I 

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. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE; FINDINGS AND SENSE OF CON4 GRESS. 

5 (a) SHORT TITLE.—This Act may be cited as the 

6 ‘‘National Trauma Care System Act’’. 

7 (b) FINDINGS.—Congress finds the following: 


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1 (1) Trauma is the leading killer of Americans 

2 under the age of 46 in the United States, killing 

3 more than 192,000 Americans each year. 

4 (2) The National Research Council has indi5 cated since 1966 that Federal funding for trauma 

6 research was inadequate—leading the Institute of 

7 Medicine in 1999 to conclude that, ‘‘The nation’s 

8 current investment in injury [trauma] research is 

9 not commensurate with the magnitude of the prob10 lem.’’. 

11 (3) The National Academies of Sciences found 

12 that between 200,000 and 300,000 Americans may 

13 have died from survivable traumatic injuries between 

14 2001 and 2011. 

15 (4) According to the Centers for Disease Con16 trol and Prevention, the economic burden of trauma 

17 was more than $671,000,000,000 in 2013 and it is 

18 one of the most expensive health care problems in 

19 the country. 

20 (5) According to the National Trauma Center, 

21 the National Institutes of Health spends less than 

22 $200 each year on trauma research for each year of 

23 potential life lost. 


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1 (6) The Institute of Medicine has recommended 

2 greater consideration of a disease’s societal and eco3 nomic burden when allocating research funding. 

4 (7) Nearly all combat deaths in the Armed 

5 Forces are due to trauma-related incidents, and be6 tween 2001 and 2011, nearly 25 percent of battle7 field deaths were caused by survivable injuries. 

8 (8) The 75th Ranger Regiment of the Army 

9 nearly eliminated its preventable fatalities by imple10 menting data-driven performance improvement poli11 cies and taking command-ownership of treatment 

12 outcomes. 

13 (9) Military and civilian trauma practitioners 

14 must be able to share data, techniques, and proce15 dures easily so they can institutionalize advances in 

16 care within their respective organizations. 

17 (10) The National Academy of Sciences con18 cluded ‘‘that a national strategy and joint military– 

19 civilian approach for improving trauma care is lack20 ing, placing lives unnecessarily at risk . . . that a 

21 unified effort is needed to address this gap and en22 sure the delivery of optimal trauma care to save the 

23 lives of Americans injured within the United States 

24 and on the battlefield.’’. 


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1 (c) SENSE OF CONGRESS.—It is the sense of Con2 gress that— 

3 (1) the President should establish and articu4 late a goal of achieving zero preventable deaths after 

5 injury and minimizing trauma-related disability and 

6 direct efforts towards that end; 

7 (2) the Federal Government should promote the 

8 development of a learning health system that enables 

9 a continuous improvement of military and civilian 

10 trauma systems through evidence-based initiatives; 

11 and 

12 (3) the Federal Government should promote 

13 greater collaboration between, and integration of, 

14 military and civilian trauma systems, including with 

15 respect to the permanent assignment of military 

16 trauma teams in civilian trauma centers, to prepare 

17 for mass trauma incidents in the homeland. 

18 SEC. 2. TASK FORCE ON ELIMINATING PREVENTABLE 

19 DEATHS OR DISABILITIES DUE TO TRAU20 MATIC INJURIES. 

21 (a) ESTABLISHMENT.—There is established a task 

22 force to be known as the ‘‘Task Force on Eliminating Pre23 ventable Deaths or Disabilities due to Traumatic Injuries’’ 

24 (in this section referred to as the ‘‘Task Force’’). 


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1 (b) MEMBERSHIP.—The Task Force shall be com2 posed of the following: 

3 (1) The Director of the Office of Management 

4 and Budget, who shall serve as the chairperson of 

5 the Task Force. 

6 (2) The Secretary of Defense. 

7 (3) The Secretary of Health and Human Serv8 ices. 

9 (4) The Secretary of Transportation. 

10 (5) The Secretary of Veterans Affairs. 

11 (6) The Secretary of Homeland Security. 

12 (7) The Commissioner of Food and Drugs. 

13 (8) The Director of the Domestic Policy Coun14 cil. 

15 (9) The Director of the National Institutes of 

16 Health. 

17 (10) The Administrator of the Centers for 

18 Medicare & Medicaid Services. 

19 (11) The Director of the Centers for Disease 

20 Control and Prevention. 

21 (12) The Assistant Secretary of Health of the 

22 Department of Health and Human Services. 

23 (13) The Assistant Secretary of Preparedness 

24 and Response of the Department of Health and 

25 Human Services. 


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1 (14) The head of the Office of the National Co2 ordinator for Health Information Technology of the 

3 Department of Health and Human Services. 

4 (15) A representative from the National Acad5 emies of Sciences, Engineering, and Medicine. 

6 (c) PLAN.— 

7 (1) DEVELOPMENT.—The Task Force shall de8 velop a plan to establish a national trauma care sys9 tem to facilitate the ability of the United States to— 

10 (A) eliminate the occurrence of preventable 

11 deaths related to injuries; 

12 (B) eliminate the occurrence of trauma-re13 lated disabilities; and 

14 (C) respond to mass trauma incidents. 

15 (2) GOALS.—The Task Force shall establish 

16 specific goals and milestones, and responsibilities for 

17 heads of departments and agencies of the Federal 

18 Government to meet such goals and milestones, to 

19 carry out the plan under paragraph (1). 

20 (3) ELEMENTS.—The plan under paragraph (1) 

21 shall include the following elements: 

22 (A) Establishing a national trauma care 

23 system capable of continuous learning and im24 provement. 


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1 (B) Fostering of greater collaboration and 

2 uniformity of standards of care. 

3 (C) Promoting access to patient-level data 

4 from across the continuum of care and just-in5 time access to high-quality knowledge for trau6 ma care teams and personnel who support such 

7 teams. 

8 (d) ESTABLISHMENT OF NATIONAL TRAUMA CARE

9 SYSTEM.— 

10 (1) GOVERNANCE.—The Task Force shall col11 laborate with representatives of State and local gov12 ernments, the private sector, and academia to— 

13 (A) establish the national trauma care sys14 tem pursuant to the plan developed under sub15 section (c), including by developing and car16 rying out the aims, design, and governance of 

17 the national trauma care system; and 

18 (B) jointly define a framework for the na19 tional trauma care system, including the des20 ignation of the roles, responsibilities, authori21 ties, and accountabilities of stakeholders. 

22 (2) CRITERIA.—The Task Force shall ensure 

23 the following: 


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1 (A) The national trauma care system de2 scribed in subsection (c)(3)(A) includes mecha3 nisms for accountability. 

4 (B) Each budget of the President sub5 mitted to Congress under section 1105(a) of 

6 title 31, United States Code, requests funding 

7 in amounts necessary to develop and support 

8 the national trauma care system. 

9 (C) The national trauma care system in10 cludes a data-driven research agenda. 

11 (D) The national trauma care system— 

12 (i) ensures military and civilian trau13 ma systems collect and share common data 

14 covering the entire continuum of care; and 

15 (ii) is capable of disseminating data 

16 related to prevention, mortality, disability, 

17 mental health, patient experience, and 

18 other intermediate and final clinical and 

19 cost outcomes. 

20 (E) The national trauma care system is 

21 developed and carried out in a manner that re22 duces regulatory and legal barriers to the full 

23 integration of the trauma continuum of care 

24 from the point of injury, to acute hospitaliza25 tion, and through rehabilitation and recovery. 


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1 (F) The national trauma care system is ca2 pable of responding domestically to any inten3 tional or unintentional mass casualty incident. 

4 (e) NATIONAL TRAUMA RESEARCH ACTION PLAN.— 

5 (1) IN GENERAL.—The Task Force shall de6 velop and implement a national trauma research ac7 tion plan to carry out a coordinated approach to 

8 trauma care research conducted by the Federal Gov9 ernment (including by the Department of Defense, 

10 the Department of Health and Human Services, the 

11 Department of Veterans Affairs, and the National 

12 Institutes of Health) and academia and other private 

13 institutions. 

14 (2) ELEMENTS.—The plan under paragraph (1) 

15 shall include the following elements: 

16 (A) An analysis of the performance gaps 

17 with respect to trauma care provided by the 

18 Armed Forces and trauma care provided by ci19 vilian health care providers, including with re20 spect to the full continuum of care and with re21 spect to needs specific to intentional or uninten22 tional mass casualty incidents and specific pa23 tient populations. 

24 (B) Requirements-driven and patient-cen25 tered research strategies and priorities for adVerDate Sep 11 2014 02:26 Sep 27, 2016 Jkt 059200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H6132.IH H6132

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1 dressing the gaps identified under subpara2 graph (A). 

3 (C) An integrated strategy for the Armed 

4 Forces and civilians with short, intermediate 

5 and long-term steps for— 

6 (i) ensuring that appropriate military 

7 and civilian resources are directed toward 

8 efforts to fill the gaps identified under sub9 paragraph (A) (particularly between peri10 ods in which the Armed Forces are en11 gaged in conflicts or contingency oper12 ations); and 

13 (ii) designating the responsibilities 

14 and milestones for implementing the strat15 egy by the Armed Forces, the Federal Gov16 ernment, and industry stakeholders. 

17 (D) The promotion of military-civilian re18 search partnerships to ensure that knowledge is 

19 transferred to and from the Armed Forces and 

20 that lessons learned from combat can be refined 

21 during periods in which the Armed Forces are 

22 not engaged in conflicts or contingency oper23 ations. 

24 (f) STAFF.— 


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1 (1) DETAILEES.—Upon request of the chair2 person of the Task Force, the head of any Federal 

3 department or agency may detail, on a reimbursable 

4 basis, any of the personnel of that department or 

5 agency to the Task Force to assist it in carrying out 

6 its duties under this section. 

7 (2) APPOINTMENT OF ADDITIONAL PER8 SONNEL.—With the approval of the Task Force, the 

9 Chairperson may appoint and fix the pay of addi10 tional personnel of the Task Force. 

11 (g) REPORTS.—Not later than 540 days after the 

12 date of the enactment of this Act, and annually thereafter, 

13 the Task Force shall submit to Congress a report on the 

14 activities of the Task Force, including— 

15 (1) the plan under subsection (c); 

16 (2) the national trauma research action plan 

17 under subsection (e); and 

18 (3) any recommendations regarding legislative 

19 action required to fully implement such plans and to 

20 carry out this Act. 

21 (h) TRAUMA CARE SYSTEM DEFINED.—In this sec22 tion, the term ‘‘trauma care system’’ means an organized, 

23 inclusive approach to facilitating and coordinating a multi24 disciplinary system response to severely injured patients 


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1 that encompasses a continuum of care provision and inclu2 sive of— 

3 (1) injury prevention and control; 

4 (2) public health; 

5 (3) emergency medical services field interven6 tion; 

7 (4) emergency department care; 

8 (5) surgical interventions; 

9 (6) intensive and general surgical in-hospital 

10 care; 

11 (7) rehabilitative services; and 

12 (8) social services and support groups that as13 sist injured people and significant others of such in14 jured people with returning to society at the most 

15 productive level possible. 

16 SEC. 3. TRAUMA STANDARDS AND POLICIES FOR THE DE17 PARTMENT OF HEALTH AND HUMAN SERV18 ICES. 

19 The Secretary of Health and Human Services shall— 

20 (1) not later than 540 days after the date of 

21 the enactment of this Act, develop and publish 

22 standards for trauma care in pre-hospital and hos23 pital settings; 

24 (2) identify, evaluate, and, to the extent prac25 ticable, implement policies to ensure coordination beVerDate Sep 11 2014 02:26 Sep 27, 2016 Jkt 059200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H6132.IH H6132

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1 tween prehospital trauma care and trauma care at 

2 trauma centers and hospitals; 

3 (3) work with the Secretary of Defense, the 

4 Secretary of Veterans Affairs, and other stake5 holders as the Secretary of Health and Human Serv6 ices determines necessary to facilitate the collection 

7 and sharing of data among trauma systems of the 

8 Federal Government and non-governmental trauma 

9 systems across the continuum of care, to the extent 

10 practicable pursuant to the regulations described in 

11 paragraph (4); 

12 (4) revise regulations and clarify existing regu13 lations through policy statements to clarify the scope 

14 and applicability of regulations and guidance issued 

15 pursuant to the Health Insurance Portability and 

16 Accountability Act with respect to trauma care such 

17 that barriers to the use and disclosure of protected 

18 health information across the continuum of care are 

19 minimized; 

20 (5) ensure the civilian trauma systems partici21 pate in a structured trauma quality improvement 

22 process; 

23 (6) not later than one year after the date of the 

24 enactment of this Act, submit a report to Congress 


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1 that identifies statutory or regulatory changes need2 ed to— 

3 (A) ensure that emergency medical services 

4 are appropriately compensated under Federal 

5 law; 

6 (B) condition reimbursement under Fed7 eral law of ambulance services on the quality of 

8 care provided; 

9 (C) waive or modify the requirement of in10 formed consent for minimal-risk research in the 

11 emergency medical service context; and 

12 (D) improve data collection in health care 

13 settings where practical and ethical concerns 

14 constrain the use of randomized control trials, 

15 including settings in which emergency medical 

16 services are provided; and 

17 (7) in developing the report in paragraph (6), 

18 consult with relevant stakeholders in the private and 

19 public sectors and provide an analysis of the effects 

20 of any proposed statutory or regulatory changes, in21 cluding— 

22 (A) the costs of delivery of trauma care in 

23 different care settings; and 

24 (B) anticipated changes in treatment out25 comes for emergency medical services. 


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

2 DEFENSE. 

3 (a) PLAN.— 

4 (1) IN GENERAL.—Not later than 180 days 

5 after the date of the enactment of this Act, the Sec6 retary of Defense shall submit to the Committees on 

7 Armed Services of the House of Representatives and 

8 the Senate an implementation plan to establish a 

9 Joint Trauma System within the Defense Health 

10 Agency that promotes improved trauma care to 

11 members of the Armed Forces and other individuals 

12 who are eligible to be treated for trauma at a mili13 tary medical treatment facility. 

14 (2) IMPLEMENTATION.—The Secretary shall 

15 implement the plan under paragraph (1) after a 90- 

16 day period has elapsed following the date on which 

17 the Comptroller General of the United States is re18 quired to submit to the Committees on Armed Serv19 ices of the House of Representatives and the Senate 

20 the review under subsection (c). In implementing 

21 such plan, the Secretary shall take into account any 

22 recommendation made by the Comptroller General 

23 under such review. 

24 (b) ELEMENTS.—The Joint Trauma System de25 scribed in subsection (a)(1) shall include the following ele26 ments: 


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1 (1) Serve as the reference body for all trauma 

2 care provided across the military health system. 

3 (2) Establish standards of care for trauma 

4 services provided at military medical treatment fa5 cilities. 

6 (3) Coordinate the translation of research from 

7 the centers of excellence of the Department of De8 fense into standards of clinical trauma care. 

9 (4) Coordinate the incorporation of lessons 

10 learned from the trauma education and training 

11 partnerships pursuant to section 5 into clinical prac12 tice. 

13 (5) Participate in a structured trauma quality 

14 improvement process. 

15 (c) REVIEW.—Not later than 120 days after the date 

16 on which the Secretary submits to the Committees on 

17 Armed Services of the House of Representatives and the 

18 Senate the implementation plan under subsection (a)(1), 

19 the Comptroller General of the United States shall submit 

20 to such committees a review of such plan to determine if 

21 each element under subsection (b) is included in such plan. 

22 (d) REVIEW OF MILITARY TRAUMA SYSTEM.—In es23 tablishing a Joint Trauma System, the Secretary of De24 fense shall seek to enter into an agreement with a non25 governmental entity with subject matter experts to— 


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1 (1) conduct a system-wide review of the military 

2 trauma system; and 

3 (2) not later than 180 days after the date of 

4 the enactment of this Act, make publicly available a 

5 report containing such review and recommendations 

6 to establish a comprehensive trauma system for the 

7 Armed Forces. 

8 SEC. 5. JOINT TRAUMA EDUCATION AND TRAINING DIREC9 TORATE OF THE DEPARTMENT OF DEFENSE. 

10 (a) ESTABLISHMENT.—The Secretary of Defense 

11 shall establish a Joint Trauma Education and Training 

12 Directorate (in this section referred to as the ‘‘Direc13 torate’’) to ensure that the military trauma care providers 

14 maintain readiness and are able to be rapidly deployed for 

15 future armed conflicts. The Secretary shall carry out this 

16 section in collaboration with the Secretaries of the military 

17 departments. 

18 (b) DUTIES.—The duties of the Directorate are as 

19 follows: 

20 (1) To enter into and coordinate the partner21 ships under subsection (c). 

22 (2) To establish the goals of such partnerships 

23 necessary for military trauma teams led by military 

24 trauma care providers to maintain professional com25 petency in trauma care. 


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1 (3) To establish metrics for measuring the per2 formance of such partnerships in achieving such 

3 goals. 

4 (4) To develop methods of data collection and 

5 analysis for carrying out paragraph (3). 

6 (5) To communicate and coordinate lessons 

7 learned from such partnerships with the Joint Trau8 ma System established under section 4. 

9 (c) PARTNERSHIPS.— 

10 (1) IN GENERAL.—The Secretary shall enter 

11 into partnerships with civilian trauma centers. 

12 (2) MILITARY TRAUMA TEAMS.—Under the 

13 partnerships entered into with civilian trauma cen14 ters under paragraph (1), military trauma teams led 

15 by military trauma care providers shall embed within 

16 the civilian trauma centers on an enduring basis. 

17 (3) SELECTION.—The Secretary shall select ci18 vilian trauma centers to enter into partnerships 

19 under paragraph (1) based on patient volume, acu20 ity, and other factors the Secretary determines nec21 essary to ensure that the military trauma care pro22 viders and the associated clinical support teams have 

23 adequate and continuous exposure to critically in24 jured patients. 


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1 (4) CONSIDERATION.—In entering into partner2 ships under paragraph (1), the Secretary may con3 sider the experiences and lessons learned by the mili4 tary departments that have entered into memoranda 

5 of understanding with civilian medical centers for 

6 trauma care. 

7 (5) RESERVE COMPONENTS.—The Secretary 

8 shall ensure that the partnerships under paragraph 

9 (1) provide opportunities for the participation of 

10 military trauma care providers and military trauma 

11 teams of the reserve components of the Armed 

12 Forces. 

13 (d) ANALYSIS.—The Secretary of Defense shall con14 duct an analysis to determine the number of military trau15 ma care providers, by specialty and component, that must 

16 be maintained within the Department of Defense to meet 

17 the requirements of the combatant commands. 

18 (e) IMPLEMENTATION PLAN.—Not later than one 

19 year after the date of the enactment of this Act, the Sec20 retary shall submit to the Committees on Armed Services 

21 of the House of Representatives and the Senate an imple22 mentation plan for establishing the Joint Trauma Edu23 cation and Training Directorate under subsection (a) and 

24 entering into partnerships under subsection (c). 

25 (f) DEFINITIONS.—In this section: 


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1 (1) The term ‘‘military trauma care provider’’ 

2 means a member of the Armed Forces who furnishes 

3 emergency, critical care, and other trauma acute 

4 care, including a physician, military surgeon, physi5 cian assistant, nurse, respiratory therapist, flight 

6 paramedic, combat medic, or enlisted medical techni7 cian. 

8 (2) The term and ‘‘military trauma team’’ 

9 means a complete military trauma team consisting 

10 of military trauma care providers. 

11 SEC. 6. EVALUATION OF THE SECRETARIAL DESIGNEE PRO12 GRAM. 

13 (a) IN GENERAL.—Not later than one year after the 

14 date of the enactment of this Act, the Secretary of Defense 

15 shall submit to the Committees on Armed Services of the 

16 House of Representatives and the Senate a report on the 

17 activities of the Secretarial Designee Program, includ18 ing— 

19 (1) the number of applicants admitted to the 

20 Program since the inception of the Program; 

21 (2) the criteria used to grant admittance to the 

22 Program; 

23 (3) the admittance rate into the Program; 

24 (4) the costs associated with administering the 

25 Program; 


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1 (5) the feasibility of allowing private institu2 tions and individuals to nominate applicants for ad3 mission to the Program; 

4 (6) recommendations for improving processing 

5 times of applications for the Program; 

6 (7) the current ability of the military health 

7 system to provide support to civil authorities during 

8 a mass casualty incident; and 

9 (8) an assessment of the Program. 

10 (b) STANDARDIZED ADMISSION POLICIES AND PROC11 ESSES.—The Secretary shall standardize the admission 

12 policies and processes of the Secretarial Designee Program 

13 with respect to the Secretary and each Secretary con14 cerned implementing the Program. 

15 (c) DEFINITIONS.—In this section: 

16 (1) The term ‘‘Secretarial Designee Program’’ 

17 means the program under which health care is pro18 vided to individuals other than members of the uni19 form services and dependents of such members at 

20 military medical treatment facilities, as described in 

21 Department of Defense Instruction 6025.23, dated 

22 October 2, 2013, and implemented by the Office of 

23 the Secretary of Defense and the military depart24 ments. 


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1 (2) The term ‘‘Secretary concerned’’ has the 

2 meaning given that term in section 101(a)(9) of title 

3 10, United States Code. 

Æ 


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