79–006 

111TH CONGRESS REPORT " ! HOUSE OF REPRESENTATIVES 1st Session 111–43 

WAKEFIELD ACT 

MARCH 23, 2009.—Committed to the Committee of the Whole House on the State 

of the Union and ordered to be printed 

Mr. WAXMAN, from the Committee on Energy and Commerce, 

submitted the following 

R E P O R T 

[To accompany H.R. 479] 

[Including cost estimate of the Congressional Budget Office] 

The Committee on Energy and Commerce, to whom was referred 

the bill (H.R. 479) to amend the Public Health Service Act to provide a means for continued improvement in emergency medical 

services for children, having considered the same, report favorably 

thereon with an amendment and recommend that the bill as 

amended do pass. 

The amendment is as follows: 

Strike all after the enacting clause and insert the following: 

SECTION 1. SHORT TITLE. 

This Act may be cited as the ‘‘Wakefield Act’’. 

SEC. 2. FINDINGS AND PURPOSE. 

(a) FINDINGS.—Congress makes the following findings: 

(1) There are 31,000,000 child and adolescent visits to the Nation’s emergency departments every year. 

(2) Over 90 percent of children requiring emergency care are seen in general hospitals, not in free-standing children’s hospitals, with one-quarter to one-third of the 

patients being children in the typical general hospital emergency department. 

(3) Severe asthma and respiratory distress are the most common emergencies for 

pediatric patients, representing nearly one-third of all hospitalizations among children under the age of 15 years, while seizures, shock, and airway obstruction are 

other common pediatric emergencies, followed by cardiac arrest and severe trauma. 

(4) Up to 20 percent of children needing emergency care have underlying medical 

conditions such as asthma, diabetes, sickle-cell disease, low birth weight, and bronchopulmonary dysplasia. 

(5) Significant gaps remain in emergency medical care delivered to children. Only 

about 6 percent of hospitals have available all the pediatric supplies deemed essential by the American Academy of Pediatrics and the American College of Emergency 

Physicians for managing pediatric emergencies, while about half of hospitals have 

at least 85 percent of those supplies. 


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(6) Providers must be educated and trained to manage children’s unique physical 

and psychological needs in emergency situations, and emergency systems must be 

equipped with the resources needed to care for this especially vulnerable population. 

(7) Systems of care must be continually maintained, updated, and improved to ensure that research is translated into practice, best practices are adopted, training 

is current, and standards and protocols are appropriate. 

(8) The Emergency Medical Services for Children (EMSC) Program under section 

1910 of the Public Health Service Act (42 U.S.C. 300w–9) is the only Federal program that focuses specifically on improving the pediatric components of emergency 

medical care. 

(9) The EMSC Program promotes the nationwide exchange of pediatric emergency 

medical care knowledge and collaboration by those with an interest in such care and 

is depended upon by Federal agencies and national organizations to ensure that this 

exchange of knowledge and collaboration takes place. 

(10) The EMSC Program also supports a multi-institutional network for research 

in pediatric emergency medicine, thus allowing providers to rely on evidence rather 

than anecdotal experience when treating ill or injured children. 

(11) The Institute of Medicine stated in its 2006 report, ‘‘Emergency Care for Children: Growing Pains’’, that the EMSC Program ‘‘boasts many accomplishments . . . 

and the work of the program continues to be relevant and vital’’. 

(12) The EMSC Program is celebrating its 25th anniversary, marking a quartercentury of driving key improvements in emergency medical services to children, and 

should continue its mission to reduce child and youth morbidity and mortality by 

supporting improvements in the quality of all emergency medical and emergency 

surgical care children receive. 

(b) PURPOSE.—It is the purpose of this Act to reduce child and youth morbidity 

and mortality by supporting improvements in the quality of all emergency medical 

care children receive. 

SEC. 3. REAUTHORIZATION OF EMERGENCY MEDICAL SERVICES FOR CHILDREN PROGRAM. 

Section 1910 of the Public Health Service Act (42 U.S.C. 300w–9) is amended— 

(1) in subsection (a), by striking ‘‘3-year period (with an optional 4th year’’ and 

inserting ‘‘4-year period (with an optional 5th year’’; 

(2) in subsection (d)— 

(A) by striking ‘‘and such sums’’ and inserting ‘‘such sums’’; and 

(B) by inserting before the period the following: ‘‘, $25,000,000 for fiscal year 2010, $26,250,000 for fiscal year 2011, $27,562,500 for fiscal year 2012, $28,940,625 for 

fiscal year 2013, and $30,387,656 for fiscal year 2014’’; 

(3) by redesignating subsections (b) through (d) as subsections (c) through (e), respectively; and 

(4) by inserting after subsection (a) the following: 

‘‘(b)(1) The purpose of the program established under this section is to reduce 

child and youth morbidity and mortality by supporting improvements in the quality 

of all emergency medical care children receive, through the promotion of projects focused on the expansion and improvement of such services, including those in rural 

areas and those for children with special health care needs. In carrying out this purpose, the Secretary shall support emergency medical services for children by supporting projects that— 

‘‘(A) develop and present scientific evidence; 

‘‘(B) promote existing and innovative technologies appropriate for the care of children; or 

‘‘(C) provide information on health outcomes and effectiveness and cost-effectiveness. 

‘‘(2) The program established under this section shall— 

‘‘(A) strive to enhance the pediatric capability of emergency medical service systems originally designed primarily for adults; and 

‘‘(B) in order to avoid duplication and ensure that Federal resources are used efficiently and effectively, be coordinated with all research, evaluations, and awards related to emergency medical services for children undertaken and supported by the 

Federal Government.’’. 

CONTENTS 

Page 

Purpose and Summary ............................................................................................ 3 

Background and Need for Legislation .................................................................... 3 

Hearings ................................................................................................................... 3 

Committee Consideration ........................................................................................ 3 

Committee Votes ...................................................................................................... 4 

Committee Oversight Findings ............................................................................... 4 


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Statement of General Performance Goals and Objectives .................................... 4 

New Budget Authority, Entitlement Authority, and Tax Expenditures ............. 4 

Earmarks and Tax and Tariff Benefits .................................................................. 4 

Committee Cost Estimate ....................................................................................... 4 

Congressional Budget Office Estimate ................................................................... 5 

Federal Mandates Statement ................................................................................. 6 

Advisory Committee Statement .............................................................................. 6 

Constitutional Authority Statement ...................................................................... 6 

Applicability to Legislative Branch ........................................................................ 6 

Section-by-Section Analysis of the Legislation ...................................................... 6 

Explanation of Amendments ................................................................................... 7 

Changes in Existing Law Made by the Bill, As Reported .................................... 7 

PURPOSE AND SUMMARY

The purpose of H.R. 479, the ‘‘Wakefield Act’’, is to amend the 

Public Health Service Act to provide a means for continued improvement in emergency medical services for children. The bill revises and extends the authorization for the Emergency Medicaid 

Services for Children program for the 5-year period FY 2010 

through FY 2014. The amounts authorized to be appropriated for 

this program are $25 million in FY 2010 and $138.14 million over 

5 years. 

BACKGROUND AND NEED FOR LEGISLATION

Each year, injury alone claims more lives of children between the 

ages of 1 and 19 than do all forms of illness. Although Early Emergency Medical Services (EMS) systems were designed to provide 

rapid intervention for sudden cardiac arrest in adults and rapid 

transport for motor vehicle crash victims, there has been limited 

recognition that children require specialized care. In many EMS 

systems, children’s needs were overlooked as services were developed for adult trauma and cardiac patients. 

The Emergency Medical Services for Children (EMSC) program 

began in 1984 and is designed to ensure state-of-the-art emergency 

medical care for ill or injured children and adolescents. It covers 

the entire spectrum of emergency medical care. The EMSC program provides grants to states to improve existing EMS systems 

and to schools of medicine to develop and evaluate improved procedures and protocols for treating children. Since its establishment 

25 years ago, the EMSC program has driven major improvements 

in emergency care for children. Injury-related deaths among children have dropped by 40% over that period. 

Although much progress has been achieved, more remains to be 

done. The EMSC program’s authorization expired in September 

2005. 

HEARINGS

The Committee on Energy and Commerce did not hold hearings 

on the legislation. 

COMMITTEE CONSIDERATION

The Committee on Energy and Commerce met in open markup 

session on Wednesday, March 4, 2009, and, pursuant to a motion 

by Mr. Waxman, agreed by unanimous consent to consider and approve H.R. 479 and several other bills en bloc. H.R. 479 was ordered favorably reported, amended, to the House by a voice vote. 


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A manager’s amendment to H.R. 479 offered by Mr. Waxman was 

adopted by unanimous consent. 

COMMITTEE VOTES

Clause 3(b) of rule XIII of the Rules of the House of Representatives requires the Committee to list the record votes on the motion 

to report legislation and amendments thereto. There were no recorded votes taken during consideration or ordering H.R. 479 reported to the House. 

COMMITTEE OVERSIGHT FINDINGS

Regarding clause 3(c)(1) of rule XIII of the Rules of the House 

of Representatives, the oversight findings of the Committee are reflected in this report. 

STATEMENT OF GENERAL PERFORMANCE GOALS AND OBJECTIVES

The objective of H.R. 479 is to extend by one year the length of 

time for which a grant may be awarded under the EMSC grant 

program, which allows the Secretary of Health and Human Services (HHS) to make grants to states or schools of medicine to support projects to expand and improve EMS for children who need 

treatment for trauma or critical care. Furthermore, H.R. 479 sets 

forth as the purpose of the program the reduction of child and 

youth morbidity and mortality by supporting improvements in the 

quality of all emergency medical care children receive. H.R. 479 requires the Secretary of HHS to support emergency medical services 

for children by supporting projects that: (1) develop and present 

scientific evidence; (2) promote existing innovative technologies appropriate for the care of children; and (3) provide information on 

health outcomes and effectiveness and cost-effectiveness. Lastly, 

H.R. 479 states that the EMSC program shall strive to enhance the 

pediatric capability of EMS systems and must be coordinated with 

all research, evaluations, and awards undertaken by the federal 

government related to EMS for children. 

NEW BUDGET AUTHORITY, ENTITLEMENT AUTHORITY, AND TAX

EXPENDITURES

Regarding compliance with clause 3(c)(2) of rule XIII of the Rules 

of the House of Representatives, the Committee finds that H.R. 479 

would result in no new or increased budget authority, entitlement 

authority, or tax expenditures or revenues. 

EARMARKS AND TAX AND TARIFF BENEFITS

In compliance with clause 9 of rule XXI of the Rules of the House 

of Representatives, H.R. 479 does not contain any congressional 

earmarks, limited tax benefits, or limited tariff benefits as defined 

in clause 9(d), 9(e), or 9(f) of rule XXI. 

COMMITTEE COST ESTIMATE

The Committee adopts as its own the cost estimate on H.R. 479 

prepared by the Director of the Congressional Budget Office pursuant to section 402 of the Congressional Budget Act of 1974. 


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CONGRESSIONAL BUDGET OFFICE ESTIMATE

Pursuant to clause 3(c)(3) of rule XIII of the Rules of the House 

of Representatives, the following is the cost estimate on H.R. 479 

provided by the Congressional Budget Office pursuant to section 

402 of the Congressional Budget Act of 1974: 

U.S. CONGRESS, 

CONGRESSIONAL BUDGET OFFICE, Washington DC, March 18, 2009. 

Hon. HENRY A. WAXMAN, 

Chairman, Committee on Energy and Commerce, 

House of Representatives, Washington, DC. 

DEAR MR. CHAIRMAN: The Congressional Budget Office has prepared the enclosed cost estimate for H.R. 479, the Wakefield Act. 

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

to provide them. The CBO staff contact is Lisa Ramirez-Branum. 

Sincerely, 

DOUGLAS W. ELMENDORF, 

Director. 

Enclosure. 

H.R. 479—Wakefield Act 

H.R. 479 would amend the Public Health Service Act to direct 

the Secretary of Health and Human Services to provide grants to 

states and medical schools for several activities intended to reduce 

child morbidity and mortality by improving emergency medical 

services for children. 

The bill would authorize the appropriation of $25 million for 

2010 and $138 million over the 2010–2014 period for those purposes. Based on historical patterns of spending for similar activities, CBO estimates that implementing H.R. 479 would cost $4 million in 2010 and $96 million over the 2010–2014 period, assuming 

appropriation of the specified amounts. Enacting H.R. 479 would 

have no effect on direct spending or revenues. 

H.R. 479 contains no intergovernmental or private-sector mandates as defined in the Unfunded Mandates Reform Act. 

The estimated budgetary impact of H.R. 479 is shown in the following table. The costs of the legislation fall within budget function 

550 (health). 

By fiscal year, in millions of dollars— 

2010 2011 2012 2013 2014 2010– 

2014 

CHANGES IN SPENDING SUBJECT TO APPROPRIATION 

Authorization Level ................................................................................... 25 26 28 29 30 138 

Estimated Outlays .................................................................................... 4 15 23 27 28 96 

The CBO staff contact for this estimate is Lisa Ramirez-Branum. 

This estimate was approved by Peter H. Fontaine, Assistant Director for Budget Analysis. 


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FEDERAL MANDATES STATEMENT

The Committee adopts as its own the estimate of federal mandates regarding H.R. 479 prepared by the Director of the Congressional Budget Office pursuant to section 423 of the Unfunded Mandates Reform Act. 

ADVISORY COMMITTEE STATEMENT

No advisory committees within the meaning of section 5(b) of the 

Federal Advisory Committee Act were created by H.R. 479. 

CONSTITUTIONAL AUTHORITY STATEMENT

Pursuant to clause 3(d)(1) of rule XIII of the Rules of the House 

of Representatives, the Committee finds that the constitutional authority for H.R. 479 is provided in the provisions of Article I, section 8, clause 1, that relate to expending funds to provide for the 

general welfare of the United States. 

APPLICABILITY TO LEGISLATIVE BRANCH

The Committee finds that H.R. 479 does not relate to the terms 

and conditions of employment or access to public services or accommodations within the meaning of section 102(b)(3) of the Congressional Accountability Act of 1995. 

SECTION-BY-SECTION ANALYSIS OF THE LEGISLATION

Section 1. Short title 

Section 1 establishes the short title of the Act as the ‘‘Wakefield 

Act’’. 

Section 2. Findings and purpose 

Section 2 states the congressional findings. 

Section 3. Reauthorization of emergency medical services for children program 

Section 3 of this legislation amends Section 1910 of the Public 

Health Service Act (42 U.S.C. 300w–9). 

Section 3 extends by 1 year the length of time for which a grant 

may be awarded under the EMSC program. The Secretary of HHS 

awards these grants to states or schools of medicine to support 

projects to expand and improve emergency medical services for 

children who need treatment for trauma or critical care. 

Section 3 sets forth as the purpose of the program the reduction 

of child and youth morbidity and mortality by supporting improvements in the quality of all emergency medical care children receive. 

Section 3 requires that the Secretary of HHS support emergency 

medical services for children by supporting projects that develop 

and present scientific evidence which promotes existing innovative 

technologies appropriate for the care of children and which provides information on health outcomes, effectiveness, and cost-effectiveness. 

Section 3 states that the EMSC program shall strive to enhance 

the pediatric capability of EMS systems and, in order to avoid duVerDate Nov 24 2008 04:59 Mar 25, 2009 Jkt 079006 PO 00000 Frm 00006 Fmt 6659 Sfmt 6602 E:\HR\OC\HR043.XXX HR043

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plication, coordinate with all research, evaluations, and awards undertaken by the federal government related to EMS for children. 

Finally, Section 3 amends the authorization of appropriations for 

the EMSC program. H.R. 479 changes ‘‘and such sums’’ to ‘‘such 

sums’’ and inserts ‘‘$25,000,000 for fiscal year 2010, $26,250,000 for 

fiscal year 2011, $27,562,500 for fiscal year 2012, $28,940,625 for 

fiscal year 2013, and $30,387,656 for fiscal year 2014’’. 

EXPLANATION OF AMENDMENTS

Mr. Waxman offered a manager’s amendment to restore certain 

provisions to H.R. 479 that had appeared in H.R. 2464 in the 110th 

Congress. These include certain program requirements as well as 

requirements regarding how the Secretary will, through projects 

the Department funds, support emergency medical services for children. 

CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED

In compliance with clause 3(e) of rule XIII of the Rules of the 

House of Representatives, changes in existing law made by the bill, 

as reported, are shown as follows (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 

* * * * * * * 

TITLE XIX—BLOCK GRANTS 

PART A—PREVENTIVE HEALTH AND HEALTH SERVICES BLOCK

GRANT

* * * * * * * 

EMERGENCY MEDICAL SERVICES FOR CHILDREN

SEC. 1910. (a) For activities in addition to the activities which 

may be carried out by States under section 1904(a)(1)(F), the Secretary may make grants to States or accredited schools of medicine 

in States to support a program of demonstration projects for the expansion and improvement of emergency medical services for children who need treatment for trauma or critical care. Any grant 

made under this subsection shall be for not more than a ø3-year 

period (with an optional 4th year¿ 4-year period (with an optional 

5th year based on performance), subject to annual evaluation by 

the Secretary. Only 3 grants under this subsection may be made 

in a State (to a State or to a school of medicine in such State) in 

any fiscal year. 

(b)(1) The purpose of the program established under this section 

is to reduce child and youth morbidity and mortality by supporting 

improvements in the quality of all emergency medical care children 

receive, through the promotion of projects focused on the expansion 

and improvement of such services, including those in rural areas 

and those for children with special health care needs. In carrying 

out this purpose, the Secretary shall support emergency medical 

services for children by supporting projects that— 


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(A) develop and present scientific evidence; 

(B) promote existing and innovative technologies appropriate 

for the care of children; or 

(C) provide information on health outcomes and effectiveness 

and cost-effectiveness. 

(2) The program established under this section shall— 

(A) strive to enhance the pediatric capability of emergency 

medical service systems originally designed primarily for 

adults; and 

(B) in order to avoid duplication and ensure that Federal resources are used efficiently and effectively, be coordinated with 

all research, evaluations, and awards related to emergency 

medical services for children undertaken and supported by the 

Federal Government. 

ø(b)¿ (c) The Secretary may renew a grant made under subsection (a) for one additional one-year period only if the Secretary 

determines that renewal of such grant will provide significant benefits through the collection, analysis, and dissemination of information or data which will be useful to States in which grants under 

such subsection have not been made. 

ø(c)¿ (d) For purposes of this section— 

(1) * * * 

* * * * * * * 

ø(d)¿ (e) To carry out this section, there are authorized to be appropriated $2,000,000 for fiscal year 1985 and for each of the two 

succeeding fiscal years, $3,000,000 for fiscal year 1989, $4,000,000 

for fiscal year 1990, $5,000,000 for each of the fiscal years 1991 

and 1992, øand such sums¿ such sums as may be necessary for 

each of the fiscal years 1993 through 2005, $25,000,000 for fiscal 

year 2010, $26,250,000 for fiscal year 2011, $27,562,500 for fiscal 

year 2012, $28,940,625 for fiscal year 2013, and $30,387,656 for fiscal year 2014. 

* * * * * * * 

Æ 


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