19–010

Calendar No. 123

108TH CONGRESS REPORT " SENATE ! 1st Session 108–59

TRAUMA CARE SYSTEMS PLANNING AND DEVELOPMENT 

ACT OF 2003

JUNE 9, 2003.—Ordered to be printed 

Mr. GREGG, from the Committee on Health, Education, Labor, and 

Pensions, submitted the following 

R E P O R T 

[To accompany S. 239]

The Committee on Health, Education, Labor, and Pensions, to 

which was referred the bill (S. 239) to amend the Public Health 

Service Act to add requirements regarding trauma care, and for 

other purposes, having considered the same, reports favorably 

thereon without amendment and recommends that the bill do pass.

CONTENTS 

Page 

I. Purpose and need for legislation .................................................................. 1

II. Summary ........................................................................................................ 2

III. History of legislation and votes in committee ............................................. 3

IV. Explanation of bill and committee views ..................................................... 3

V. Cost estimate and unfunded mandate statement ....................................... 4

VI. Regulatory impact statement ........................................................................ 6

VII. Application of law to the legislative branch ................................................ 6

VIII. Section-by-section analysis ............................................................................ 6

IX. Changes in existing law ................................................................................ 7

I. PURPOSE AND NEED FOR LEGISLATION

The purpose of the ‘‘Trauma Care Systems Planning and Development Act of 2003’’ is to assist State governments in the development, implementation, and improvement of statewide and regional 

systems of trauma care. By providing incentives to States to establish well-coordinated systems, severely injured individuals can receive specialized, high quality care as rapidly as possible following 

their injury. Experience has proven that death and disability for 

severely injured patients are both reduced dramatically when deVerDate Jan 31 2003 18:14 Jun 11, 2003 Jkt 019010 PO 00000 Frm 00001 Fmt 6659 Sfmt 6602 E:\HR\OC\SR059.XXX SR059
2

finitive care is provided within the so-called ‘‘golden hour’’ following 

their injury. 

Trauma is the leading killer of Americans up to age 34. Every 

year, more than 150,000 Americans die from traumatic injuries, 

many of which result from motor vehicle collisions, violence and 

falls. Given the events of September 11, 2001, and the nation’s renewed focus on enhancing disaster preparedness, it is critical that 

the Federal Government increase its commitment to strengthening 

Title XII programs governing trauma care system planning and development. 

Survival among severely injured patients requires specialist care 

delivered promptly and in a coordinated manner. Care begins at 

the scene of injury, continues through emergency transport to the 

trauma center, intensive care unit, hospital floor, and ultimately to 

rehabilitation. Optimal acute care depends on technical expertise 

and coordination between teams of providers, including first responders, trauma center teams, acute care and rehabilitative care 

teams. 

A trauma care system is an organized approach to facilitating 

and coordinating a multidisciplinary system response to severely 

injured patients. It is inclusive of injury prevention, emergency department care, surgical interventions, intensive and general surgical in-hospital care, rehabilitative services, along with social services and support groups that enable the patient to return to society 

at the most productive level possible. 

Research has shown that functioning trauma systems can prevent death and disability resulting from trauma. For example, the 

establishment of an effective trauma system in San Diego County, 

CA was credited with reducing the proportion of preventable fatalities out of all deaths from 13.6 percent to 2.7 percent. It is estimated that at least 25,000 deaths due to trauma can be prevented 

every year through the proper preventive, acute and rehabilitative 

care that trauma care systems can provide. 

Trauma care and emergency medical services systems are an integral component of our nation’s health and public health infrastructure and an important public safety resource in all States. 

Throughout the U.S., trauma systems face ongoing and increasing 

challenges of both natural and man-made disasters. 

Strong Federal support for Title XII and the goals of the ‘‘Trauma Care Systems Planning and Development Act’’ will help States 

and communities in need of improved infrastructure to provide effective and efficient care to severely injured patients.

II. SUMMARY

This legislation reauthorizes Title XII of the Public Health Service Act for a period of 5 years; doubles the funding available for 

trauma system development under Parts A–C of Title XII for fiscal 

year 2004, from $6 million to $12 million; and authorizes $750,000 

for fiscal year 2004 and fiscal year 2005 for the IOM study under 

Part E. 

First, the ‘‘Trauma Care Systems Planning and Development Act 

of 2003’’ improves the collection and analysis of trauma patient 

data with the goal of improving the overall system of care for these 

patients; second, at this time of increasing pressure on State budgets, the bill provides some relief to States in their matching reVerDate Jan 31 2003 16:08 Jun 11, 2003 Jkt 19010 PO 00000 Frm 000002 Fmt 06659 Sfmt 06602 E:\HR\OC\SR059.XXX SR059
3

quirements; third, the legislation provides a self-evaluation mechanism to assist States in assessing and improving their trauma care 

systems; fourth, it authorizes an Institute of Medicine (IOM) study 

on the state of trauma care and trauma research; and finally, it 

doubles the funding available for this program to allow additional 

States to participate. 

III. HISTORY OF LEGISLATION AND VOTES IN COMMITTEE

The ‘‘Trauma Care Systems Planning and Development Act of 

1990,’’ (PAL. 101–590) which created Title XII of the Public Health 

Service Act (PHS), was enacted to improve trauma care systems 

nationwide. From 1992 to 1994, the Health Resources and Services 

Administration (HRSA) administered the Federal funds to execute 

the responsibilities specified in the Act. The program’s authority 

expired in 1995 and funding was discontinued. Title XII was reauthorized in 1998 for fiscal year 2000 through fiscal year 2002 in 

PAL. 105–392, the ‘‘Health Professions Partnership Act of 1998’’

and funding re-initiated in fiscal year 2001. 

During the first session of the 108th Congress, S. 239, the Trauma Care Systems Planning and Development Act of 2003, was introduced January 29th, 2003, to reauthorize the program. The 

Committee on Health, Education, Labor, and Pensions reported the 

bill favorably without amendment on February 12, 2003. 

IV. EXPLANATION OF BILL AND COMMITTEE VIEWS

The bill has a variety of provisions, the explanation of and committee views on which follow below: 

The Clearinghouse on Trauma Care and Emergency Medical 

Services was authorized in previous legislation but never established at the Department. As a result, the committee collapsed 

clearinghouse functions into the general trauma care program. 

The bill adds a provision to an existing program for improving 

trauma care in rural areas that would increase coordination of 

State trauma systems with EMS operations in rural areas of the 

State. In rural areas, the barriers to coordination between first responders and State trauma systems may be greater. The committee 

expects that this change to the existing program will help to overcome some of those barriers. 

The bill reduces the States’ contribution to the Federal matching 

requirement. It is hoped that this reduction will provide some relief 

to States and encourage more States to further develop their trauma care systems. The committee believes that although the Federal 

Government should provide assistance in ensuring the availability 

of quality trauma care for Americans, each State should be responsible for developing and maintaining a trauma care system that is 

tailored to its own needs. The revised matching requirement sustains the policy that the State investment in trauma care exceed 

the Federal contribution. 

It is critical that State trauma care systems coordinate well with 

other State-based health emergency systems, such as the bioterrorism and hospital preparedness systems. The bill adds a requirement for such coordination with State preparedness efforts. 

The bill requests an Institute of Medicine report on the status of 

the nation’s trauma care and trauma care systems. The committee 

4

expects that this report will be important in properly evaluating 

trauma care systems and identifying priorities for trauma research 

in the future. 

The bill updates and revises the existing provision for the Secretary, acting through the Director of the NIH, to establish a comprehensive program of trauma research.

V. COST ESTIMATE AND UNFUNDED MANDATE STATEMENT

U.S. CONGRESS, 

CONGRESSIONAL BUDGET OFFICE, 

Washington, DC, March 13, 2003. 

Hon. JUDD GREGG, 

Chairman, Committee on Health, Education, Labor, and Pensions, 

U.S. Senate, Washington, DC. 

DEAR MR. CHAIRMAN: The Congressional Budget Office has prepared the enclosed cost estimate for S. 239, the Trauma Care Systems Planning and Development Act of 2003. 

If you wish further details on this estimate, we will be pleased 

to provide them. The CBO staff contact is Alexis Ahlstrom. 

Sincerely, 

DOUGLAS HOLTZ-EAKIN, Director. 

Enclosure. 

S. 239—Trauma Care System Planning and Development Act of 

2003

Summary: S. 239 would amend the Public Health Service Act to 

reauthorize the emergency services and trauma care programs administered by the Health Resources and Services Administration 

(HRSA). Those programs include grants to states for the development of trauma care systems, an emergency care residency training 

program, and a traumatic brain injury demonstration project. S. 

239 also would require HRSA to contract for a study on trauma 

care and trauma research. 

Assuming the appropriation of the necessary amounts (including 

annual adjustments for anticipated inflation), CBO estimates that 

implementing S. 239 would cost $4 million in 2004 and $71 million 

over the 2004–2008 period. The legislation would not affect direct 

spending or receipts. 

The bill contains no intergovernmental or private-sector mandates as defined in the Unfunded Mandates Reform Act (UMRA) 

and would impose no costs on state, local, or tribal governments. 

Estimated cost to the Federal Government: The estimated budgetary impact of S. 239 is shown in the following table. The costs 

of this legislation fall within budget function 550 (health).

By fiscal year, in millions of dollars—

2003 2004 2005 2006 2007 2008

SPENDING SUBJECT TO APPROPRIATION

Spending Under Current Law: 

Estimated Authorization Level 1 .......................................... 13 10 10 0 0 0

Estimated Outlays ............................................................... 10 11 10 7 2 1

Proposed Changes: 2

Estimated Authorization Level ............................................. 0 13 13 23 23 24

Estimated Outlays ............................................................... 0 4 10 15 20 22

5

By fiscal year, in millions of dollars—

2003 2004 2005 2006 2007 2008

Spending Under S. 239: 

Estimated Authorization Level 1 .......................................... 13 23 23 23 23 24

Estimated Outlays ............................................................... 10 15 20 22 23 23

1 The 2003 level is the amount appropriated for that year for the Trauma/Emergency Medical Systems program. 

2 Including adjustments for anticipated inflation, the estimated outlay changes would total $71 million over the 2004–2008 period. Without 

such adjustments, the five-year total would be $68 million. 

Basis of estimate: S. 239 would reauthorize three trauma-related 

programs and would require HRSA to contract for a study on the 

current state of trauma care. Assuming the appropriation of the 

necessary amounts, CBO estimates that implementing S. 239 

would cost $4 million in 2004 and $71 million over the 2004–2008 

period. 

HRSA currently administers grants to states for the planning, 

development, and improvement of trauma centers and systems and 

maintains a clearinghouse on trauma care. S. 239 would authorize 

the appropriation of $12 million in 2004 and such sums as necessary through 2008 for those activities. 

The planning grant part of that program provides federal matching payments to funds spent by states. Under current law, the federal government does not require contribution of state funds in the 

first year, but requires a matching payment of $1 for every $1 of 

state spending in the second year, and a $3 for every $1 subsequently. Under the bill, states would receive grants without the 

contribution of their own funds for the first two years. In the third 

year, the federal government would provide a matching payment of 

$1 for every $1 of state spending. In subsequent years, the federal 

government would provide a matching payment of $1 for every $2 

of state spending.

State participation under the current, less-generous program is 

very high. States in 2002 were not required to contribute any 

matching funds, and used grant monies from HRSA to do needs assessments and to plan for future uses of grant money. Although 

states will have to contribute $1 for every $1 they receive in federal 

grants under current law in 2003, HRSA believes that state participation in 2003 will be similar to the level in 2002. Since the bill 

would provide for a more-generous program (i.e., lower statematching requirements), we expect that participation would remain 

high under S. 239. 

The authorization level for 2004 under S. 239 for this program 

would be almost four times higher than the 2003 appropriation 

level of $3.5 million. Based on current state spending for the planning grant program and on discussions with HRSA about strong interest by states for participation in this program. CBO estimates 

that state contributions toward these grants would be sufficient to 

obligate the proposed level of appropriation in S. 239. Based on historical spending patterns for this program, CBO estimates that implementing this provision would cost a little less than $4 million 

in 2004 and $48 million over the 2004–2008 period. 

S. 239 also would reauthorize a residency training program in 

emergency medicine for the 2004–2008 period. The bill would authorize $400,000 each year for grants to public and private nonprofit entities for the development of residency programs with an 

emphasis on treatment and referral of domestic violence cases. 

6

CBO estimates that implementing this provision would cost $2 million over the 2004–2008 period. 

Under current law, HRSA is administering a demonstration 

project that provides grants to states to improve access to health 

and other services in brain injury cases. S. 239 would reauthorize 

this program and remove its designation as a demonstration 

project. The bill would authorize such sums as necessary. Based on 

historical spending for the demonstration program and assuming 

the appropriation of the necessary amounts, CBO estimates that 

implementing this provision would cost $3 million in 2006 and $20 

million over the 2006–2008 period. (This provision would have no 

effect on discretionary spending in 2004 or 2005 because the program is authorized through 2005 under current law.) 

S. 239 would require the Secretary of Health and Human Services to contract with the Institutes of Medicine or a similar entity 

to conduct a study on trauma care. The bill would authorize the appropriation of $750,000 in both 2004 and 2005. Based on spending 

for similar activities, CBO estimates that implementing this provision would cost $1.5 million over the 2004–2006 period. 

Intergovernmental and private-sector impact: The bill contains 

no intergovernmental or private-sector mandates as defined in 

UMRA and would impose no costs on state, local, or tribal governments. The bill would reauthorize and increase authorized funding 

for a grant program designed to improve the quality of trauma care 

systems. States that choose to apply for those grants would have 

to provide matching funds, but any costs they incur would be voluntary. 

Estimated prepared by: Federal Costs: Alexis Ahlstrom; Impact 

on State, Local, and Tribal Governments: Leo Lex; and Impact on 

the Private Sector: David Auerbach. 

Estimate approved by: Peter H. Fontaine, Deputy Assistant Director for Budget Analysis.

VI. REGULATORY IMPACT STATEMENT

In accordance with paragraph 11(b) of rule XXVI of the Standing 

Rules of the Senate, the committee has determined that there will 

be minimal increases in the regulatory burden imposed by this bill. 

VII. APPLICATION OF LAW TO THE LEGISLATIVE BRANCH

The committee has determined that there is no impact of this 

law on the Legislative Branch. 

VIII. SECTION-BY-SECTION ANALYSIS

Section 1. Short title 

‘‘Trauma Care Systems Planning and Development Act of 2003’’. 

Section 2. Findings 

This Section makes certain findings regarding the cost and burden of trauma and the importance of trauma care systems. 

Section 3. Amendments 

This Section reauthorizes the current grant program to enable a 

State to develop, implement, and maintain statewide trauma care 

7

systems. This Section collapses the duties of the Clearinghouse into 

the general program description and authorizes the Secretary, acting through HRSA, to promote the reporting and collection of trauma data in a consistent, standardized manner and strikes it from 

its original position in the statute. This Section also eliminates authorization for the Clearinghouse on Trauma Care and Emergency 

Medical Services. 

This Section authorizes the Secretary to make grants for programs for improving trauma care in rural areas. Grants are authorized to increase coordination of emergency medical services 

(EMS) in rural areas with statewide trauma systems, under existing rural grant programs. 

The Section requires matching funds for fiscal years subsequent 

to first fiscal year of payments. The Section amends the requirement of State matching funds in the following manner: first fiscal 

year—no match; second fiscal year—$1 State: $1 Federal; third fiscal year—$1 State: $1 Federal; fourth fiscal year—$2 State: $1 

Federal; and fifth fiscal year—$2 State: $1 Federal. 

Section 3 promotes standardized trauma data collection requirements under the trauma care component of the State plan for EMS 

and promotes coordination with State disaster emergency planning 

and bioterrorism hospital preparedness planning under the trauma 

care component of the State plan for EMS. Section 3 also requests 

the Secretary to update the model trauma care plan. 

This Section authorizes the appropriation of $12,000,000 for fiscal year 2004 and such sums as may be necessary for fiscal years 

2005 through 2008. 

This Section requests an Institute of Medicine study on the state 

of trauma care and trauma research and authorizes $750,000 for 

fiscal years 2004 and 2005 for such study.

IX. CHANGES IN EXISTING LAW

In compliance with rule XXVI paragraph 12 of the Standing 

Rules of the Senate, the following provides a print of the statute 

or the part or section thereof to be amended or replaced (existing 

law proposed to be omitted is enclosed in black brackets, new matter is printed in italic, existing law in which no change is proposed 

is shown in roman): 

PUBLIC HEALTH SERVICE ACT 

* * * * * * *

TRAUMA CARE SYSTEMS PLANNING AND 

DEVELOPMENT ACT OF 2003

* * * * * * *

TITLE XII—TRAUMA CARE 

PART A—GENERAL AUTHORITY AND DUTIES OF SECRETARY

* * * * * * *

8

SEC. 1201. ESTABLISHMENT. 

(a) IN GENERAL.—The Secretary, acting through the Administrator of the Health Resources and Services Administration, shall, 

with respect to trauma care—

(1) conduct and support research, training, evaluations, and 

demonstration projects; 

(2) foster the development of appropriate, modern systems of 

such care through the sharing of information among agencies 

and individuals involved in the study and provision of such 

care; 

(3) collect, compile, and disseminate information on the 

achievements of, and problems experienced by, State and local 

agencies and private entities in providing trauma care and 

emergency medical services and, in so doing, give special consideration to the unique needs of rural areas; 

ø(3)¿ (4) provide to State and local agencies technical assistance to enhance each State’s capability to develop, implement, 

and sustain the trauma care component of each State’s plan for 

the provision of emergency medical services; øand¿

ø(4)¿ (5) sponsor workshops and conferences; and 

(6) promote the collection and categorization of trauma data 

in a consistent and standardized manner.

(b) GRANTS, COOPERATIVE AGREEMENTS, AND CONTRACTS.—The 

Secretary acting through the Administrator of the Health Resources 

and Services Administration, may make grants, and enter into cooperative agreements and contracts, for the purpose of carrying out 

subsection (a). 

ø(c) ADMINISTRATION.—The Administrator of the Health Resources and Services Administration shall ensure that this title is 

administered by the Division of Trauma and Emergency Medical 

Systems within such Administration. Such Division shall be headed 

by a director appointed by the Secretary from among individuals 

who are knowledgeable by training or experience in the development and operation of trauma and emergency medical systems.¿

* * * * * * *

øSEC. 1202. CLEARINGHOUSE ON TRAUMA CARE AND EMERGENCY 

MEDICAL SERVICES. 

ø(a) ESTABLISHMENT.—The Secretary shall by contract provide 

for the establishment and operation of a National Clearinghouse on 

Trauma Care and Emergency Medical Services (hereafter in this 

section referred to as the ‘‘Clearinghouse’’). 

ø(b) DUTIES.—The Clearinghouse shall—

ø(1) foster the development of appropriate, modern trauma 

care and emergency medical services (including the development of policies for the notification of family members of individuals involved in medical emergencies) through the sharing 

of information among agencies and individuals involved in 

planning, furnishing, and studying such services and care; 

ø(2) collect, compile, and disseminate information on the 

achievements of, and problems experienced by, State and local 

agencies and private entities in providing trauma care and 

emergency medical services and, in so doing, give special consideration of the unique needs of rural areas; 

9

ø(3) provide technical assistance relating to trauma care and 

emergency medical services to State and local agencies; and 

ø(4) sponsor workshops and conferences on trauma care and 

emergency medical services. 

ø(c) FEES AND ASSESSMENTS.—A contract entered into by the Secretary under this section may provide that the Clearinghouse 

charge fees or assessments in order to defray, and beginning with 

fiscal year 1992, to cover, the costs of operating the Clearinghouse.¿

SEC. ø1203.¿ 1202. ESTABLISHMENT OF PROGRAMS FOR IMPROVING 

TRAUMA CARE IN RURAL AREAS. 

(a) IN GENERAL.—***

* * * * * * *

(2) by developing model curricula, such as advanced trauma 

life support, for training emergency medical services personnel, 

including first responders, emergency medical technicians, 

emergency nurses and physicians, and paramedics— (A) * * *

(B) * * *

* * * * * * *

(4) by developing innovative protocols and agreements to increase access to prehospital care and equipment necessary for 

the transportation of seriously injured patients to the appropriate facilities; øand¿

(5) by evaluating the effectiveness of protocols with respect 

to emergency medical services and systemsø.¿; and

(6) by increasing communication and coordination with State 

trauma systems. 

* * * * * * *

SEC. 1212. REQUIREMENT OF MATCHING FUNDS FOR FISCAL YEARS 

SUBSEQUENT TO FIRST FISCAL YEAR OF PAYMENTS. 

(a) NON-FEDERAL CONTRIBUTIONS.— (1) IN GENERAL.—The Secretary may not make payments 

under section 1211(a) unless the State involved agrees, with 

respect to the costs described in paragraph (2), to make available non-Federal contributions (in cash or in kind under subsection (b)(1)) toward such costs in an amount equal to— (A) for the second fiscal year of such payments to the State, not less than $1 for each $1 of Federal funds provided in such payments for such fiscal year; øand¿

ø(B) for any subsequent fiscal year of such payments to the State, not less than $3 for each $1 of Federal funds 

provided in such payments for such fiscal year.¿

(B) for the third fiscal year of such payments to the State, not less than $1 for each $1 of Federal funds provided in 

such payments for such fiscal year; 

(C) for the fourth fiscal year of such payments to the State, not less than $2 for each $1 of Federal funds provided in such payments for such fiscal year; and 

(D) for the fifth fiscal year of such payments to the State, not less than $2 for each $1 of Federal funds provided in 

such payments for such fiscal year. 

* * * * * * *

10

(b) DETERMINATION OF AMOUNT OF NON-FEDERAL CONTRIBUTION.—With respect to compliance with subsection (a) as a condition of receiving payments under section 1211(a)—

(1) a State may make the non-Federal contributions required 

in such subsection in cash or in kind, fairly evaluated, including plant, equipment, or services; and

(2) the Secretary may not, in making a determination of the 

amount of non-Federal contributions, include amounts provided by the Federal Government or services assisted or subsidized to any significant extent by the Federal Governmentø; 

and¿.

ø(3) the Secretary shall, in making such a determination, include only non-Federal contributions in excess of the amount 

of non-Federal contributions made by the State during fiscal 

year 1990 toward—

ø(A) the costs of providing trauma care in the State; and 

ø(B) the costs of improving the quality and availability 

of emergency medical services in rural areas of the State.¿

SEC. 1213. REQUIREMENTS WITH RESPECT TO CARRYING OUT PURPOSE OF ALLOTMENTS. 

(a) TRAUMA CARE MODIFICATIONS TO STATE PLAN FOR EMERGENCY MEDICAL SERVICES.—***

(1) * * *

(2) * * *

(3) subject to subsection (b), contains nationally recognized

standards and requirements for the designation of level I and 

level II trauma centers, and in the case of rural areas level III 

trauma centers (including trauma centers with specified capabilities and expertise in the care of the pediatric trauma patient), by such entity, including standards and requirements 

for—

(A) the number and types of trauma patients for whom 

such centers must provide care in order to ensure that 

such centers will have sufficient experience and expertise 

to be able to provide quality care for victims of injury; 

* * * * * * *

(5) subject to subsection (b), contains nationally recognized 

standards and requirements for medically directed triage and 

transport of severely injured children to designated trauma 

centers with specified capabilities and expertise in the care of 

the pediatric trauma patient; 

(6) øspecifies procedures for the evaluation of designated¿

utilizes a program with procedures for the evaluation of trauma 

centers (including trauma centers described in paragraph (5)) 

and trauma care systems;

(7) provides for the establishment and collection of data in 

accordance with data collection requirements developed in consultation with surgical, medical, and nursing specialty groups, 

State and local emergency medical services directors, and other 

trained professionals in trauma care from each designated 

trauma center in the State of a central data reporting and 

analysis system—

11

(A) to identify the number of severely injured trauma 

patients and the number of deaths from trauma within regional trauma care systems in the State; 

* * * * * * *

(F) to identify patients transferred within a regional 

trauma system, including reasons for such transfer and 

the outcomes of such patients; 

* * * * * * *

(9) provides for appropriate transportation and transfer policies to ensure the delivery of patients to designated trauma 

centers and other facilities within and outside of the jurisdiction of such system, including policies to ensure that only individuals appropriately identified as trauma patients are transferred to designated trauma centers, and to provide periodic reviews of the transfers and the auditing of such transfers that 

are determined to be appropriate; 

(10) coordinates planning for trauma systems with State disaster emergency planning and bioterrorism hospital preparedness planning; 

ø(10)¿ (11) conducts public education activities concerning 

injury prevention and obtaining access to trauma care; and 

ø(11)¿ (12) with respect to the requirements established in 

this subsection, provides for coordination and cooperation between the State and any other State with which the State 

shares any standard metropolitan statistical area.

(b) CERTAIN STANDARDS WITH RESPECT TO TRAUMA CARE CENTER

AND SYSTEM.— (1) IN GENERAL.—The Secretary may not make payments 

under section 1211(a) for a fiscal year unless the State involved agrees that, in carrying out paragraphs (3) through (5) 

of subsection (a), the State will adopt standards for the designation of trauma centers, and for triage, transfer, and transportation policies, and that the State will, in adopting such 

standards—

(A) take into account national standards øconcerning 

such¿ that outline resources for optimal care of the injured 

patient; 

* * * * * * *

(D) beginning in fiscal year ø1992¿ 2004, take into account the model plan described in subsection (c). 

* * * * * * *

(3) APPROVAL BY SECRETARY.—The Secretary may not make 

payments under section 1211(a) to a State if the Secretary determines that—

(A) in the case of payments for fiscal year ø1991¿ 2004

and subsequent fiscal years, the State has not taken into 

account national standards, including those of the American College of Surgeons, the American College of Emergency Physicians and the American Academy of Pediatrics, 

in adopting standards under this subsection; or 

(B) in the case of payments for fiscal year ø1992¿ 2004

and subsequent fiscal years, the State has not, in adopting 

12

such standards, taken into account the model plan developed under subsection (c). 

(c) MODEL TRAUMA CARE PLAN.—Not later than 1 year after the 

date of the enactment of the Trauma Care Systems Planning and 

Development Act of ø1990, the Secretary shall develop a model 

plan¿ 2003, the Secretary shall update the model plan for the designation of trauma centers and for triage, transfer and transportation policies that may be adopted for guidance by the State. Such 

plan shall—

* * * * * * *

SEC. 1214. REQUIREMENT OF SUBMISSION TO SECRETARY OF TRAUMA 

PLAN AND CERTAIN INFORMATION. 

(a) TRAUMA PLAN.—

(1) IN GENERAL.—For fiscal year ø1991¿ 2004 and subsequent fiscal years, the Secretary may not make payments 

under section 1211(a) unless, subject to paragraph (2), the 

State involved submits to the Secretary the trauma care component of the State plan for the provision of emergency medical 

services that includes changes and improvements made and 

plans to address deficiencies identified.

(2) INTERIM PLAN OR DESCRIPTION OF EFFORTS.—For fiscal 

year ø1991¿ 2004, if a State has not completed the trauma 

care component of the State plan described in paragraph (1), 

the State may provide, in lieu of a completed such component, 

an interim component or a description of efforts made toward 

the completion of the component. 

* * * * * * *

SEC. 1215. RESTRICTIONS ON USE OF PAYMENTS. 

(a) IN GENERAL.—The Secretary may not, except as provided in 

subsection (b), make payments under section 1211(a) for a fiscal 

year unless the State involved agrees that the payments will not 

be expended—

(1) subject to section 1233, for any purpose other than developing, implementing, and monitoring the modifications required by section 1211(b) to be made to the State plan for the 

provision of emergency medical servicesø.¿;

* * * * * * *

øSEC. 1216. REQUIREMENT OF REPORTS BY STATES. 

ø(a) IN GENERAL.—The Secretary may not make payments under 

section 1211(a) for a fiscal year unless the State involved agrees to 

prepare and submit to the Secretary an annual report in such form 

and containing such information as the Secretary determines (after 

consultation with the States) to be necessary for—

ø(1) securing a record and a description of the purposes for 

which payments received by the State pursuant to such section 

were expended and of the recipients of such payments; and 

ø(2) determining whether the payments were expended in accordance with the purpose of the program involved. 

ø(b) AVAILABILITY TO PUBLIC OF REPORTS.—The Secretary may 

not make payments under section 1211(a) unless the State involved 

agrees that the State will make copies of the report described in 

subsection (a) available for public inspection. 

13

ø(c) EVALUATIONS BY COMPTROLLER GENERAL.—The Comptroller 

General of the United States shall evaluate the expenditures by 

States of payments under section 1211(a) in order to assure that 

expenditures are consistent with the provisions of this part, and 

not later than December 1, 1994, prepare and submit to the Committee on Energy and Commerce of the House of Representatives 

and the Committee on Labor and Human Resources of the Senate 

a report concerning such evaluation.¿

SEC. 1216. [RESERVED]. 

* * * * * * *

SEC. 1222. REPORT BY SECRETARY. 

Not later than October 1, ø1995¿ 2006, the Secretary shall report 

to the appropriate committees of Congress on the activities of the 

States carried out pursuant to section 1211. Such report shall include an assessment of the extent to which Federal and State efforts to develop systems of trauma care and to designate trauma 

centers have reduced the incidence of mortality, and the incidence 

of permanent disability, resulting from trauma. Such report may 

include any recommendations of the Secretary for appropriate administrative and legislative initiatives with respect to trauma care. 

* * * * * * *

SEC. 1232. FUNDING. 

ø(a) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of 

carrying out parts A and B, there are authorized to be appropriated 

$6,000,000 for fiscal year 1994, and such sums as may be necessary 

for each of the fiscal years 1995 through 2002.¿

(a) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of carrying out parts A and B, there are authorized to be appropriated 

$12,000,000 for fiscal year 2004, and such sums as may be necessary for each of the fiscal years 2005 through 2008.

(b) ALLOCATIONS OF FUNDS BY SECRETARY.—

(1) GENERAL AUTHORITY.—For the purpose of carrying out 

part A, the Secretary shall make available 10 percent of the 

amounts appropriated for a fiscal year under subsection (a). 

(2) RURAL GRANTS.—For the purpose of carrying out section 

ø1204¿ 1202, the Secretary shall make available 10 percent of 

the amounts appropriated for a fiscal year under subsection 

(a). 

* * * * * * *

øPart E—Miscellaneous Programs¿

PART E—MISCELLANEOUS PROGRAMS

SEC. 1251. RESIDENCY TRAINING PROGRAMS IN EMERGENCY MEDICINE. 

(a) IN GENERAL.—***

* * * * * * *

(c) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of carrying out this section, there is authorized to be appropriated 

14

$400,000 for each of the fiscal years ø1993 through 1995¿ 2004 

through 2008. 

* * * * * * *

SEC. 1252. STATE GRANTS FOR øDEMONSTRATION¿ PROJECTS REGARDING TRAUMATIC BRAIN INJURY. 

(a) IN GENERAL.—***

* * * * * * *

SEC. 1254. INSTITUTE OF MEDICINE STUDY. 

(a) IN GENERAL.—The Secretary shall enter into a contract with 

the Institute of Medicine of the National Academy of Sciences, or 

another appropriate entity, to conduct a study on the state of trauma care and trauma research. 

(b) CONTENT.—The study conducted under subsection (a) shall—

(1) examine and evaluate the state of trauma care and trauma systems research (including the role of Federal entities in 

trauma research) on the date of enactment of this section, and 

identify trauma research priorities; 

(2) examine and evaluate the clinical effectiveness of trauma 

care and the impact of trauma care on patient outcomes, with 

special attention to high-risk groups, such as children, the elderly, and individuals in rural areas; 

(3) examine and evaluate trauma systems development and 

identify obstacles that prevent or hinder the effectiveness of 

trauma systems and trauma systems development; 

(4) examine and evaluate alternative strategies for the organization, financing, and delivery of trauma care within an overall 

systems approach; and 

(5) examine and evaluate the role of trauma systems and 

trauma centers in preparedness for mass casualties. 

(c) REPORT.—Not later than 2 years after the date of enactment 

of this section, the Secretary shall submit to the appropriate committees of Congress a report containing the results of the study conducted under this section. 

(d) AUTHORIZATION OF APPROPRIATIONS.—There is authorized to 

be appropriated to carry out this section $750,000 for each of fiscal 

years 2004 and 2005. 

* * * * * * *

PART F—INTERAGENCY PROGRAM FOR TRAUMA RESEARCH

SEC. 1261. ESTABLISHMENT OF PROGRAM. 

(a) IN GENERAL.—The Secretary, acting through the Director of 

the National Institutes of Health (in this section referred to as the 

‘‘Director’’), shall establish a comprehensive program of øconducting 

basic and clinical research on trauma (in this section referred to as 

the ‘‘Program’’). The Program shall include research regarding the 

diagnosis, treatment, rehabilitation, and general management of 

trauma.¿ basic and clinical research on trauma (in this section referred to as the ‘‘Program’’), including the prevention, diagnosis, 

treatment, and rehabilitation of trauma-related injuries. 

ø(b) PLAN FOR PROGRAM.—

ø(1) IN GENERAL.—The Director, in consultation with the 

Trauma Research Interagency Coordinating Committee estabVerDate Jan 31 2003 16:08 Jun 11, 2003 Jkt 19010 PO 00000 Frm 000014 Fmt 06659 Sfmt 06602 E:\HR\OC\SR059.XXX SR059
15

lished under subsection (g), shall establish and implement a 

plan for carrying out the activities of the Program, including 

the activities described in subsection (d). All such activities 

shall be carried out in accordance with the plan. The plan shall 

be periodically reviewed, and revised as appropriate. 

ø(2) SUBMISSION TO CONGRESS.—Not later than December 1, 

1993, the Director shall submit the plan required in paragraph 

(1) to the Committee on Energy and Commerce of the House 

of Representatives, and to the Committee on Labor and 

Human Resources of the Senate, together with an estimate of 

the funds needed for each of the fiscal years 1994 through 1996 

to implement the plan.¿

(b) PLAN FOR PROGRAM.—The Director shall establish and implement a plan for carrying out the activities of the Program, taking 

into consideration the recommendations contained within the report 

of the NIH Trauma Research Task Force. The plan shall be periodically reviewed, and revised as appropriate. 

* * * * * * *

(d) CERTAIN ACTIVITIES OF PROGRAM.—The Program shall include—

(1) * * *

* * * * * * *

(4) the authority to make awards of grants or contracts to 

public or nonprofit private entities for the conduct of basic and 

applied research regarding traumatic brain injury, which research may include—

(A) the development of new methods and modalities for 

the more effective diagnosis, measurement of degree of 

brain injury, post-injury monitoring and prognostic assessment of head injury for acute, subacute and later phases 

of care; 

(B) the development, modification and evaluation of 

therapies that retard, prevent or reverse brain damage 

after øacute head injury¿ traumatic brain injury, that arrest further deterioration following injury and that provide 

the restitution of function for individuals with long-term 

injuries; 

* * * * * * *

ø(D) the development of programs that increase the participation of academic centers of excellence in øhead¿ traumatic brain injury treatment and rehabilitation research 

and training; and 

* * * * * * *

ø(g) COORDINATING COMMITTEE.—

ø(1) IN GENERAL.—There shall be established a Trauma Research Interagency Coordinating Committee (in this section referred to as the ‘‘Coordinating Committee’’). 

ø(2) DUTIES.—The Coordinating Committee shall make recommendations regarding—

ø(A) the activities of the Program to be carried out by 

each of the agencies represented on the Committee and the 

amount of funds needed by each of the agencies for such 

activities; and 

16

ø(B) effective collaboration among the agencies in carrying out the activities. 

ø(3) COMPOSITION.—The Coordinating Committee shall be 

composed of the Directors of each of the agencies that, under 

subsection (c), have responsibilities under the Program, and 

any other individuals who are practitioners in the trauma field 

as designated by the Director of the National Institutes of 

Health.¿

ø(h)¿ (g) DEFINITIONS.—For purposes of this section: 

(1) The term ‘‘designated trauma center’’ has the meaning 

given such term in section 1231(1). 

(2) The term ‘‘Director’’ means the Director of the National 

Institutes of Health. 

(3) The term ‘‘trauma’’ means any serious injury that could 

result in loss of life or in significant disability and that would 

meet pre-hospital triage criteria for transport to a designated 

trauma center. 

(4) The term ‘‘traumatic brain injury’’ means an acquired injury to the brain. Such term does not include brain dysfunction 

caused by congenital or degenerative disorders, nor birth trauma, but may include brain injuries caused by anoxia due to 

trauma. The Secretary may revise the definition of such term 

as the Secretary determines necessary, after consultation with 

States and other appropriate public or nonprofit private entities. 

ø(i)¿ (h) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of 

carrying out this section, there are authorized to be appropriated 

such sums as may be necessary for each of the fiscal years ø2001 

through 2005¿ 2004 through 2008. 

* * * * * * *

Æ