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THE MAGNITUDE OF THE PROBLEM Deaths Accidents are the leading cause of death among persons between the ages of 1 and 37; and they are the fourth leading cause of death at all ages. Among accidental deaths, those due to motor vehicles constitute the leading cause for all age groups under 75. Since 1903, when the "horseless carriage" toll assumed signifi- cance, there have been more than 6,500,000 deaths from accidents in this country, over 1,690,000 involving motor vehicles. In 1965, the accident death toll was approximately 107,000, including 49,000 from motor vehicles, 28,500 at home, and 14,100 at work. Deaths from traffic injuries have increased annually; 10,000 more were killed in 1965 than in 1955, and the increase from 1964 to 1965 was 3 percent. Seventy percent of the motor vehicle deaths occurred in rural areas and in communities with populations under 2500.~ Despite increasing mechanization, death rates from work acci- dents in manufacturing have decreased in the past 33 years, from approximately 37 accidental deaths per 100,000 workers in 1933 to a rate of 20 per 100,000 in 1965.~ This reduction is due largely to education, training, and surveillance of industrial workers, and elimination of hazardous machinery in industrial plants. Similar efforts should be directed to the increasing millions of drivers and to vehicles. The tragedy of the high accidental death rate is that trauma kills thousands who otherwise could expect to live long and productive lives, whereas those afflicted with malignancy, heart disease, stroke, and many chronic diseases usually die late in life. Thus many more millions of productive man-years are lost owing to deaths from accidents than from chronic diseases among older persons. The human suffering and financial loss from preventable acci- dental death constitute a public health problem second only to the ravages of ancient plagues or world wars. In one year alone vehicle accidents kill more than we lost in the Korean War, and in the past 60 years more Americans have died from accidents than from combat wounds in all of our Warsaw In the 20-year period 8

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from 1945 through 1964, there were over 97,000 accidental deaths among military personnel, predominantly caused by motor vehicles. Disability The total number of nondisabling injuries treated at home, in doctors' offices, in outpatient clinics or in emergency departments is unknown. In 1965, disabling injuries numbered over 10,500,000, including 400,000 that resulted in some degree of permanent impairment. It is estimated that the number of United States citizens now physically impaired by injuries is over 11 million, including nearly 200,000 persons who have lost a leg, a foot, an arm, or a hand and 50(),000 with varying degrees of impaired ~ v~s~on. Costs In 1965, accident costs totaled about $18 billion, including wage losses of $5.3 billion, medical expenses of $1.8 billion, adminis- trative and claim settlements of $3.6 billion, property loss in fires of $1.4 billion, property damage in motor-vehicle accidents of $3.1 billion, and indirect cost of work accidents of $2.8 billion. The total approaches the current national annual appropriation for conducting the war in Vietnam. Medical Load The care of accident cases imposes a staggering load on physicians, paramedical personnel, and hospitals. Approximately one of every four Americans suffers an accident of some degree each year. Of the more than 52,000,000 persons injured in 1965, although many were treated at home or at work, most received medical attention in physicians' offices or in outpatient or emergency departments of hospitals. It is estimated that in 1965 more than 2,000,000 victims of accidental injury were hospitalized; they occupied 65,000 hospital beds for 22,000,000 bed-days and received the services of 88,00() hospital personnel. This exceeds the number of bed-days required to care for the 4 million babies born each year or for all the heart patients and it is more than four times greater than that required for cancer patients. Approximately 1 of 8 beds in general hospitals in the United States is occupied by an accident victims 9