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INTRODUCTION
In 1965, 52 million accidental injuries killed 107,000, temporarily
disabled over 10 million and permanently impaired 400,000
American citizens at a cost of approximately $18 billion. This
neglected epidemic of modern society is the nation's most impor-
tant environmental health problem. It is the leading cause of death
in the first half of life's span.
Although 49,000 deaths in 1965 were due to motor-vehicle
accidents, more than this number died from accidents at work, in
the home, in other forms of transportation, in public buildings,
in recreational activities, etc.
Public apathy to the mounting toll from accidents must be
transformed into an action program under strong leadership. This
can be accomplished by the methods employed to bring poliomye-
litis and other epidemics under control, and to make frontal attacks
to conquer cancer, heart disease, and mental disease. Federal and
voluntary agencies have mobilized to prevent and treat birth
defects, muscular dystrophy, sclerosis, and palsy. Such concerted
attacks have been mounted by conduct of national conferences at
the Executive level, appropriation of funds by the Congress, pool-
ing of resources by lay and professional groups through voluntary
health agencies, expansion of research, and implementation of
programs at regional and community levels. Basic to this unified
approach is identification of the individual citizen with a means
by which he can satisfy the inherent desire to serve his fellow man.
Accidental death and disability too, can be attacked by such
concerted actions.
This report summarizes current practices and deficiencies at
various levels of emergency care. Salient factors which require
early solutions are:
The general public is insensitive to the magnitude of the problem
of accidental death and injury.
Millions lack instruction in basic first aid.
Few are adequately trained in the advanced techniques of cardio-
pulmonary resuscitation, childbirth, or other lifesaving measures,
yet every ambulance and rescue squad attendant, policeman, fire-
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fighter, paramedical worker and worker in high-risk industry should
be trained.
Local political authorities have neglected their responsibility to
provide optimal emergency medical services.
Research on trauma has not been supported or identified at the
National Institutes of Health on a level consistent with its impor-
tance as the fourth leading cause of death and the primary cause
of disability.
Potentials of the U. S. Public Health Service programs in accident
prevention and emergency medical services have not been fully
exploited.
Data are lacking on which to determine the number of individuals
whose lives are lost or injuries are compounded by misguided
attempts at rescue or first aid, absence of physicians at the scene of
injury, unsuitable ambulances with inadequate equipment and
untrained attendants, lack of traffic control, or the lack of voice
communication facilities.
Helicopter ambulances have not been adapted to civilian peace-
time needs.
Emergency departments of hospitals are overcrowded, some are
archaic, and there are no systematic surveys on which to base
requirements for space, equipment, or staffing for present, let alone
future, needs.
Fundamental research in shock and trauma is inadequately
supported.
Medical and health-related organizations have failed to join
forces to apply knowledge already available to advance the treat-
ment of trauma, or to educate the public and inform the Congress.
Specific recommendations follow discussions of the various levels
of emergency care. Major steps toward a total national effort
include:
Conduct of National Conferences on Emergency Medical Services
Under medical leadership, national forums should be conducted at
the highest levels on all subjects important to total emergency care
from the time of receipt of an injury through rehabilitation. The
public must be aroused and full, informed of present practices,
shortcomings in emergency services, and wave in which optimal care
can be assured.
Establishment of a 'national Trauma Association
Responsible professional and lay organizations should pool their
efforts through a voluntary National Trauma Association as a means
of stimulating public demand for accident prevention and emergency
medical services and satisfying these needs through research, public
and professional education, and community services.
6
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Organization of Community Councils on Emergency Medical Services
In each community, coordination of lay and professional responsi-
bilities for emergency medical care should be centralized in a
council on emergency services. A council would serve to coordinate
teaching programs on basic and advanced first aid of the Red Cross,
the Medical Self-Help Program of the Public Health Service, cardio-
pulmonary resuscitation of the American Heart Association, and
others. It would bring together the resources of chapters of the
Red Cross and the National Safety Council, committees on trauma
of the American College of Surgeons, local and county medical
societies of the American Medical Association, health departments,
civic bodies, scouts, and others, to procure equipment, construct
facilities and ensure optimal emergency care on a day-to-day basis
as well as in disaster or national emergency. Councils could serve as
active units to implement measures and to share in the contributions
and benefits of nationwide programs of a National Trauma Associ-
ation and other voluntary health and allied agencies devoted to
emergency medical services.
Formation of a National Council on Accident Prevention
This report is concerned primarily with emergency care indicated
after receipt of an injury and deals only briefly with problems of
accident prevention. All pertinent research in this field should be
reviewed. An analysis is in order of the several safety acts pertaining
to government departments with administrative responsibility in
accident prevention. The newly established Department of Trans-
portation deals not only with motor vehicles but also with aviation,
railroads, and other forms of transport. Other departments deal with
mining, industry, flammable clothing, foods, and drugs. There are
many common denominators of human behavior, environment, and
mechanization applicable to each of these areas and their identifi-
cation is essential to a systematic attack on this vital problem.
Creation of a National Institute of Trauma
Appropriated funds should be earmarked in support of the program
of research in the therapy of trauma recently announced by the
National Institute of General Medical Sciences. This would include
processing of grant requests for research related to shock and
trauma which are now considered by numerous Institutes. Training
for academic careers and fellowships in traumatology should be
supported. These combined activities call for establishment under
the U. S. Public Health Service of a National Institute of Trauma.
7
Representative terms from entire chapter:
medical services
