals. CONVALESCENCE, DISABILITY AND REHABILITATION Development of additional studies on the quantitation of degrees of disability and the stages of convalescence at which return to productive work is indicated. Development of studies on rehabilitation with emphasis on measures to be initiated in the earliest phases of treatment. MEDICOLEGAL PROBLEMS Judicial application of the principle of seeking impartial medical advice in the determination of disability. 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 Routine performance and analysis of complete autopsies of accident . . . victims. 36

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CARE OF CASUALTIES UNDER CONDITIONS OF NATURAL DISASTER Development of a center to document and analyze types and numbers of casualties in disasters, to identify by on-site medical observation prob- lems encountered in caring for disaster victims, and to serve as a national educational and advisory body to the public and the medical profession in the orderly expansion of day-to-day emergency services to meet the needs imposed by disaster or national emergency. RESEARCH IN TRAUMA Increased federal and voluntary financial support of basic and applied research in trauma. Long-term financial support of specialized centers for clinical research in shock and trauma. Expansion of clinical research in war wounds. Expansion within the U. S. Public Health Service of research in shock, trauma, and emergency medical conditions, with the goal of establishing a National Institute of Trauma. 37