engineering to medical leadership, and by 1958 began in a modest way to respond to demands for program services in the area of traffic injury prevention. PROGRAM OF RESEARCH, CONSULTATION, TECHNICAL ASSISTANCE, AND PRODUCTION OF EDUCATIONAL MATERIALS BY PHS In keeping with growing concern of State and local health departments for the mounting toll of motor vehicle deaths and injuries, the Public Health Service instituted a program of research, consultation, technical assistance, and the production of educational materials in this field. Since February 1961, accident prevention in the Public Health Service has enjoyed division status. NEED FOR GREATER RESEARCH AND APPLICATION In emphasing our concern with the human side of traffic accidents, I do not intend to minimize the need for greater research and application with respect to vehicles, highways, and other factors. We agree with most authorities that the causes of traffic accidents are very complex and that the prevention of traffic accidents will be equally complex. This means that the resources and skills of many organízations, within and outside the Federal Government, and a wide range of professional skills, must be brought to bear on the problem. COOPERATION AND SUPPORT FROM MANY SOURCES Throughout the Department's comparatively brief and modest work in the field of traffic accident prevention, we have enjoyed broad cooperation and support from many sources. We subscribe fully to the action program of the President's Committee for Traffic Safety, which provides sound leadership for a coordinated approach to the challenge of traffic safety. We have worked successfully and harmoniously with the other Federal agencies concerned with other aspects of the problem. We have collaborated with and stimulated new interest in accident prevention on the part of the health, safety, and motor vehicle authorities in the State and local governments. We have brought about more active participation by the organized health professions and medical research institutions, and have worked closely with the voluntary agencies concerned either with the prevention of traffic accidents or with their tragic results. DHEW CONTRIBUTIONS I believe that the Department has already made significant contributions and, perhaps more important, has indicated clearly that expansion of the study of the human factors will eventually lead to a marked impact on the toll of traffic tragedies. RESEARCH PROVED SEAT BELTS DECREASE DEATHS AND INJURIES Perhaps the most dramatic single contribution of the Department to the prevention of traffic deaths and injuries has been the support of research which conclusively proved that the universal use of seat belts would greatly decrease the number of deaths and the severity of injuries inflicted in traffic accidents. This research, plus a major educational effort in concert with the National Safety Council, the American Medical Association, and others, led directly to greater p voluntary installation and use of the seat belt and subsequently to its adoption as an item of standard equipment. We are continuing our support of research of restraining devices, particularly those which may be safer and more effective for infants and toddlers, and expanding our interest in other devices which might come under a general heading of better "passenger packaging." NEED FOR GREATER KNOWLEDGE OF HUMAN FACTORS INVOLVED A significant contribution of the Department has been to emphasize: the need for greater knowledge of the human factors involved in traffic safety in the area of driving behavior. In February 1961, in cooperation with the Bureau of Public Roads and the Automotive Safety Foundation, the Public Health Service cosponsored a national conference on driving simulation which urged a greatly expanded research effort toward realistic simulation of the driving environment in which, for the first time, all human factors could be studied and preventive measures evaluated without the obvious risks of conducting such studies on our crowded streets and highways. We are confident that such simulation will become a reality in the near future. I can think of no more significant tool for enabling our scientists, at long last, to pinpoint every human factor-mental, social, physical, and physiological-which contributes in any way to the causation or prevention of traffic accidents; to study them singly and in combination under controlled and reproducible conditions; and to relate them to the machines and the environment which form the other two sides of the traffic triangle. EXHIBIT 17 DRIVER SIMULATORS CAN IMPROVE AND EXPAND COMMUNITY TRAINING PROGRAMS 1 by Dr. Herbert J. Stack IMULATORS such as the Aetna S1 Drivotrainer system have been of outstanding value in the development of high school driver education. Insurance agents associations have furnished 30 high schools and colleges with Drivotrainer installations; one association, in Oklahoma City, has provided these simulators to eleven schools. Today more than 250 Drivotrainer classrooms are in use in 34 states and Canada. Los Angeles, for example, has eleven 12-place mobile units that are moved from school to school servicing 37 public high 37 public high schools. These units have expanded the city's training program 46 per cent while reducing the per pupil Scost by at least 30 per cent. Simulators, such as as the DrivoI trainer system, provide one of the best answers to the problem of how to increase the number of students that can be trained. In the traditional plan the instructor teaches one student at a time, with two or three others as observers. In the Drivotrainer method from 5 to 25 students can be given instruction at one time— the usual number being 12. The simulator consists of a number of stationary "cars," each equipped with the instruments and devices of a typical automobile. Wide-screen training films in full color are used to give the student a wide variety of practical driving experiences. These films show typica! driving situations. The simulators have several advantages over dual-controi cars. They can be used in any kind of weather, day or night. They show a wide variety of situations some of which could not be included in the traditional dual-control car plan. For illustration, one film includes emer The American Agency Bulletin, Mar. 1965, p. 35. 1 gencies; another, driving on expressways; still another driving in inclement weather. It would be dangerous to introduce some situations of this kind in regular on-the-street practice. Centrally Controlled The Drivotrainer cars are connected electrically to a central control unit so that the instructor has a record of the performance of each student. Another advantage is that in the Aetna plan students are given 12 periods of instruction in the simulator in addition to 3 periods of on-the-road instruction—a total of 15 periods, while in the dual-control plan, only 6 pe. riods are included. Drivotrainer students get more than twice the amount of practice behind the wheel. A question will naturally be raised as to the quality of the instruction using simulators as compared to the on-the-road plan. Several research studies have shown these students trained on simulators develop just as good skills and attitudes and are as well informed as those who receive instruction under the dual-control plan. This is extremely important. Simulators have been approved by safety organizations and state departments of education. At present, most insurance companies allow reduced rates for male drivers under age 25 who have completed approved courses. Research Shows Research has shown that school trained drivers have a better accident record than those without such train. ing. Since the reduction in rates is good up to age 25, it has been esti mated that if all forms of automobile insurance were carried the total "savings" of the average driver or his family would be several times the cost of the instruction. Schools cannot afford not to have driver educa tion. The Drivotrainer system is available in two forms, the classroom installation and the mobile unit. The latter has advantages that it can be moved from school to school and is used to offset, classroom shortages. Mobile units are heated and in some instances air conditioned. The Aetna Casualty and Surety Company has developed the Drivotrainer system, its equipment and training program. The Rockwell Manufacturing Company of Pittsburgh, Pennsylvania is the manufacturer and distributor. Information regarding cost can be secured from the latter. Recent Report According to a recent report of the Insurance Institute for Highway Safety, driver education has shown a consistent growth during the last decade. The last year showed 12,720 schools with courses enrolling 1.6 million students. Nearly one half of the states have some form of state fi nancial support by which funds are allocated to school districts on the basis of the number of students trained. On the other hand nearly 60 per cent of the students who grad. uate from high school have not completed driver education courses. Simulators would be of great value in reaching a larger percentage of students: Agents associations can make an important contribution to the driver education movement in their commu nity by donating Aetna Drivotrainer units to the local high schools as have many other associations. P COOPERATIVE EFFORT ON MEDICAL ASPECTS OF DRIVER LICENSURE In a different but related area, we have initiated and developed a broad cooperative effort between health officers and motor vehicle administrators on the medical aspects of driver licensure. The motor vehicle administrators have the critical task of deciding who, individually or as a member of a group, shall be given or deprived of the right to drive a right on which may hinge a person's mobility, his independence, and, to an increasing extent, his livelihood. It is clearly imperative that this decision be based upon medical reality. Yet, heretofore, the motor vehicle administrator has had little professional medical guidance, while the health officer who has the needed professional competence has been understandably reluctant to intrude into the licensing field where he had neither official responsibility nor indication of a welcome. A series of regional meetings embracing the health and motor vehicle administrators of all States culminated last November in the First National Conference on Medical Aspects of Driver Licensure, cosponsored by the Public Health Service, the American Association of Motor Vehicle Administrators, and the American Medical Association. Looking to the future, the most critical need is to increase substantially our scientific store of information on the human factors related to traffic safety. This can be achieved only through a carefully planned program of research in the health sciences, drawing upon the resources which have produced an explosion of scientific knowledge in other health fields. For this reason the major focus of the Department in motor vehicle injury prevention is on research. At the present time, no less than 75 percent of the approximately $1.7 million a year used for supporting research grants in accident prevention pays for research primarily into the human factors of the traffic safety problem. PIONEER STUDY RELATING TO TRAFFIC SAFETY IN CONNECTICUT The Public Health Service also is conducting a pioneering study relating to traffic safety in Connecticut, which may have wide application elsewhere. In this study, 17,000 drivers were given physical examinations and their abnormal conditions were identified. Then they were given a test to determine their attitudes. Now their traffic violation and accident experience is being accumulated over a period of years. When these records are related to the findings of the physical examination and the attitude tests, we shall have a greatly expanded store of useful information-information which, among other things, will be of immediate practical value to motor vehicle administrators and other officials. NEED FOR WIDER APPLICATION OF HEALTH-RELATED PREVENTIVE MEASURES Beyond the need for more research, there is an immediate need for wider application of health-related preventive measures which appear to be promising. One of these is the establishment of medical advisory bodies to State motor vehicle licensing authorities. Another |