The following paper deals with a type of accident whose etiology includes an aspect of modern technology—in this case the use of flammable fabrics in commercially manufactured clothing. In its opening pages, the paper deals with one of the essential first steps in the development of countermeasures, namely, the large-scale and systematic gathering of epidemiologic data. Without such data, the prevalence of the problem cannot be known, and in the absence of information on prevalence it is possible that an important cause of morbidity or mortality will go unnoticed or unchecked, or on the other hand, that disproportionate amounts of money and manpower will be devoted to countermeasures against relatively trivial causes. Moreover, it is only through sound and extensive epidemiological data that some understanding of etiology can be obtained. Another important contribution made by this paper is the recognition that in the prevention of clothing burns, as in the prevention of many other kinds of accidental injury, several alternative countermeasures are available. All too often practitioners in accident prevention regard a single countermeasure as the only feasible one and as far more effective than it turns out to be when applied. Although the paper recognizes the existence of alternatives, however, it falls short both in enumerating them and in evaluating them critically. Clothing burns involve three factors: flammable fabric, the behavior of the wearer, and the presence of a source of heat. Although the paper discusses legislation (to eliminate flammable fabrics) and education (to modify the behavior of the wearer), it says nothing about legislation, education, or other efforts to eliminate or provide safeguards against the heat source. However, there are convincing data to indicate that the elimination of open flames (through the substitution of central heating for fireplaces, for example) is one of the most effective countermeasures against clothing burns. Such a reduction of open flames may be achieved through legislation (against certain types of space heaters) or technological changes. Moreover, although it is important to recognize that there are alternative countermeasures, it is even more important to distinguish their relative effectiveness. In discussing education, for example, it is important to note that few, if any, systematic studies have shown that an educational program—whether in driver education or in home safety—has shown any reduction in accidents whereas legislative efforts have been highly successful, especially when the countermeasure has involved a modification of a technological practice. Certainly in the case of flammable clothing, an educational program would have to be addressed primarily to those who have been recognized as "hard to reach" and who live surrounded by environmental hazards which cannot be removed by education alone. In its treatment of legislative efforts, this paper leaves a number of questions unanswered. Why, for example, did 9 years elapse between the "cowboy chaps" incident and the enactment of legislation against flammable fabrics? And why was the initial legislation so inadequate as to require amendment, which did not occur until 13 years later? Despite the very high effectiveness of legislative countermeasures against industrial accidents, many people involved in public health and other areas related to safety seem reluctant to initiate legislation that might effectively remove certain environmental hazards. Perhaps because of their own professional traditions, they prefer to rely on education and publicity programs, despite their demonstrated ineffectiveness. It is possible that a clearer understanding of the legislative process, coupled with the identification of special interest groups which oppose such legislation, might lead to far more effective countermeasures.
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