WASHINGTON -- Thousands of lives could be saved each year if a greater national effort were mounted to prevent and treat traumatic injuries, according to a new report from a committee of the Institute of Medicine. The report calls for a new national policy to reduce injuries from firearms that builds on lessons learned in the successful campaign against motor vehicle injuries. It urges federal, state, and local officials to increase their support for injury prevention programs, emergency medical services, trauma care, and the public health infrastructure.
"There is a large gap between what is known about how to prevent and treat injuries, and what is actually being done in our communities, workplaces, and clinics," said committee chair Richard J. Bonnie, professor of law and director of the Institute of Law, Psychiatry, and Public Policy at the University of Virginia, Charlottesville. "Despite its great potential for improving public health, the field of injury prevention and treatment has not received the same consistent public attention as the prevention and treatment of diseases."
Injuries are the leading cause of death and disability among people under age 35 in the United States. They result in nearly 150,000 deaths, 2.6 million hospitalizations, and 36 million visits to emergency rooms each year. The lost productivity and hospital costs resulting from injuries top $260 billion annually.
Firearm injuries caused nearly 36,000 deaths in 1996, second only to automobiles, which caused approximately 42,000 fatalities. While injuries from firearms have risen in recent decades, the rate of motor vehicle injuries has decreased under the leadership of the National Highway Traffic Safety Administration. The reduction has come largely as a result of federal legislation, road improvements, better vehicle design, and changes in behavior. Such a comprehensive approach provides lessons that could be applied to reducing injuries from firearms, the report says.
A workable consensus on reducing gun-related injuries will emerge only if discussion is focused on explicit steps to reduce injuries -- such as keeping guns out of the hands of children and adolescents -- rather than on firearm ownership issues, the report says. Officials at all levels should focus on reducing the number of locations where children have access to guns; restricting their ability to gain access to guns and ammunition; building features into guns to reduce the risk of accidental or unauthorized use if the gun does get into their hands; and building community coalitions to make youth environments safer.
In addition to the success in reducing motor vehicle injury, progress has been made in reducing occupational, residential, and recreational injuries. The three federal agencies responsible for these successes are the National Institute for Occupational Safety and Health, the National Center for Injury Prevention and Control, and the Consumer Product Safety Commission.
Many injury prevention initiatives are focused on the local level, and depend on local officials and advocacy groups who personally interact with citizens to educate them about such things as the proper use of infant car seats, bicycle helmets, and smoke detectors, and safe storage of firearms. To support this type of community-level approach, the report says, state resources must be strengthened. Every state health department should have an adequately staffed program of injury prevention to support the work of local communities and organizations. Support should continue to come as well from the National Center for Injury Prevention and Control, in collaboration with state and local governments.
Trauma care is another critical component in reducing the burden of injury. Inadequate funding has hampered the ability of hospitals and trauma centers to treat the most severely injured patients. Costs of trauma care should be shared at the federal, state, and local levels, the report says. Better research is needed to determine best practices in trauma care; explore the appropriate ways to organize and finance acute care services and rehabilitation; understand the impact of managed care; and develop methods for measure the severity of injuries.
The study was funded by the Robert Wood Johnson Foundation, W.K. Kellogg Foundation, and the John D. and Catherine T. MacArthur Foundation. The Institute of Medicine is a private, non-profit organization that provides health policy advice under a congressional charter granted to the National Academy of Sciences.
*Pre-publication copies of REDUCING THE BURDEN OF INJURY: ADVANCING PREVENTION AND TREATMENT are available from the IOM's Division on Health Promotion and Disease Prevention; tel. (202) 334-1361. Reporters may obtain a copy from the Office of News and Public Information.