49–010 

Calendar No. 359 

109TH CONGRESS REPORT " ! SENATE 2d Session 109–215 

TRAUMA CARE SYSTEMS PLANNING AND DEVELOPMENT 

ACT OF 2005 

FEBRUARY 2, 2006.—Ordered to be printed 

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

Pensions, submitted the following 

R E P O R T 

[To accompany S. 265] 

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

which was referred the bill (S. 265) 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 Committee Action ............................................. 3 

IV. Explanation of Bill and Committee Views ................................................... 3 

V. Cost Estimate and Unfunded Mandate Statement ..................................... 4 

VI. Application of Law to the Legislative Branch ............................................. 6 

VII. Regulatory Impact Statement ....................................................................... 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 2005’’ 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 definitive care is provided within the so-called ‘‘golden hour’’ following 

their injury. Yet, according to the Centers for Disease Control 


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(CDC), only one fourth of the United States’ population lives in an 

area served by a trauma system. 

Trauma is the leading cause of death for Americans between the 

ages of 1 and 44 years and is among the top five causes of death 

in the general population of the United States. According to the 

CDC every year, more than 150,000 Americans die from traumatic 

injuries, many of which result from motor vehicle collisions, violence, and falls. Given 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. 

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 United States, trauma systems face ongoing and 

increasing challenges of both natural and man-made disasters. The 

National Center for Injury Prevention and Control reports studies 

showing that as many as 35 percent of trauma patient deaths could 

have been prevented if optimal acute care had been available. 

Strong Federal support for Title XII of the Public Health Service 

Act 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. A 1999 study in the Journal of Trauma, Injury, Infection and Critical Care reported that seriously injured patients have a 15 to 20 percent improved survival rate if the patients access a trauma system. 

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 2006, from $6 million to $12 million; and authorizes $750,000 

for fiscal year 2008 for an Institute of Medicine (IOM) study of 

trauma care systems. 

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

of 2005’’ improves the collection and analysis of trauma patient 

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

patients. Second, the bill adjusts States matching requirements for 

Federal grant funding; third, the legislation provides a self-evaluaVerDate Aug 31 2005 11:36 Feb 03, 2006 Jkt 004901 PO 00000 Frm 00002 Fmt 6659 Sfmt 6602 E:\HR\OC\SR215.XXX SR215

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tion mechanism to assist States in assessing and improving their 

trauma care systems; and finally, it authorizes an IOM study on 

the state of trauma care and trauma research. 

III. HISTORY OF LEGISLATION AND COMMITTEE ACTION

The ‘‘Trauma Care Systems Planning and Development Act of 

1990,’’ (P.L. 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 

P.L. 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 on January 29, 2003, to reauthorize the program. The 

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

bill favorably without amendment on February 12, 2003. The Senate passed the bill on July 1, 2003 by unanimous consent. The 

House received S. 239 from the Senate and referred it to the House 

Energy and Commerce Committee, Subcommittee on Health. No 

further action was taken during the 108th Congress. 

During the first session of the 109th Congress, S. 265, the Trauma Care Systems Planning and Development Act of 2005, was introduced February 2, 2005, to reauthorize the program. After accepting a substitute amendment offered by Senator Frist, the Committee on Health, Education, Labor, and Pensions reported the bill 

favorably by unanimous voice vote on February 9, 2005. 

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 bill reauthorizes and makes improvements to the Trauma 

Care Program under Title XII of the Public Health Service Act. 

This committee expects the program to continue to be administered 

by the Health Resources and Services Administration (HRSA). A 

Clearinghouse on Trauma Care and Emergency Medical Services 

was authorized in previous legislation but never established at the 

Department. As a result, the committee has collapsed clearinghouse functions into the general trauma care program. 

The bill reduces the States’ contribution to the Federal matching 

requirement for grants under the Trauma Care Program. It is 

hoped that this reduction will enable some States to be able to participate in the program and encourage other 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 State investments 

in trauma care exceed the Federal contribution. 


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The committee supports the Interagency Program for Trauma 

Research and strongly urges the NIH to continue with this important work to conduct basic and clinical research on trauma. 

The Senate bill as reported out of committee reauthorized the 

program through fiscal year 2009. However, the committee notes 

that this program would be more appropriately placed in Title IV 

of the Public Health Service Act which authorizes the National Institutes of Health (NIH) and also is under the committee’s jurisdiction. The committee fully intends to actively pursue reauthorization 

of the NIH and plans to retain authority for the Interagency Program for Trauma Research as part of that effort. 

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 Emergency Medical Systems (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 requests an Institute of Medicine report on the status of 

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

expects that this report will be important in properly evaluating 

trauma care systems and identifying priorities for trauma research 

in the future. 

V. COST ESTIMATE AND UNFUNDED MANDATE STATEMENT

U.S. CONGRESS, 

CONGRESSIONAL BUDGET OFFICE, Washington, DC, May 27, 2005. 

Hon. MIKE ENZI, 

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. 265, the Trauma Care Systems Planning and Development Act of 2005. 

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

to provide them. The CBO staff contact is Tim Gronniger. 

Sincerely, 

DOUGLAS HOLTZ-EAKIN, 

Director. 

Enclosure. 

S. 265—Trauma Care Systems Planning and Development Act of 

2005 

Summary: S. 265 would amend the Public Health Service Act to 

authorize several 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 and an emergency care residency 

training program. S. 265 also would require HRSA to contract for 

a study on trauma care and trauma research. 

Assuming that the necessary amounts (including annual adjustments for anticipated inflation) are appropriated for fiscal years 

2006 through 2009, CBO estimates that implementing S. 265 


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would cost $47 million over the 2006–2010 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). 

The bill would authorize and increase appropriations for grant programs 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 face would be incurred voluntarily. 

Estimated cost to the Federal Government: The estimated budgetary impact of S. 265 is shown in the following table. The costs 

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

By fiscal year, in millions of dollars— 

2005 2006 2007 2008 2009 2010 

SPENDING SUBJECT TO APPROPRIATION 

Spending Under Current Law: 

Estimated Budget Authority 1 .............................................. 3 0 0 0 0 0 

Estimated Outlays ............................................................... 3 2 1 0 0 0 

Proposed Changes 2 3

Estimated Authorization Level ............................................. 0 13 13 13 13 0 

Estimated Outlays ............................................................... 0 4 9 13 13 9 

Spending Under S. 265: 

Estimated Authorization Level 1 .......................................... 3 13 13 13 13 0 

EstImated Outlays ............................................................... 3 6 10 13 13 9 

1 The 2005 level is the amount appropriated for that year. 

2 The bill also would authorize funding for 2005, but this estimate assumes that no additional funds will be appropriated this year. 3 Including adjustments for anticipated inflation, the estimated outlay changes would total $47 million over the 2006–2010 period. Without 

such adjustments, the five-year total would be $46 million. 

Basis of estimate: S. 265 would authorize two 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. 265 

would cost $47 million over the 2006–2010 period. 

HRSA currently administers grants to states for the planning, 

development, and improvement of trauma centers and systems. S. 

265 would authorize the appropriation of $12 million in 2005 and 

such sums as necessary through 2009 for those activities. In 2005, 

$3 million was appropriated for those activities, although the authorization expired in 2004. For this estimate, CBO assumes that 

no additional funds will be appropriated for the current year. 

The planning grant part of that program provides federal matching payments to funds spent by states. Under prior law, the federal 

government did not require contribution of state funds in the first 

year, but required a matching payment of $1 for every $1 of state 

spending in the second year, and a $3 match for every $1 spent in 

subsequent years. In 2005, however, because the appropriation is 

not sufficient to fund that schedule of matching payments, HRSA 

is providing roughly equal amounts to each participating state. 

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 the fourth and fifth years, the 

federal government would provide a matching payment of $1 for 

every $2 of state spending. 


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State participation under the current, less-generous program is 

very high. The authorization level for 2005 under S. 265 for this 

program would be four times higher than the 2005 appropriation 

level of $3 million. Based on information provided by HRSA about 

states’ trauma-planning activities and on historical spending patterns for this program, CBO estimates that the cost of implementing this provision would be $4 million in 2006 and $46 million 

over the 2006–2010 period. 

S. 265 also would authorize a residency training program in 

emergency medicine. The bill would authorize $400,000 each year 

through 2009 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. CBO estimates that 

implementing this provision would cost $1.6 million over the 2006–

2009 period. 

S. 265 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 2005 and 2006. Assuming the availability of appropriated funds, conducting the study could cost up to 

$1.5 million. 

Intergovernmental and private-sector impact: The bill contains 

no intergovemmental or private-sector mandates as defined in 

UMRA and would impose no costs on state, local, or tribal governments. The bill would authorize 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. 

Estimate prepared by: Federal costs: Tim Gronniger; impact on 

state, local, and tribal governments: Leo Lex; impact on the private 

sector: Peter Richmond. 

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

VI. APPLICATION OF LAW TO THE LEGISLATIVE BRANCH

The committee has determined that there is no impact of this 

law on the Legislative Branch. 

VII. 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. 

VIII. SECTION-BY-SECTION ANALYSIS

Section 1. Short title 

‘‘Trauma Care Systems Planning and Development Act of 2005’’. 

Section 2. Amendments 

This section reauthorizes the current grant program to enable a 

State to develop, implement, and maintain statewide trauma care 

systems. This section collapses the duties of the Clearinghouse into 

the general program description and authorizes the Secretary, actVerDate Aug 31 2005 11:36 Feb 03, 2006 Jkt 004901 PO 00000 Frm 00006 Fmt 6659 Sfmt 6602 E:\HR\OC\SR215.XXX SR215

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ing through HRSA, to promote the reporting and collection of trauma data in a consistent and standardized manner. This Section 

also eliminates authorization for the Clearinghouse on Trauma 

Care and Emergency Medical Services (EMS). 

This section 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. It also requests the Secretary to update the model trauma care plan. 

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

fiscal years—$2 State: $1 Federal. 

This section authorizes the appropriation of $12,000,000 for fiscal 

year 2006 and such sums as may be necessary for fiscal years 2007 

through 2010. 

This section requests an Institute of Medicine study on the state of trauma care and trauma research and authorizes $750,000 for 

fiscal year 2008 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 2005 

* * * * * * * 

TITLE XII—TRAUMA CARE 

PART A—GENERAL AUTHORITY AND DUTIES OF SECRETARY

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) * * * 


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(2) * * * 

(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; 

ø(4)¿ (5) sponsor workshops and conferencesø.¿; 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 be 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; 

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.¿ 


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SEC. ø1203¿. 1202 ESTABLISHMENT OF PROGRAMS FOR IMPROVING 

TRAUMA CARE IN RURAL AREAS. 

(a) IN GENERAL.—* * * 

(1) * * * 

(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—* * * 

* * * * * * * 

(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.—* * * 

(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. 

* * * * * * * 

(b) * * * 

(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 


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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 or requirements 

for—

* * * * * * * 

(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 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—

(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) * * * 

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

pregardeness planniong; 

ø10¿ (11) * * * 

ø11¿ (12) * * * 

(b) CERTAIN STANDARDS WITH RESPECT TO TRAUMA CARE CENTERS AND SYSTEMS.—

(1) IN GENERAL.—* * * 


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(A) take into account national standards øconcerning 

such¿ that outline resources for optimal care of the injured 

patient; 

* * * * * * * 

(D) beginning in fiscal year ø1992¿ 2005, take into account the model plan described in subsection (c). 

* * * * * * * 

(3) APPROVAL BY SECRETARY.—* * * 

(A) in the case of payments for fiscal year ø1991¿ 2005 

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¿ 2005 

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

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¿ 2005, 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¿ 2005 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¿ 2005, 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.—* * * 

(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.¿; 

* * * * * * * 


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SEC. 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. 

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¿ 2007, 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 2005, and such sums as may be necessary for each of the fiscal years 2006 through 2009. 

(b) ALLOCATION OF FUNDS BY SECRETARY.— (1) * * * 

(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). 

* * * * * * * 


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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 

$400,000 for each of the fiscal years ø1993 through 1995¿ 2005 

through 2009. 

* * * * * * * 

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

* * * * * * * 

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 2005 and 2006. 

* * * * * * * 

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 


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14 

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 established 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) * * * 

(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; 

* * * * * * * 

(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—


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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 

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) * * * 

* * * * * * * 

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¿ 2005 through 2009. 

* * * * * * * 

Æ 


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