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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