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[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6132 Introduced in House (IH)]

<DOC>

114th CONGRESS
  2d Session
                                H. R. 6132

To establish a task force to develop a national trauma care system, to 
 improve the trauma care system of the Department of Defense, and for 
                            other purposes.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                           September 22, 2016

Ms. Duckworth introduced the following bill; which was referred to the 
 Committee on Energy and Commerce, and in addition to the Committee on 
   Armed Services, for a period to be subsequently determined by the 
  Speaker, in each case for consideration of such provisions as fall 
           within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL

 
To establish a task force to develop a national trauma care system, to 
 improve the trauma care system of the Department of Defense, and for 
                            other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; FINDINGS AND SENSE OF CONGRESS.

    (a) Short Title.--This Act may be cited as the ``National Trauma 
Care System Act''.
    (b) Findings.--Congress finds the following:
            (1) Trauma is the leading killer of Americans under the age 
        of 46 in the United States, killing more than 192,000 Americans 
        each year.
            (2) The National Research Council has indicated since 1966 
        that Federal funding for trauma research was inadequate--
        leading the Institute of Medicine in 1999 to conclude that, 
        ``The nation's current investment in injury [trauma] research 
        is not commensurate with the magnitude of the problem.''.
            (3) The National Academies of Sciences found that between 
        200,000 and 300,000 Americans may have died from survivable 
        traumatic injuries between 2001 and 2011.
            (4) According to the Centers for Disease Control and 
        Prevention, the economic burden of trauma was more than 
        $671,000,000,000 in 2013 and it is one of the most expensive 
        health care problems in the country.
            (5) According to the National Trauma Center, the National 
        Institutes of Health spends less than $200 each year on trauma 
        research for each year of potential life lost.
            (6) The Institute of Medicine has recommended greater 
        consideration of a disease's societal and economic burden when 
        allocating research funding.
            (7) Nearly all combat deaths in the Armed Forces are due to 
        trauma-related incidents, and between 2001 and 2011, nearly 25 
        percent of battlefield deaths were caused by survivable 
        injuries.
            (8) The 75th Ranger Regiment of the Army nearly eliminated 
        its preventable fatalities by implementing data-driven 
        performance improvement policies and taking command-ownership 
        of treatment outcomes.
            (9) Military and civilian trauma practitioners must be able 
        to share data, techniques, and procedures easily so they can 
        institutionalize advances in care within their respective 
        organizations.
            (10) The National Academy of Sciences concluded ``that a 
        national strategy and joint military-civilian approach for 
        improving trauma care is lacking, placing lives unnecessarily 
        at risk . . . that a unified effort is needed to address this 
        gap and ensure the delivery of optimal trauma care to save the 
        lives of Americans injured within the United States and on the 
        battlefield.''.
    (c) Sense of Congress.--It is the sense of Congress that--
            (1) the President should establish and articulate a goal of 
        achieving zero preventable deaths after injury and minimizing 
        trauma-related disability and direct efforts towards that end;
            (2) the Federal Government should promote the development 
        of a learning health system that enables a continuous 
        improvement of military and civilian trauma systems through 
        evidence-based initiatives; and
            (3) the Federal Government should promote greater 
        collaboration between, and integration of, military and 
        civilian trauma systems, including with respect to the 
        permanent assignment of military trauma teams in civilian 
        trauma centers, to prepare for mass trauma incidents in the 
        homeland.

SEC. 2. TASK FORCE ON ELIMINATING PREVENTABLE DEATHS OR DISABILITIES 
              DUE TO TRAUMATIC INJURIES.

    (a) Establishment.--There is established a task force to be known 
as the ``Task Force on Eliminating Preventable Deaths or Disabilities 
due to Traumatic Injuries'' (in this section referred to as the ``Task 
Force'').
    (b) Membership.--The Task Force shall be composed of the following:
            (1) The Director of the Office of Management and Budget, 
        who shall serve as the chairperson of the Task Force.
            (2) The Secretary of Defense.
            (3) The Secretary of Health and Human Services.
            (4) The Secretary of Transportation.
            (5) The Secretary of Veterans Affairs.
            (6) The Secretary of Homeland Security.
            (7) The Commissioner of Food and Drugs.
            (8) The Director of the Domestic Policy Council.
            (9) The Director of the National Institutes of Health.
            (10) The Administrator of the Centers for Medicare & 
        Medicaid Services.
            (11) The Director of the Centers for Disease Control and 
        Prevention.
            (12) The Assistant Secretary of Health of the Department of 
        Health and Human Services.
            (13) The Assistant Secretary of Preparedness and Response 
        of the Department of Health and Human Services.
            (14) The head of the Office of the National Coordinator for 
        Health Information Technology of the Department of Health and 
        Human Services.
            (15) A representative from the National Academies of 
        Sciences, Engineering, and Medicine.
    (c) Plan.--
            (1) Development.--The Task Force shall develop a plan to 
        establish a national trauma care system to facilitate the 
        ability of the United States to--
                    (A) eliminate the occurrence of preventable deaths 
                related to injuries;
                    (B) eliminate the occurrence of trauma-related 
                disabilities; and
                    (C) respond to mass trauma incidents.
            (2) Goals.--The Task Force shall establish specific goals 
        and milestones, and responsibilities for heads of departments 
        and agencies of the Federal Government to meet such goals and 
        milestones, to carry out the plan under paragraph (1).
            (3) Elements.--The plan under paragraph (1) shall include 
        the following elements:
                    (A) Establishing a national trauma care system 
                capable of continuous learning and improvement.
                    (B) Fostering of greater collaboration and 
                uniformity of standards of care.
                    (C) Promoting access to patient-level data from 
                across the continuum of care and just-in-time access to 
                high-quality knowledge for trauma care teams and 
                personnel who support such teams.
    (d) Establishment of National Trauma Care System.--
            (1) Governance.--The Task Force shall collaborate with 
        representatives of State and local governments, the private 
        sector, and academia to--
                    (A) establish the national trauma care system 
                pursuant to the plan developed under subsection (c), 
                including by developing and carrying out the aims, 
                design, and governance of the national trauma care 
                system; and
                    (B) jointly define a framework for the national 
                trauma care system, including the designation of the 
                roles, responsibilities, authorities, and 
                accountabilities of stakeholders.
            (2) Criteria.--The Task Force shall ensure the following:
                    (A) The national trauma care system described in 
                subsection (c)(3)(A) includes mechanisms for 
                accountability.
                    (B) Each budget of the President submitted to 
                Congress under section 1105(a) of title 31, United 
                States Code, requests funding in amounts necessary to 
                develop and support the national trauma care system.
                    (C) The national trauma care system includes a 
                data-driven research agenda.
                    (D) The national trauma care system--
                            (i) ensures military and civilian trauma 
                        systems collect and share common data covering 
                        the entire continuum of care; and
                            (ii) is capable of disseminating data 
                        related to prevention, mortality, disability, 
                        mental health, patient experience, and other 
                        intermediate and final clinical and cost 
                        outcomes.
                    (E) The national trauma care system is developed 
                and carried out in a manner that reduces regulatory and 
                legal barriers to the full integration of the trauma 
                continuum of care from the point of injury, to acute 
                hospitalization, and through rehabilitation and 
                recovery.
                    (F) The national trauma care system is capable of 
                responding domestically to any intentional or 
                unintentional mass casualty incident.
    (e) National Trauma Research Action Plan.--
            (1) In general.--The Task Force shall develop and implement 
        a national trauma research action plan to carry out a 
        coordinated approach to trauma care research conducted by the 
        Federal Government (including by the Department of Defense, the 
        Department of Health and Human Services, the Department of 
        Veterans Affairs, and the National Institutes of Health) and 
        academia and other private institutions.
            (2) Elements.--The plan under paragraph (1) shall include 
        the following elements:
                    (A) An analysis of the performance gaps with 
                respect to trauma care provided by the Armed Forces and 
                trauma care provided by civilian health care providers, 
                including with respect to the full continuum of care 
                and with respect to needs specific to intentional or 
                unintentional mass casualty incidents and specific 
                patient populations.
                    (B) Requirements-driven and patient-centered 
                research strategies and priorities for addressing the 
                gaps identified under subparagraph (A).
                    (C) An integrated strategy for the Armed Forces and 
                civilians with short, intermediate and long-term steps 
                for--
                            (i) ensuring that appropriate military and 
                        civilian resources are directed toward efforts 
                        to fill the gaps identified under subparagraph 
                        (A) (particularly between periods in which the 
                        Armed Forces are engaged in conflicts or 
                        contingency operations); and
                            (ii) designating the responsibilities and 
                        milestones for implementing the strategy by the 
                        Armed Forces, the Federal Government, and 
                        industry stakeholders.
                    (D) The promotion of military-civilian research 
                partnerships to ensure that knowledge is transferred to 
                and from the Armed Forces and that lessons learned from 
                combat can be refined during periods in which the Armed 
                Forces are not engaged in conflicts or contingency 
                operations.
    (f) Staff.--
            (1) Detailees.--Upon request of the chairperson of the Task 
        Force, the head of any Federal department or agency may detail, 
        on a reimbursable basis, any of the personnel of that 
        department or agency to the Task Force to assist it in carrying 
        out its duties under this section.
            (2) Appointment of additional personnel.--With the approval 
        of the Task Force, the Chairperson may appoint and fix the pay 
        of additional personnel of the Task Force.
    (g) Reports.--Not later than 540 days after the date of the 
enactment of this Act, and annually thereafter, the Task Force shall 
submit to Congress a report on the activities of the Task Force, 
including--
            (1) the plan under subsection (c);
            (2) the national trauma research action plan under 
        subsection (e); and
            (3) any recommendations regarding legislative action 
        required to fully implement such plans and to carry out this 
        Act.
    (h) Trauma Care System Defined.--In this section, the term ``trauma 
care system'' means an organized, inclusive approach to facilitating 
and coordinating a multidisciplinary system response to severely 
injured patients that encompasses a continuum of care provision and 
inclusive of--
            (1) injury prevention and control;
            (2) public health;
            (3) emergency medical services field intervention;
            (4) emergency department care;
            (5) surgical interventions;
            (6) intensive and general surgical in-hospital care;
            (7) rehabilitative services; and
            (8) social services and support groups that assist injured 
        people and significant others of such injured people with 
        returning to society at the most productive level possible.

SEC. 3. TRAUMA STANDARDS AND POLICIES FOR THE DEPARTMENT OF HEALTH AND 
              HUMAN SERVICES.

    The Secretary of Health and Human Services shall--
            (1) not later than 540 days after the date of the enactment 
        of this Act, develop and publish standards for trauma care in 
        pre-hospital and hospital settings;
            (2) identify, evaluate, and, to the extent practicable, 
        implement policies to ensure coordination between prehospital 
        trauma care and trauma care at trauma centers and hospitals;
            (3) work with the Secretary of Defense, the Secretary of 
        Veterans Affairs, and other stakeholders as the Secretary of 
        Health and Human Services determines necessary to facilitate 
        the collection and sharing of data among trauma systems of the 
        Federal Government and non-governmental trauma systems across 
        the continuum of care, to the extent practicable pursuant to 
        the regulations described in paragraph (4);
            (4) revise regulations and clarify existing regulations 
        through policy statements to clarify the scope and 
        applicability of regulations and guidance issued pursuant to 
        the Health Insurance Portability and Accountability Act with 
        respect to trauma care such that barriers to the use and 
        disclosure of protected health information across the continuum 
        of care are minimized;
            (5) ensure the civilian trauma systems participate in a 
        structured trauma quality improvement process;
            (6) not later than one year after the date of the enactment 
        of this Act, submit a report to Congress that identifies 
        statutory or regulatory changes needed to--
                    (A) ensure that emergency medical services are 
                appropriately compensated under Federal law;
                    (B) condition reimbursement under Federal law of 
                ambulance services on the quality of care provided;
                    (C) waive or modify the requirement of informed 
                consent for minimal-risk research in the emergency 
                medical service context; and
                    (D) improve data collection in health care settings 
                where practical and ethical concerns constrain the use 
                of randomized control trials, including settings in 
                which emergency medical services are provided; and
            (7) in developing the report in paragraph (6), consult with 
        relevant stakeholders in the private and public sectors and 
        provide an analysis of the effects of any proposed statutory or 
        regulatory changes, including--
                    (A) the costs of delivery of trauma care in 
                different care settings; and
                    (B) anticipated changes in treatment outcomes for 
                emergency medical services.

SEC. 4. JOINT TRAUMA SYSTEM OF THE DEPARTMENT OF DEFENSE.

    (a) Plan.--
            (1) In general.--Not later than 180 days after the date of 
        the enactment of this Act, the Secretary of Defense shall 
        submit to the Committees on Armed Services of the House of 
        Representatives and the Senate an implementation plan to 
        establish a Joint Trauma System within the Defense Health 
        Agency that promotes improved trauma care to members of the 
        Armed Forces and other individuals who are eligible to be 
        treated for trauma at a military medical treatment facility.
            (2) Implementation.--The Secretary shall implement the plan 
        under paragraph (1) after a 90-day period has elapsed following 
        the date on which the Comptroller General of the United States 
        is required to submit to the Committees on Armed Services of 
        the House of Representatives and the Senate the review under 
        subsection (c). In implementing such plan, the Secretary shall 
        take into account any recommendation made by the Comptroller 
        General under such review.
    (b) Elements.--The Joint Trauma System described in subsection 
(a)(1) shall include the following elements:
            (1) Serve as the reference body for all trauma care 
        provided across the military health system.
            (2) Establish standards of care for trauma services 
        provided at military medical treatment facilities.
            (3) Coordinate the translation of research from the centers 
        of excellence of the Department of Defense into standards of 
        clinical trauma care.
            (4) Coordinate the incorporation of lessons learned from 
        the trauma education and training partnerships pursuant to 
        section 5 into clinical practice.
            (5) Participate in a structured trauma quality improvement 
        process.
    (c) Review.--Not later than 120 days after the date on which the 
Secretary submits to the Committees on Armed Services of the House of 
Representatives and the Senate the implementation plan under subsection 
(a)(1), the Comptroller General of the United States shall submit to 
such committees a review of such plan to determine if each element 
under subsection (b) is included in such plan.
    (d) Review of Military Trauma System.--In establishing a Joint 
Trauma System, the Secretary of Defense shall seek to enter into an 
agreement with a non-governmental entity with subject matter experts 
to--
            (1) conduct a system-wide review of the military trauma 
        system; and
            (2) not later than 180 days after the date of the enactment 
        of this Act, make publicly available a report containing such 
        review and recommendations to establish a comprehensive trauma 
        system for the Armed Forces.

SEC. 5. JOINT TRAUMA EDUCATION AND TRAINING DIRECTORATE OF THE 
              DEPARTMENT OF DEFENSE.

    (a) Establishment.--The Secretary of Defense shall establish a 
Joint Trauma Education and Training Directorate (in this section 
referred to as the ``Directorate'') to ensure that the military trauma 
care providers maintain readiness and are able to be rapidly deployed 
for future armed conflicts. The Secretary shall carry out this section 
in collaboration with the Secretaries of the military departments.
    (b) Duties.--The duties of the Directorate are as follows:
            (1) To enter into and coordinate the partnerships under 
        subsection (c).
            (2) To establish the goals of such partnerships necessary 
        for military trauma teams led by military trauma care providers 
        to maintain professional competency in trauma care.
            (3) To establish metrics for measuring the performance of 
        such partnerships in achieving such goals.
            (4) To develop methods of data collection and analysis for 
        carrying out paragraph (3).
            (5) To communicate and coordinate lessons learned from such 
        partnerships with the Joint Trauma System established under 
        section 4.
    (c) Partnerships.--
            (1) In general.--The Secretary shall enter into 
        partnerships with civilian trauma centers.
            (2) Military trauma teams.--Under the partnerships entered 
        into with civilian trauma centers under paragraph (1), military 
        trauma teams led by military trauma care providers shall embed 
        within the civilian trauma centers on an enduring basis.
            (3) Selection.--The Secretary shall select civilian trauma 
        centers to enter into partnerships under paragraph (1) based on 
        patient volume, acuity, and other factors the Secretary 
        determines necessary to ensure that the military trauma care 
        providers and the associated clinical support teams have 
        adequate and continuous exposure to critically injured 
        patients.
            (4) Consideration.--In entering into partnerships under 
        paragraph (1), the Secretary may consider the experiences and 
        lessons learned by the military departments that have entered 
        into memoranda of understanding with civilian medical centers 
        for trauma care.
            (5) Reserve components.--The Secretary shall ensure that 
        the partnerships under paragraph (1) provide opportunities for 
        the participation of military trauma care providers and 
        military trauma teams of the reserve components of the Armed 
        Forces.
    (d) Analysis.--The Secretary of Defense shall conduct an analysis 
to determine the number of military trauma care providers, by specialty 
and component, that must be maintained within the Department of Defense 
to meet the requirements of the combatant commands.
    (e) Implementation Plan.--Not later than one year after the date of 
the enactment of this Act, the Secretary shall submit to the Committees 
on Armed Services of the House of Representatives and the Senate an 
implementation plan for establishing the Joint Trauma Education and 
Training Directorate under subsection (a) and entering into 
partnerships under subsection (c).
    (f) Definitions.--In this section:
            (1) The term ``military trauma care provider'' means a 
        member of the Armed Forces who furnishes emergency, critical 
        care, and other trauma acute care, including a physician, 
        military surgeon, physician assistant, nurse, respiratory 
        therapist, flight paramedic, combat medic, or enlisted medical 
        technician.
            (2) The term and ``military trauma team'' means a complete 
        military trauma team consisting of military trauma care 
        providers.

SEC. 6. EVALUATION OF THE SECRETARIAL DESIGNEE PROGRAM.

    (a) In General.--Not later than one year after the date of the 
enactment of this Act, the Secretary of Defense shall submit to the 
Committees on Armed Services of the House of Representatives and the 
Senate a report on the activities of the Secretarial Designee Program, 
including--
            (1) the number of applicants admitted to the Program since 
        the inception of the Program;
            (2) the criteria used to grant admittance to the Program;
            (3) the admittance rate into the Program;
            (4) the costs associated with administering the Program;
            (5) the feasibility of allowing private institutions and 
        individuals to nominate applicants for admission to the 
        Program;
            (6) recommendations for improving processing times of 
        applications for the Program;
            (7) the current ability of the military health system to 
        provide support to civil authorities during a mass casualty 
        incident; and
            (8) an assessment of the Program.
    (b) Standardized Admission Policies and Processes.--The Secretary 
shall standardize the admission policies and processes of the 
Secretarial Designee Program with respect to the Secretary and each 
Secretary concerned implementing the Program.
    (c) Definitions.--In this section:
            (1) The term ``Secretarial Designee Program'' means the 
        program under which health care is provided to individuals 
        other than members of the uniform services and dependents of 
        such members at military medical treatment facilities, as 
        described in Department of Defense Instruction 6025.23, dated 
        October 2, 2013, and implemented by the Office of the Secretary 
        of Defense and the military departments.
            (2) The term ``Secretary concerned'' has the meaning given 
        that term in section 101(a)(9) of title 10, United States Code.
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