II 

Calendar No. 98 

110TH CONGRESS 

1ST SESSION S. 657 

To amend the Public Health Service Act to add requirements regarding 

trauma care, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

FEBRUARY 16, 2007 

Mr. REED (for himself, Mr. ROBERTS, Mr. KENNEDY, Mr. BURR, Mrs. MURRAY, Mr. HATCH, Mr. BROWN, Mrs. CLINTON, Mr. ISAKSON, Mr. BINGAMAN, Ms. COLLINS, and Mr. BIDEN) introduced the following bill; which 

was read twice and referred to the Committee on Health, Education, 

Labor, and Pensions 

MARCH 29, 2007 

Reported by Mr. KENNEDY, with an amendment 

[Strike out all after the enacting clause and insert the part printed in italic] 

A BILL 

To amend the Public Health Service Act to add requirements 

regarding trauma care, 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. 

4 This Act may be cited as the ‘‘Trauma Care Systems 

5 Planning and Development Act of 2007’’. 


hsrobinson on PROD1PC76 with BILLS
2 

•S 657 RS

1 SEC. 2. ESTABLISHMENT. 

2 Section 1201 of the Public Health Service Act (42 

3 U.S.C. 300d) is amended to read as follows: 

4 ‘‘SEC. 1201. ESTABLISHMENT. 

5 ‘‘(a) IN GENERAL.—The Secretary shall, with respect 

6 to trauma care— 

7 ‘‘(1) conduct and support research, training, 

8 evaluations, and demonstration projects; 

9 ‘‘(2) foster the development of appropriate, 

10 modern systems of such care through the sharing of 

11 information among agencies and individuals involved 

12 in the study and provision of such care; 

13 ‘‘(3) collect, compile, and disseminate informa14 tion on the achievements of, and problems experi15 enced by, State and local agencies and private enti16 ties in providing trauma care and emergency medical 

17 services and, in so doing, give special consideration 

18 to the unique needs of rural areas; 

19 ‘‘(4) provide to State and local agencies tech20 nical assistance to enhance each State’s capability to 

21 develop, implement, and sustain the trauma care 

22 component of each State’s plan for the provision of 

23 emergency medical services; 

24 ‘‘(5) sponsor workshops and conferences; and 


hsrobinson on PROD1PC76 with BILLS
3 

•S 657 RS

1 ‘‘(6) promote the collection and categorization 

2 of trauma data in a consistent and standardized 

3 manner. 

4 ‘‘(b) GRANTS, COOPERATIVE AGREEMENTS, AND

5 CONTRACTS.—The Secretary may make grants, and enter 

6 into cooperative agreements and contracts, for the purpose 

7 of carrying out subsection (a).’’. 

8 SEC. 3. CLEARINGHOUSE ON TRAUMA CARE AND EMER9 GENCY MEDICAL SERVICES. 

10 The Public Health Service Act (42 U.S.C. 201 et 

11 seq.) is amended— 

12 (1) by striking section 1202; and 

13 (2) by redesignating section 1203 as section 

14 1202. 

15 SEC. 4. ESTABLISHMENT OF PROGRAMS FOR IMPROVING 

16 TRAUMA CARE IN RURAL AREAS. 

17 Section 1202 of the Public Health Service Act, as re18 designated by section 3(2), is amended to read as follows: 

19 ‘‘SEC. 1202. ESTABLISHMENT OF PROGRAMS FOR IMPROV20 ING TRAUMA CARE IN RURAL AREAS. 

21 ‘‘(a) IN GENERAL.—The Secretary may make grants 

22 to public and nonprofit private entities for the purpose of 

23 carrying out research and demonstration projects with re24 spect to improving the availability and quality of emer25 gency medical services in rural areas— 


hsrobinson on PROD1PC76 with BILLS
4 

•S 657 RS

1 ‘‘(1) by developing innovative uses of commu2 nications technologies and the use of new commu3 nications technology; 

4 ‘‘(2) by developing model curricula, such as ad5 vanced trauma life support, for training emergency 

6 medical services personnel, including first respond7 ers, emergency medical technicians, emergency 

8 nurses and physicians, and paramedics— 

9 ‘‘(A) in the assessment, stabilization, treat10 ment, preparation for transport, and resuscita11 tion of seriously injured patients, with special 

12 attention to problems that arise during long 

13 transports and to methods of minimizing delays 

14 in transport to the appropriate facility; and 

15 ‘‘(B) in the management of the operation 

16 of the emergency medical services system; 

17 ‘‘(3) by making training for original certifi18 cation, and continuing education, in the provision 

19 and management of emergency medical services 

20 more accessible to emergency medical personnel in 

21 rural areas through telecommunications, home stud22 ies, providing teachers and training at locations ac23 cessible to such personnel, and other methods; 

24 ‘‘(4) by developing innovative protocols and 

25 agreements to increase access to prehospital care 


hsrobinson on PROD1PC76 with BILLS
5 

•S 657 RS

1 and equipment necessary for the transportation of 

2 seriously injured patients to the appropriate facili3 ties; 

4 ‘‘(5) by evaluating the effectiveness of protocols 

5 with respect to emergency medical services and sys6 tems; and 

7 ‘‘(6) by increasing communication and coordi8 nation with State trauma systems. 

9 ‘‘(b) SPECIAL CONSIDERATION FOR CERTAIN RURAL

10 AREAS.—In making grants under subsection (a), the Sec11 retary shall give special consideration to any applicant for 

12 the grant that will provide services under the grant in any 

13 rural area identified by a State under section 1214(d)(1). 

14 ‘‘(c) REQUIREMENT OF APPLICATION.—The Sec15 retary may not make a grant under subsection (a) unless 

16 an application for the grant is submitted to the Secretary 

17 and the application is in such form, is made in such man18 ner, and contains such agreements, assurances, and infor19 mation as the Secretary determines to be necessary to 

20 carry out this section.’’. 

21 SEC. 5. COMPETITIVE GRANTS. 

22 Part A of title XII of the Public Health Service Act, 

23 as amended by section 3, is amended by adding at the 

24 end the following: 


hsrobinson on PROD1PC76 with BILLS
6 

•S 657 RS

1 ‘‘SEC. 1203. COMPETITIVE GRANTS FOR THE IMPROVEMENT 

2 OF TRAUMA CARE. 

3 ‘‘(a) IN GENERAL.—The Secretary, acting through 

4 the Administrator of the Health Resources and Services 

5 Administration, may make grants to States, political sub6 divisions, or consortia of States or political subdivisions 

7 for the purpose of improving access to and enhancing the 

8 development of trauma care systems. 

9 ‘‘(b) USE OF FUNDS.—The Secretary may make a 

10 grant under this section only if the applicant agrees to 

11 use the grant— 

12 ‘‘(1) to integrate and broaden the reach of a 

13 trauma care system, such as by developing innova14 tive protocols to increase access to prehospital care; 

15 ‘‘(2) to strengthen, develop, and improve an ex16 isting trauma care system; 

17 ‘‘(3) to expand communications between the 

18 trauma care system and emergency medical services 

19 through improved equipment or a telemedicine sys20 tem; 

21 ‘‘(4) to improve data collection and retention; 

22 or 

23 ‘‘(5) to increase education, training, and tech24 nical assistance opportunities, such as training and 

25 continuing education in the management of emer26 gency medical services accessible to emergency medVerDate Aug 31 2005 22:37 Mar 30, 2007 Jkt 059200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6401 E:\BILLS\S657.RS S657

hsrobinson on PROD1PC76 with BILLS
7 

•S 657 RS

1 ical personnel in rural areas through telehealth, 

2 home studies, and other methods. 

3 ‘‘(c) PREFERENCE.—In selecting among States, po4 litical subdivisions, and consortia of States or political 

5 subdivisions for purposes of making grants under this sec6 tion, the Secretary shall give preference to applicants 

7 that— 

8 ‘‘(1) have developed a process, using national 

9 standards, for designating trauma centers; 

10 ‘‘(2) recognize protocols for the delivery of seri11 ously injured patients to trauma centers; 

12 ‘‘(3) implement a process for evaluating the 

13 performance of the trauma system; and 

14 ‘‘(4) agree to participate in information systems 

15 described in section 1202 by collecting, providing, 

16 and sharing information. 

17 ‘‘(d) PRIORITY.—In making grants under this sec18 tion, the Secretary shall give priority to applicants that 

19 will use the grants to focus on improving access to trauma 

20 care systems. 

21 ‘‘(e) SPECIAL CONSIDERATION.—In awarding grants 

22 under this section, the Secretary shall give special consid23 eration to projects that demonstrate strong State or local 

24 support, including availability of non-Federal contribu25 tions.’’. 


hsrobinson on PROD1PC76 with BILLS
8 

•S 657 RS

1 SEC. 6. REQUIREMENT OF MATCHING FUNDS FOR FISCAL 

2 YEARS SUBSEQUENT TO FIRST FISCAL YEAR 

3 OF PAYMENTS. 

4 Section 1212 of the Public Health Service Act (42 

5 U.S.C. 300d–12) is amended to read as follows: 

6 ‘‘SEC. 1212. REQUIREMENT OF MATCHING FUNDS FOR FIS7 CAL YEARS SUBSEQUENT TO FIRST FISCAL 

8 YEAR OF PAYMENTS. 

9 ‘‘(a) NON-FEDERAL CONTRIBUTIONS.— 

10 ‘‘(1) IN GENERAL.—The Secretary may not 

11 make payments under section 1211(a) unless the 

12 State involved agrees, with respect to the costs de13 scribed in paragraph (2), to make available non-Fed14 eral contributions (in cash or in kind under sub15 section (b)(1)) toward such costs in an amount 

16 that— 

17 ‘‘(A) for the second and third fiscal years 

18 of such payments to the State, is not less than 

19 $1 for each $1 of Federal funds provided in 

20 such payments for such fiscal years; and 

21 ‘‘(B) for the fourth and subsequent fiscal 

22 years of such payments to the State, is not less 

23 than $2 for each $1 of Federal funds provided 

24 in such payments for such fiscal years. 

25 ‘‘(2) PROGRAM COSTS.—The costs referred to 

26 in paragraph (1) are— 


hsrobinson on PROD1PC76 with BILLS
9 

•S 657 RS

1 ‘‘(A) the costs to be incurred by the State 

2 in carrying out the purpose described in section 

3 1211(b); or 

4 ‘‘(B) the costs of improving the quality 

5 and availability of emergency medical services 

6 in rural areas of the State. 

7 ‘‘(3) INITIAL YEAR OF PAYMENTS.—The Sec8 retary may not require a State to make non-Federal 

9 contributions as a condition of receiving payments 

10 under section 1211(a) for the first fiscal year of 

11 such payments to the State. 

12 ‘‘(b) DETERMINATION OF AMOUNT OF NON-FED13 ERAL CONTRIBUTION.—With respect to compliance with 

14 subsection (a) as a condition of receiving payments under 

15 section 1211(a)— 

16 ‘‘(1) a State may make the non-Federal con17 tributions required in such subsection in cash or in 

18 kind, fairly evaluated, including plant, equipment, or 

19 services; and 

20 ‘‘(2) the Secretary may not, in making a deter21 mination of the amount of non-Federal contribu22 tions, include amounts provided by the Federal Gov23 ernment or services assisted or subsidized to any sig24 nificant extent by the Federal Government.’’. 


hsrobinson on PROD1PC76 with BILLS
10 

•S 657 RS

1 SEC. 7. REQUIREMENTS WITH RESPECT TO CARRYING OUT 

2 PURPOSE OF ALLOTMENTS. 

3 Section 1213 of the Public Health Service Act (42 

4 U.S.C. 300d–13) is amended to read as follows: 

5 ‘‘SEC. 1213. REQUIREMENTS WITH RESPECT TO CARRYING 

6 OUT PURPOSE OF ALLOTMENTS. 

7 ‘‘(a) TRAUMA CARE MODIFICATIONS TO STATE PLAN

8 FOR EMERGENCY MEDICAL SERVICES.—With respect to 

9 the trauma care component of a State plan for the provi10 sion of emergency medical services, the modifications re11 ferred to in section 1211(b) are such modifications to the 

12 State plan as may be necessary for the State involved to 

13 ensure that the plan provides for access to the highest pos14 sible quality of trauma care, and that the plan— 

15 ‘‘(1) specifies that the modifications required 

16 pursuant to paragraphs (2) through (11) will be im17 plemented by the principal State agency with respect 

18 to emergency medical services or by the designee of 

19 such agency; 

20 ‘‘(2) specifies a public or private entity that will 

21 designate trauma care regions and trauma centers in 

22 the State; 

23 ‘‘(3) subject to subsection (b), contains national 

24 standards and requirements of the American College 

25 of Surgeons or another appropriate entity for the 

26 designation of level I and level II trauma centers, 


hsrobinson on PROD1PC76 with BILLS
11 

•S 657 RS

1 and in the case of rural areas level III trauma cen2 ters (including trauma centers with specified capa3 bilities and expertise in the care of pediatric trauma 

4 patient), by such entity, including standards and re5 quirements for— 

6 ‘‘(A) the number and types of trauma pa7 tients for whom such centers must provide care 

8 in order to ensure that such centers will have 

9 sufficient experience and expertise to be able to 

10 provide quality care for victims of injury; 

11 ‘‘(B) the resources and equipment needed 

12 by such centers; and 

13 ‘‘(C) the availability of rehabilitation serv14 ices for trauma patients; 

15 ‘‘(4) contains standards and requirements for 

16 the implementation of regional trauma care systems, 

17 including standards and guidelines (consistent with 

18 the provisions of section 1867 of the Social Security 

19 Act) for medically directed triage and transportation 

20 of trauma patients (including patients injured in 

21 rural areas) prior to care in designated trauma cen22 ters; 

23 ‘‘(5) subject to subsection (b), contains national 

24 standards and requirements, including those of the 

25 American Academy of Pediatrics and the American 


hsrobinson on PROD1PC76 with BILLS
12 

•S 657 RS

1 College of Emergency Physicians, for medically di2 rected triage and transport of severely injured chil3 dren to designated trauma centers with specified ca4 pabilities and expertise in the care of the pediatric 

5 trauma patient; 

6 ‘‘(6) utilizes a program with procedures for the 

7 evaluation of designated trauma centers (including 

8 trauma centers described in paragraph (5)) and 

9 trauma care systems; 

10 ‘‘(7) provides for the establishment and collec11 tion of data in accordance with data collection re12 quirements developed in consultation with surgical, 

13 medical, and nursing specialty groups, State and 

14 local emergency medical services directors, and other 

15 trained professionals in trauma care, from each des16 ignated trauma center in the State of a central data 

17 reporting and analysis system— 

18 ‘‘(A) to identify the number of severely in19 jured trauma patients and the number of 

20 deaths from trauma within trauma care sys21 tems in the State; 

22 ‘‘(B) to identify the cause of the injury 

23 and any factors contributing to the injury; 

24 ‘‘(C) to identify the nature and severity of 

25 the injury; 


hsrobinson on PROD1PC76 with BILLS
13 

•S 657 RS

1 ‘‘(D) to monitor trauma patient care (in2 cluding prehospital care) in each designated 

3 trauma center within regional trauma care sys4 tems in the State (including relevant emer5 gency-department discharges and rehabilitation 

6 information) for the purpose of evaluating the 

7 diagnosis, treatment, and treatment outcome of 

8 such trauma patients; 

9 ‘‘(E) to identify the total amount of un10 compensated trauma care expenditures for each 

11 fiscal year by each designated trauma center in 

12 the State; and 

13 ‘‘(F) to identify patients transferred within 

14 a regional trauma system, including reasons for 

15 such transfer and the outcomes of such pa16 tients; 

17 ‘‘(8) provides for the use of procedures by para18 medics and emergency medical technicians to assess 

19 the severity of the injuries incurred by trauma pa20 tients; 

21 ‘‘(9) provides for appropriate transportation 

22 and transfer policies to ensure the delivery of pa23 tients to designated trauma centers and other facili24 ties within and outside of the jurisdiction of such 

25 system, including policies to ensure that only indiVerDate Aug 31 2005 22:37 Mar 30, 2007 Jkt 059200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6401 E:\BILLS\S657.RS S657

hsrobinson on PROD1PC76 with BILLS
14 

•S 657 RS

1 viduals appropriately identified as trauma patients 

2 are transferred to designated trauma centers, and to 

3 provide periodic reviews of the transfers and the au4 diting of such transfers that are determined to be 

5 appropriate; 

6 ‘‘(10) conducts public education activities con7 cerning injury prevention and obtaining access to 

8 trauma care; 

9 ‘‘(11) coordinates planning for trauma systems 

10 with State disaster emergency planning and bioter11 rorism hospital preparedness planning; and 

12 ‘‘(12) with respect to the requirements estab13 lished in this subsection, provides for coordination 

14 and cooperation between the State and any other 

15 State with which the State shares any standard met16 ropolitan statistical area. 

17 ‘‘(b) CERTAIN STANDARDS WITH RESPECT TO TRAU18 MA CARE CENTERS AND SYSTEMS.— 

19 ‘‘(1) IN GENERAL.—The Secretary may not 

20 make payments under section 1211(a) for a fiscal 

21 year unless the State involved agrees that, in car22 rying out paragraphs (3) through (5) of subsection 

23 (a), the State will adopt standards for the designa24 tion of trauma centers, and for triage, transfer, and 


hsrobinson on PROD1PC76 with BILLS
15 

•S 657 RS

1 transportation policies, and that the State will, in 

2 adopting such standards— 

3 ‘‘(A) take into account national standards 

4 concerning that outline resources for optimal 

5 care of the injured patient; 

6 ‘‘(B) consult with medical, surgical, and 

7 nursing speciality groups, hospital associations, 

8 emergency medical services State and local di9 rectors, concerned advocates and other inter10 ested parties; 

11 ‘‘(C) conduct hearings on the proposed 

12 standards after providing adequate notice to the 

13 public concerning such hearing; and 

14 ‘‘(D) beginning in fiscal year 2008, take 

15 into account the model plan described in sub16 section (c). 

17 ‘‘(2) QUALITY OF TRAUMA CARE.—The highest 

18 quality of trauma care shall be the primary goal of 

19 State standards adopted under this subsection. 

20 ‘‘(3) APPROVAL BY THE SECRETARY.—The Sec21 retary may not make payments under section 

22 1211(a) to a State if the Secretary determines 

23 that— 

24 ‘‘(A) in the case of payments for fiscal 

25 year 2008 and subsequent fiscal years, the 


hsrobinson on PROD1PC76 with BILLS
16 

•S 657 RS

1 State has not taken into account national 

2 standards, including those of the American Col3 lege of Surgeons, the American College of 

4 Emergency Physicians, and the American Acad5 emy of Pediatrics, in adopting standards under 

6 this subsection; or 

7 ‘‘(B) in the case of payments for fiscal 

8 year 2008 and subsequent fiscal years, the 

9 State has not, in adopting such standards, 

10 taken into account the model plan developed 

11 under subsection (c). 

12 ‘‘(c) MODEL TRAUMA CARE PLAN.— 

13 ‘‘(1) IN GENERAL.—Not later than 1 year after 

14 the date of the enactment of the Trauma Care Sys15 tems Planning and Development Act of 2007, the 

16 Secretary shall update the model plan for the des17 ignation of trauma centers and for triage, transfer, 

18 and transportation policies that may be adopted for 

19 guidance by the State. Such plan shall— 

20 ‘‘(A) take into account national standards, 

21 including those of the American College of Sur22 geons, American College of Emergency Physi23 cians, and the American Academy of Pediatrics; 

24 ‘‘(B) take into account existing State 

25 plans; 


hsrobinson on PROD1PC76 with BILLS
17 

•S 657 RS

1 ‘‘(C) be developed in consultation with 

2 medical, surgical, and nursing speciality groups, 

3 hospital associations, emergency medical serv4 ices State directors and associations, and other 

5 interested parties; and 

6 ‘‘(D) include standards for the designation 

7 of rural health facilities and hospitals best able 

8 to receive, stabilize, and transfer trauma pa9 tients to the nearest appropriate designated 

10 trauma center, and for triage, transfer, and 

11 transportation policies as they relate to rural 

12 areas. 

13 ‘‘(2) APPLICABILITY.—Standards described in 

14 paragraph (1)(D) shall be applicable to all rural 

15 areas in the State, including both non-metropolitan 

16 areas and frontier areas that have populations of 

17 less than 6,000 per square mile. 

18 ‘‘(d) RULE OF CONSTRUCTION WITH RESPECT TO

19 NUMBER OF DESIGNATED TRAUMA CENTERS.—With re20 spect to compliance with subsection (a) as a condition of 

21 the receipt of a grant under section 1211(a), such sub22 section may not be construed to specify the number of 

23 trauma care centers designated pursuant to such sub24 section.’’. 


hsrobinson on PROD1PC76 with BILLS
18 

•S 657 RS

1 SEC. 8. REQUIREMENT OF SUBMISSION TO SECRETARY OF 

2 TRAUMA PLAN AND CERTAIN INFORMATION. 

3 Section 1214 of the Public Health Service Act (42 

4 U.S.C. 300d–14) is amended to read as follows: 

5 ‘‘SEC. 1214. REQUIREMENT OF SUBMISSION TO SECRETARY 

6 OF TRAUMA PLAN AND CERTAIN INFORMA7 TION. 

8 ‘‘(a) IN GENERAL.—For each fiscal year, the Sec9 retary may not make payments to a State under section 

10 1211(a) unless, subject to subsection (b), the State sub11 mits to the Secretary the trauma care component of the 

12 State plan for the provision of emergency medical services, 

13 including any changes to the trauma care component and 

14 any plans to address deficiencies in the trauma care com15 ponent. 

16 ‘‘(b) INTERIM PLAN OR DESCRIPTION OF EF17 FORTS.—For each fiscal year, if a State has not completed 

18 the trauma care component of the State plan described 

19 in subsection (a), the State may provide, in lieu of such 

20 completed component, an interim component or a descrip21 tion of efforts made toward the completion of the compo22 nent. 

23 ‘‘(c) INFORMATION RECEIVED BY STATE REPORTING

24 AND ANALYSIS SYSTEM.—The Secretary may not make 

25 payments to a State under section 1211(a) unless the 

26 State agrees that the State will, not less than once each 


hsrobinson on PROD1PC76 with BILLS
19 

•S 657 RS

1 year, provide to the Secretary the information received by 

2 the State pursuant to section 1213(a)(7). 

3 ‘‘(d) AVAILABILITY OF EMERGENCY MEDICAL SERV4 ICES IN RURAL AREAS.—The Secretary may not make 

5 payments to a State under section 1211(a) unless— 

6 ‘‘(1) the State identifies any rural area in the 

7 State for which— 

8 ‘‘(A) there is no system of access to emer9 gency medical services through the telephone 

10 number 911; 

11 ‘‘(B) there is no basic life-support system; 

12 or 

13 ‘‘(C) there is no advanced life-support sys14 tem; and 

15 ‘‘(2) the State submits to the Secretary a list 

16 of rural areas identified pursuant to subparagraph 

17 (A) or, if there are no such areas, a statement that 

18 there are no such areas.’’. 

19 SEC. 9. RESTRICTIONS ON USE OF PAYMENTS. 

20 Section 1215 of the Public Health Service Act (42 

21 U.S.C. 300d–15) is amended to read as follows: 

22 ‘‘SEC. 1215. RESTRICTIONS ON USE OF PAYMENTS. 

23 ‘‘(a) IN GENERAL.—The Secretary may not, except 

24 as provided in subsection (b), make payments under secVerDate Aug 31 2005 22:37 Mar 30, 2007 Jkt 059200 PO 00000 Frm 00019 Fmt 6652 Sfmt 6401 E:\BILLS\S657.RS S657

hsrobinson on PROD1PC76 with BILLS
20 

•S 657 RS

1 tion 1211(a) for a fiscal year unless the State involved 

2 agrees that the payments will not be expended— 

3 ‘‘(1) for any purpose other than developing, im4 plementing, and monitoring the modifications re5 quired by section 1211(b) to be made to the State 

6 plan for the provision of emergency medical services; 

7 ‘‘(2) to make cash payments to intended recipi8 ents of services provided pursuant to this section; 

9 ‘‘(3) to purchase or improve real property 

10 (other than minor remodeling of existing improve11 ments to real property); 

12 ‘‘(4) to satisfy any requirement for the expendi13 ture of non-Federal funds as a condition for the re14 ceipt of Federal funds; or 

15 ‘‘(5) to provide financial assistance to any enti16 ty other than a public or nonprofit private entity. 

17 ‘‘(b) WAIVER.—The Secretary may waive a restric18 tion under subsection (a) only if the Secretary determines 

19 that the activities outlined by the State plan submitted 

20 under section 1214(a)(1) by the State involved cannot oth21 erwise be carried out.’’. 

22 SEC. 10. REQUIREMENTS OF REPORTS BY STATES. 

23 The Public Health Service Act (42 U.S.C. 201 et 

24 seq.) is amended by striking section 1216. 


hsrobinson on PROD1PC76 with BILLS
21 

•S 657 RS

1 SEC. 11. REPORT BY SECRETARY. 

2 Section 1222 of the Public Health Service Act (42 

3 U.S.C. 300d–22) is amended to read as follows: 

4 ‘‘SEC. 1222. REPORT BY SECRETARY. 

5 ‘‘Not later than October 1, 2008, the Secretary shall 

6 report to the appropriate committees of Congress on the 

7 activities of the States carried out pursuant to section 

8 1211. Such report shall include an assessment of the ex9 tent to which Federal and State efforts to develop systems 

10 of trauma care and to designate trauma centers have re11 duced the incidence of mortality, and the incidence of per12 manent disability, resulting from trauma. Such report 

13 may include any recommendations of the Secretary for ap14 propriate administrative and legislative initiatives with re15 spect to trauma care.’’. 

16 SEC. 12. FUNDING. 

17 Section 1232 of the Public Health Service Act (42 

18 U.S.C. 300d–32) is amended to read as follows: 

19 ‘‘SEC. 1232. FUNDING. 

20 ‘‘(a) AUTHORIZATION OF APPROPRIATIONS.—For the 

21 purpose of carrying out parts A and B, there are author22 ized to be appropriated $12,000,000 for fiscal year 2008, 

23 $10,000,000 for fiscal year 2009, and $8,000,000 for each 

24 of the fiscal years 2010 through 2012. 

25 ‘‘(b) RESERVATION OF FUNDS.—If the amount ap26 propriated under subsection (a) for a fiscal year is equal 


hsrobinson on PROD1PC76 with BILLS
22 

•S 657 RS

1 to or less than $1,000,000, such appropriation is available 

2 only for making grants under part A. If the amount so 

3 appropriated is greater than $1,000,000, 50 percent of 

4 such appropriation shall be made available for grants 

5 under part A and 50 percent shall be made available for 

6 grants under part B. 

7 ‘‘(c) ALLOCATION OF FUNDS BY SECRETARY.— 

8 ‘‘(1) GENERAL AUTHORITY.—For the purpose 

9 of carrying out part A, the Secretary shall make 

10 available 10 percent of the amounts appropriated for 

11 a fiscal year under subsection (a). 

12 ‘‘(2) RURAL GRANTS.—For the purpose of car13 rying out section 1202, the Secretary shall make 

14 available 10 percent of the amounts appropriated for 

15 a fiscal year under subsection (a).’’. 

16 SEC. 13. INSTITUTE OF MEDICINE STUDY. 

17 Part E of title XII of the Public Health Service Act 

18 (20 U.S.C. 300d–51 et seq.) is amended by adding at the 

19 end the following: 

20 ‘‘SEC. 1254. INSTITUTE OF MEDICINE STUDY. 

21 ‘‘(a) IN GENERAL.—The Secretary shall enter into 

22 a contract with the Institute of Medicine of the National 

23 Academy of Sciences, or another appropriate entity, to 

24 conduct a study on the state of trauma care and trauma 

25 research. 


hsrobinson on PROD1PC76 with BILLS
23 

•S 657 RS

1 ‘‘(b) CONTENT.—The study conducted under sub2 section (a) shall— 

3 ‘‘(1) examine and evaluate the state of trauma 

4 care and trauma systems research (including the 

5 role of Federal entities in trauma research) on the 

6 date of enactment of this section, and identify trau7 ma research priorities; 

8 ‘‘(2) examine and evaluate the clinical effective9 ness of trauma care and the impact of trauma care 

10 on patient outcomes, with special attention to high11 risk groups, such as children, the elderly, and indi12 viduals in rural areas; 

13 ‘‘(3) examine and evaluate trauma systems de14 velopment and identify obstacles that prevent or 

15 hinder the effectiveness of trauma systems and trau16 ma systems development; 

17 ‘‘(4) examine and evaluate alternative strategies 

18 for the organization, financing, and delivery of trau19 ma care within an overall systems approach; and 

20 ‘‘(5) examine and evaluate the role of trauma 

21 systems and trauma centers in preparedness for 

22 mass casualties. 

23 ‘‘(c) REPORT.—Not later than 2 years after the date 

24 of enactment of this section, the Secretary shall submit 

25 to the appropriate committees of Congress a report conVerDate Aug 31 2005 22:37 Mar 30, 2007 Jkt 059200 PO 00000 Frm 00023 Fmt 6652 Sfmt 6401 E:\BILLS\S657.RS S657

hsrobinson on PROD1PC76 with BILLS
24 

•S 657 RS

1 taining the results of the study conducted under this sec2 tion. 

3 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 

4 is authorized to be appropriated to carry out this section 

5 $750,000 for fiscal year 2008.’’. 

6 SEC. 14. RESIDENCY TRAINING PROGRAMS IN EMERGENCY 

7 MEDICINE. 

8 Section 1251 of the Public Health Service Act (42 

9 U.S.C. 300d–51) is amended to read as follows: 

10 ‘‘SEC. 1251. RESIDENCY TRAINING PROGRAMS IN EMER11 GENCY MEDICINE. 

12 ‘‘(a) IN GENERAL.—The Secretary may make grants 

13 to public and nonprofit private entities for the purpose of 

14 planning and developing approved residency training pro15 grams in emergency medicine. 

16 ‘‘(b) IDENTIFICATION AND REFERRAL OF DOMESTIC

17 VIOLENCE.—The Secretary may make a grant under sub18 section (a) only in the applicant involved agrees that the 

19 training programs under subsection (a) will provide edu20 cation and training in identifying and referring cases of 

21 domestic violence. 

22 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—For the 

23 purpose of carrying out this section, there is authorized 

24 to be appropriated $400,000 for each of the fiscal years 

25 2008 though 2012.’’. 


hsrobinson on PROD1PC76 with BILLS
25 

•S 657 RS

1 SEC. 15. STATE GRANTS FOR CERTAIN PROJECTS. 

2 Section 1252 of the Public Health Service Act (42 

3 U.S.C. 300d–52) is amended in the section heading by 

4 striking ‘‘DEMONSTRATION’’. 

5 SECTION 1. SHORT TITLE. 

6 This Act may be cited as the ‘‘Trauma Care Systems 

7 Planning and Development Act of 2007’’. 

8 SEC. 2. ESTABLISHMENT. 

9 Section 1201 of the Public Health Service Act (42 

10 U.S.C. 300d) is amended to read as follows: 

11 ‘‘SEC. 1201. ESTABLISHMENT. 

12 ‘‘(a) IN GENERAL.—The Secretary shall, with respect 

13 to trauma care— 

14 ‘‘(1) conduct and support research, training, 

15 evaluations, and demonstration projects; 

16 ‘‘(2) foster the development of appropriate, mod17 ern systems of such care through the sharing of infor18 mation among agencies and individuals involved in 

19 the study and provision of such care; 

20 ‘‘(3) collect, compile, and disseminate informa21 tion on the achievements of, and problems experienced 

22 by, State and local agencies and private entities in 

23 providing trauma care and emergency medical serv24 ices and, in so doing, give special consideration to the 

25 unique needs of rural areas; 


hsrobinson on PROD1PC76 with BILLS
26 

•S 657 RS

1 ‘‘(4) provide to State and local agencies technical 

2 assistance to enhance each State’s capability to de3 velop, implement, and sustain the trauma care com4 ponent of each State’s plan for the provision of emer5 gency medical services; 

6 ‘‘(5) sponsor workshops and conferences; and 

7 ‘‘(6) promote the collection and categorization of 

8 trauma data in a consistent and standardized man9 ner. 

10 ‘‘(b) GRANTS, COOPERATIVE AGREEMENTS, AND CON11 TRACTS.—The Secretary may make grants, and enter into 

12 cooperative agreements and contracts, for the purpose of 

13 carrying out subsection (a).’’. 

14 SEC. 3. CLEARINGHOUSE ON TRAUMA CARE AND EMER15 GENCY MEDICAL SERVICES. 

16 The Public Health Service Act (42 U.S.C. 201 et seq.) 

17 is amended— 

18 (1) by striking section 1202; and 

19 (2) by redesignating section 1203 as section 

20 1202. 

21 SEC. 4. ESTABLISHMENT OF PROGRAMS FOR IMPROVING 

22 TRAUMA CARE IN RURAL AREAS. 

23 Section 1202 of the Public Health Service Act, as re24 designated by section 3(2), is amended to read as follows: 


hsrobinson on PROD1PC76 with BILLS
27 

•S 657 RS

1 ‘‘SEC. 1202. ESTABLISHMENT OF PROGRAMS FOR IMPROV2 ING TRAUMA CARE IN RURAL AREAS. 

3 ‘‘(a) IN GENERAL.—The Secretary may make grants 

4 to public and nonprofit private entities for the purpose of 

5 carrying out research and demonstration projects with re6 spect to improving the availability and quality of emer7 gency medical services in rural areas— 

8 ‘‘(1) by developing innovative uses of commu9 nications technologies and the use of new communica10 tions technology; 

11 ‘‘(2) by developing model curricula, such as ad12 vanced trauma life support, for training emergency 

13 medical services personnel, including first responders, 

14 emergency medical technicians, emergency nurses and 

15 physicians, and paramedics— 

16 ‘‘(A) in the assessment, stabilization, treat17 ment, preparation for transport, and resuscita18 tion of seriously injured patients, with special 

19 attention to problems that arise during long 

20 transports and to methods of minimizing delays 

21 in transport to the appropriate facility; and 

22 ‘‘(B) in the management of the operation of 

23 the emergency medical services system; 

24 ‘‘(3) by making training for original certifi25 cation, and continuing education, in the provision 

26 and management of emergency medical services more 


hsrobinson on PROD1PC76 with BILLS
28 

•S 657 RS

1 accessible to emergency medical personnel in rural 

2 areas through telecommunications, home studies, pro3 viding teachers and training at locations accessible to 

4 such personnel, and other methods; 

5 ‘‘(4) by developing innovative protocols and 

6 agreements to increase access to prehospital care and 

7 equipment necessary for the transportation of seri8 ously injured patients to the appropriate facilities; 

9 ‘‘(5) by evaluating the effectiveness of protocols 

10 with respect to emergency medical services and sys11 tems; and 

12 ‘‘(6) by increasing communication and coordina13 tion with State trauma systems. 

14 ‘‘(b) SPECIAL CONSIDERATION FOR CERTAIN RURAL

15 AREAS.—In making grants under subsection (a), the Sec16 retary shall give special consideration to any applicant for 

17 the grant that will provide services under the grant in any 

18 rural area identified by a State under section 1214(d)(1). 

19 ‘‘(c) REQUIREMENT OF APPLICATION.—The Secretary 

20 may not make a grant under subsection (a) unless an appli21 cation for the grant is submitted to the Secretary and the 

22 application is in such form, is made in such manner, and 

23 contains such agreements, assurances, and information as 

24 the Secretary determines to be necessary to carry out this 

25 section.’’. 


hsrobinson on PROD1PC76 with BILLS
29 

•S 657 RS

1 SEC. 5. COMPETITIVE GRANTS. 

2 Part A of title XII of the Public Health Service Act, 

3 as amended by section 3, is amended by adding at the end 

4 the following: 

5 ‘‘SEC. 1203. COMPETITIVE GRANTS FOR THE IMPROVEMENT 

6 OF TRAUMA CARE. 

7 ‘‘(a) IN GENERAL.—The Secretary, acting through the 

8 Administrator of the Health Resources and Services Admin9 istration, may make grants to States, political subdivisions, 

10 or consortia of States or political subdivisions for the pur11 pose of improving access to and enhancing the development 

12 of trauma care systems. 

13 ‘‘(b) USE OF FUNDS.—The Secretary may make a 

14 grant under this section only if the applicant agrees to use 

15 the grant— 

16 ‘‘(1) to integrate and broaden the reach of a 

17 trauma care system, such as by developing innovative 

18 protocols to increase access to prehospital care; 

19 ‘‘(2) to strengthen, develop, and improve an ex20 isting trauma care system; 

21 ‘‘(3) to expand communications between the 

22 trauma care system and emergency medical services 

23 through improved equipment or a telemedicine sys24 tem; 

25 ‘‘(4) to improve data collection and retention; or 


hsrobinson on PROD1PC76 with BILLS
30 

•S 657 RS

1 ‘‘(5) to increase education, training, and tech2 nical assistance opportunities, such as training and 

3 continuing education in the management of emer4 gency medical services accessible to emergency medical 

5 personnel in rural areas through telehealth, home 

6 studies, and other methods. 

7 ‘‘(c) PREFERENCE.—In selecting among States, polit8 ical subdivisions, and consortia of States or political sub9 divisions for purposes of making grants under this section, 

10 the Secretary shall give preference to applicants that— 

11 ‘‘(1) have developed a process, using national 

12 standards, for designating trauma centers; 

13 ‘‘(2) recognize protocols for the delivery of seri14 ously injured patients to trauma centers; 

15 ‘‘(3) implement a process for evaluating the per16 formance of the trauma system; and 

17 ‘‘(4) agree to participate in information systems 

18 described in section 1202 by collecting, providing, and 

19 sharing information. 

20 ‘‘(d) PRIORITY.—In making grants under this section, 

21 the Secretary shall give priority to applicants that will use 

22 the grants to focus on improving access to trauma care sys23 tems. 

24 ‘‘(e) SPECIAL CONSIDERATION.—In awarding grants 

25 under this section, the Secretary shall give special considerVerDate Aug 31 2005 22:37 Mar 30, 2007 Jkt 059200 PO 00000 Frm 00030 Fmt 6652 Sfmt 6203 E:\BILLS\S657.RS S657

hsrobinson on PROD1PC76 with BILLS
31 

•S 657 RS

1 ation to projects that demonstrate strong State or local sup2 port, including availability of non-Federal contributions.’’. 

3 SEC. 6. REQUIREMENT OF MATCHING FUNDS FOR FISCAL 

4 YEARS SUBSEQUENT TO FIRST FISCAL YEAR 

5 OF PAYMENTS. 

6 Section 1212 of the Public Health Service Act (42 

7 U.S.C. 300d–12) is amended to read as follows: 

8 ‘‘SEC. 1212. REQUIREMENT OF MATCHING FUNDS FOR FIS9 CAL YEARS SUBSEQUENT TO FIRST FISCAL 

10 YEAR OF PAYMENTS. 

11 ‘‘(a) NON-FEDERAL CONTRIBUTIONS.— 

12 ‘‘(1) IN GENERAL.—The Secretary may not make 

13 payments under section 1211(a) unless the State in14 volved agrees, with respect to the costs described in 

15 paragraph (2), to make available non-Federal con16 tributions (in cash or in kind under subsection (b)(1)) 

17 toward such costs in an amount that— 

18 ‘‘(A) for the second and third fiscal years of 

19 such payments to the State, is not less than $1 

20 for each $1 of Federal funds provided in such 

21 payments for such fiscal years; and 

22 ‘‘(B) for the fourth and subsequent fiscal 

23 years of such payments to the State, is not less 

24 than $2 for each $1 of Federal funds provided in 

25 such payments for such fiscal years. 


hsrobinson on PROD1PC76 with BILLS
32 

•S 657 RS

1 ‘‘(2) PROGRAM COSTS.—The costs referred to in 

2 paragraph (1) are— 

3 ‘‘(A) the costs to be incurred by the State in 

4 carrying out the purpose described in section 

5 1211(b); or 

6 ‘‘(B) the costs of improving the quality and 

7 availability of emergency medical services in 

8 rural areas of the State. 

9 ‘‘(3) INITIAL YEAR OF PAYMENTS.—The Sec10 retary may not require a State to make non-Federal 

11 contributions as a condition of receiving payments 

12 under section 1211(a) for the first fiscal year of such 

13 payments to the State. 

14 ‘‘(b) DETERMINATION OF AMOUNT OF NON-FEDERAL

15 CONTRIBUTION.—With respect to compliance with sub16 section (a) as a condition of receiving payments under sec17 tion 1211(a)— 

18 ‘‘(1) a State may make the non-Federal con19 tributions required in such subsection in cash or in 

20 kind, fairly evaluated, including plant, equipment, or 

21 services; and 

22 ‘‘(2) the Secretary may not, in making a deter23 mination of the amount of non-Federal contributions, 

24 include amounts provided by the Federal Government 


hsrobinson on PROD1PC76 with BILLS
33 

•S 657 RS

1 or services assisted or subsidized to any significant 

2 extent by the Federal Government.’’. 

3 SEC. 7. REQUIREMENTS WITH RESPECT TO CARRYING OUT 

4 PURPOSE OF ALLOTMENTS. 

5 Section 1213 of the Public Health Service Act (42 

6 U.S.C. 300d–13) is amended to read as follows: 

7 ‘‘SEC. 1213. REQUIREMENTS WITH RESPECT TO CARRYING 

8 OUT PURPOSE OF ALLOTMENTS. 

9 ‘‘(a) TRAUMA CARE MODIFICATIONS TO STATE PLAN

10 FOR EMERGENCY MEDICAL SERVICES.—With respect to the 

11 trauma care component of a State plan for the provision 

12 of emergency medical services, the modifications referred to 

13 in section 1211(b) are such modifications to the State plan 

14 as may be necessary for the State involved to ensure that 

15 the plan provides for access to the highest possible quality 

16 of trauma care, and that the plan— 

17 ‘‘(1) specifies that the modifications required 

18 pursuant to paragraphs (2) through (11) will be im19 plemented by the principal State agency with respect 

20 to emergency medical services or by the designee of 

21 such agency; 

22 ‘‘(2) specifies a public or private entity that will 

23 designate trauma care regions and trauma centers in 

24 the State; 


hsrobinson on PROD1PC76 with BILLS
34 

•S 657 RS

1 ‘‘(3) subject to subsection (b), contains national 

2 standards and requirements of the American College 

3 of Surgeons or another appropriate entity for the des4 ignation of level I and level II trauma centers, and 

5 in the case of rural areas level III trauma centers (in6 cluding trauma centers with specified capabilities 

7 and expertise in the care of pediatric trauma pa8 tient), by such entity, including standards and re9 quirements for— 

10 ‘‘(A) the number and types of trauma pa11 tients for whom such centers must provide care 

12 in order to ensure that such centers will have 

13 sufficient experience and expertise to be able to 

14 provide quality care for victims of injury; 

15 ‘‘(B) the resources and equipment needed by 

16 such centers; and 

17 ‘‘(C) the availability of rehabilitation serv18 ices for trauma patients; 

19 ‘‘(4) contains standards and requirements for the 

20 implementation of regional trauma care systems, in21 cluding standards and guidelines (consistent with the 

22 provisions of section 1867 of the Social Security Act) 

23 for medically directed triage and transportation of 

24 trauma patients (including patients injured in rural 

25 areas) prior to care in designated trauma centers; 


hsrobinson on PROD1PC76 with BILLS
35 

•S 657 RS

1 ‘‘(5) subject to subsection (b), contains national 

2 standards and requirements, including those of the 

3 American Academy of Pediatrics and the American 

4 College of Emergency Physicians, for medically di5 rected triage and transport of severely injured chil6 dren to designated trauma centers with specified ca7 pabilities and expertise in the care of the pediatric 

8 trauma patient; 

9 ‘‘(6) utilizes a program with procedures for the 

10 evaluation of designated trauma centers (including 

11 trauma centers described in paragraph (5)) and trau12 ma care systems; 

13 ‘‘(7) provides for the establishment and collection 

14 of data in accordance with data collection require15 ments developed in consultation with surgical, med16 ical, and nursing specialty groups, State and local 

17 emergency medical services directors, and other 

18 trained professionals in trauma care, from each des19 ignated trauma center in the State of a central data 

20 reporting and analysis system— 

21 ‘‘(A) to identify the number of severely in22 jured trauma patients and the number of deaths 

23 from trauma within trauma care systems in the 

24 State; 


hsrobinson on PROD1PC76 with BILLS
36 

•S 657 RS

1 ‘‘(B) to identify the cause of the injury and 

2 any factors contributing to the injury; 

3 ‘‘(C) to identify the nature and severity of 

4 the injury; 

5 ‘‘(D) to monitor trauma patient care (in6 cluding prehospital care) in each designated 

7 trauma center within regional trauma care sys8 tems in the State (including relevant emergency9 department discharges and rehabilitation infor10 mation) for the purpose of evaluating the diag11 nosis, treatment, and treatment outcome of such 

12 trauma patients; 

13 ‘‘(E) to identify the total amount of uncom14 pensated trauma care expenditures for each fis15 cal year by each designated trauma center in the 

16 State; and 

17 ‘‘(F) to identify patients transferred within 

18 a regional trauma system, including reasons for 

19 such transfer and the outcomes of such patients; 

20 ‘‘(8) provides for the use of procedures by para21 medics and emergency medical technicians to assess 

22 the severity of the injuries incurred by trauma pa23 tients; 

24 ‘‘(9) provides for appropriate transportation and 

25 transfer policies to ensure the delivery of patients to 


hsrobinson on PROD1PC76 with BILLS
37 

•S 657 RS

1 designated trauma centers and other facilities within 

2 and outside of the jurisdiction of such system, includ3 ing policies to ensure that only individuals appro4 priately identified as trauma patients are transferred 

5 to designated trauma centers, and to provide periodic 

6 reviews of the transfers and the auditing of such 

7 transfers that are determined to be appropriate; 

8 ‘‘(10) conducts public education activities con9 cerning injury prevention and obtaining access to 

10 trauma care; 

11 ‘‘(11) coordinates planning for trauma systems 

12 with State disaster emergency planning and bioter13 rorism hospital preparedness planning; and 

14 ‘‘(12) with respect to the requirements established 

15 in this subsection, provides for coordination and co16 operation between the State and any other State with 

17 which the State shares any standard metropolitan 

18 statistical area. 

19 ‘‘(b) CERTAIN STANDARDS WITH RESPECT TO TRAUMA

20 CARE CENTERS AND SYSTEMS.— 

21 ‘‘(1) IN GENERAL.—The Secretary may not make 

22 payments under section 1211(a) for a fiscal year un23 less the State involved agrees that, in carrying out 

24 paragraphs (3) through (5) of subsection (a), the 

25 State will adopt standards for the designation of 


hsrobinson on PROD1PC76 with BILLS
38 

•S 657 RS

1 trauma centers, and for triage, transfer, and trans2 portation policies, and that the State will, in adopt3 ing such standards— 

4 ‘‘(A) take into account national standards 

5 that outline resources for optimal care of the in6 jured patient; 

7 ‘‘(B) consult with medical, surgical, and 

8 nursing speciality groups, hospital associations, 

9 emergency medical services State and local direc10 tors, concerned advocates and other interested 

11 parties; 

12 ‘‘(C) conduct hearings on the proposed 

13 standards after providing adequate notice to the 

14 public concerning such hearing; and 

15 ‘‘(D) beginning in fiscal year 2008, take 

16 into account the model plan described in sub17 section (c). 

18 ‘‘(2) QUALITY OF TRAUMA CARE.—The highest 

19 quality of trauma care shall be the primary goal of 

20 State standards adopted under this subsection. 

21 ‘‘(3) APPROVAL BY THE SECRETARY.—The Sec22 retary may not make payments under section 1211(a) 

23 to a State if the Secretary determines that— 

24 ‘‘(A) in the case of payments for fiscal year 

25 2008 and subsequent fiscal years, the State has 


hsrobinson on PROD1PC76 with BILLS
39 

•S 657 RS

1 not taken into account national standards, in2 cluding those of the American College of Sur3 geons, the American College of Emergency Physi4 cians, and the American Academy of Pediatrics, 

5 in adopting standards under this subsection; or 

6 ‘‘(B) in the case of payments for fiscal year 

7 2008 and subsequent fiscal years, the State has 

8 not, in adopting such standards, taken into ac9 count the model plan developed under subsection 

10 (c). 

11 ‘‘(c) MODEL TRAUMA CARE PLAN.— 

12 ‘‘(1) IN GENERAL.—Not later than 1 year after 

13 the date of the enactment of the Trauma Care Sys14 tems Planning and Development Act of 2007, the Sec15 retary shall update the model plan for the designation 

16 of trauma centers and for triage, transfer, and trans17 portation policies that may be adopted for guidance 

18 by the State. Such plan shall— 

19 ‘‘(A) take into account national standards, 

20 including those of the American College of Sur21 geons, American College of Emergency Physi22 cians, and the American Academy of Pediatrics; 

23 ‘‘(B) take into account existing State plans; 

24 ‘‘(C) be developed in consultation with med25 ical, surgical, and nursing speciality groups, 


hsrobinson on PROD1PC76 with BILLS
40 

•S 657 RS

1 hospital associations, emergency medical services 

2 State directors and associations, and other inter3 ested parties; and 

4 ‘‘(D) include standards for the designation 

5 of rural health facilities and hospitals best able 

6 to receive, stabilize, and transfer trauma pa7 tients to the nearest appropriate designated trau8 ma center, and for triage, transfer, and trans9 portation policies as they relate to rural areas. 

10 ‘‘(2) APPLICABILITY.—Standards described in 

11 paragraph (1)(D) shall be applicable to all rural 

12 areas in the State, including both non-metropolitan 

13 areas and frontier areas that have populations of less 

14 than 6,000 per square mile. 

15 ‘‘(d) RULE OF CONSTRUCTION WITH RESPECT TO

16 NUMBER OF DESIGNATED TRAUMA CENTERS.—With re17 spect to compliance with subsection (a) as a condition of 

18 the receipt of a grant under section 1211(a), such subsection 

19 may not be construed to specify the number of trauma care 

20 centers designated pursuant to such subsection.’’. 

21 SEC. 8. REQUIREMENT OF SUBMISSION TO SECRETARY OF 

22 TRAUMA PLAN AND CERTAIN INFORMATION. 

23 Section 1214 of the Public Health Service Act (42 

24 U.S.C. 300d–14) is amended to read as follows: 


hsrobinson on PROD1PC76 with BILLS
41 

•S 657 RS

1 ‘‘SEC. 1214. REQUIREMENT OF SUBMISSION TO SECRETARY 

2 OF TRAUMA PLAN AND CERTAIN INFORMA3 TION. 

4 ‘‘(a) IN GENERAL.—For each fiscal year, the Secretary 

5 may not make payments to a State under section 1211(a) 

6 unless, subject to subsection (b), the State submits to the 

7 Secretary the trauma care component of the State plan for 

8 the provision of emergency medical services, including any 

9 changes to the trauma care component and any plans to 

10 address deficiencies in the trauma care component. 

11 ‘‘(b) INTERIM PLAN OR DESCRIPTION OF EFFORTS.— 

12 For each fiscal year, if a State has not completed the trau13 ma care component of the State plan described in subsection 

14 (a), the State may provide, in lieu of such completed compo15 nent, an interim component or a description of efforts made 

16 toward the completion of the component. 

17 ‘‘(c) INFORMATION RECEIVED BY STATE REPORTING

18 AND ANALYSIS SYSTEM.—The Secretary may not make 

19 payments to a State under section 1211(a) unless the State 

20 agrees that the State will, not less than once each year, pro21 vide to the Secretary the information received by the State 

22 pursuant to section 1213(a)(7). 

23 ‘‘(d) AVAILABILITY OF EMERGENCY MEDICAL SERV24 ICES IN RURAL AREAS.—The Secretary may not make pay25 ments to a State under section 1211(a) unless— 


hsrobinson on PROD1PC76 with BILLS
42 

•S 657 RS

1 ‘‘(1) the State identifies any rural area in the 

2 State for which— 

3 ‘‘(A) there is no system of access to emer4 gency medical services through the telephone 

5 number 911; 

6 ‘‘(B) there is no basic life-support system; 

7 or 

8 ‘‘(C) there is no advanced life-support sys9 tem; and 

10 ‘‘(2) the State submits to the Secretary a list of 

11 rural areas identified pursuant to paragraph (1) or, 

12 if there are no such areas, a statement that there are 

13 no such areas.’’. 

14 SEC. 9. RESTRICTIONS ON USE OF PAYMENTS. 

15 Section 1215 of the Public Health Service Act (42 

16 U.S.C. 300d–15) is amended to read as follows: 

17 ‘‘SEC. 1215. RESTRICTIONS ON USE OF PAYMENTS. 

18 ‘‘(a) IN GENERAL.—The Secretary may not, except as 

19 provided in subsection (b), make payments under section 

20 1211(a) for a fiscal year unless the State involved agrees 

21 that the payments will not be expended— 

22 ‘‘(1) for any purpose other than developing, im23 plementing, and monitoring the modifications re24 quired by section 1211(b) to be made to the State 

25 plan for the provision of emergency medical services; 


hsrobinson on PROD1PC76 with BILLS
43 

•S 657 RS

1 ‘‘(2) to make cash payments to intended recipi2 ents of services provided pursuant to this section; 

3 ‘‘(3) to purchase or improve real property (other 

4 than minor remodeling of existing improvements to 

5 real property); 

6 ‘‘(4) to satisfy any requirement for the expendi7 ture of non-Federal funds as a condition for the re8 ceipt of Federal funds; or 

9 ‘‘(5) to provide financial assistance to any entity 

10 other than a public or nonprofit private entity. 

11 ‘‘(b) WAIVER.—The Secretary may waive a restriction 

12 under subsection (a) only if the Secretary determines that 

13 the activities outlined by the State plan submitted under 

14 section 1213(a)(1) by the State involved cannot otherwise 

15 be carried out.’’. 

16 SEC. 10. REQUIREMENTS OF REPORTS BY STATES. 

17 The Public Health Service Act (42 U.S.C. 201 et seq.) 

18 is amended by striking section 1216. 

19 SEC. 11. REPORT BY SECRETARY. 

20 Section 1222 of the Public Health Service Act (42 

21 U.S.C. 300d–22) is amended to read as follows: 

22 ‘‘SEC. 1222. REPORT BY SECRETARY. 

23 ‘‘Not later than October 1, 2008, the Secretary shall 

24 report to the appropriate committees of Congress on the ac25 tivities of the States carried out pursuant to section 1211. 


hsrobinson on PROD1PC76 with BILLS
44 

•S 657 RS

1 Such report shall include an assessment of the extent to 

2 which Federal and State efforts to develop systems of trau3 ma care and to designate trauma centers have reduced the 

4 incidence of mortality, and the incidence of permanent dis5 ability, resulting from trauma. Such report may include 

6 any recommendations of the Secretary for appropriate ad7 ministrative and legislative initiatives with respect to trau8 ma care.’’. 

9 SEC. 12. FUNDING. 

10 Section 1232 of the Public Health Service Act (42 

11 U.S.C. 300d–32) is amended to read as follows: 

12 ‘‘SEC. 1232. FUNDING. 

13 ‘‘(a) AUTHORIZATION OF APPROPRIATIONS.—For the 

14 purpose of carrying out parts A and B, there are authorized 

15 to be appropriated $12,000,000 for fiscal year 2008, 

16 $10,000,000 for fiscal year 2009, and $8,000,000 for each 

17 of the fiscal years 2010 through 2012. 

18 ‘‘(b) RESERVATION OF FUNDS.—If the amount appro19 priated under subsection (a) for a fiscal year is equal to 

20 or less than $1,000,000, such appropriation is available 

21 only for making grants under part A. If the amount so ap22 propriated is greater than $1,000,000, 50 percent of such 

23 appropriation shall be made available for grants under part 

24 A and 50 percent shall be made available for grants under 

25 part B. 


hsrobinson on PROD1PC76 with BILLS
45 

•S 657 RS

1 ‘‘(c) ALLOCATION OF FUNDS BY SECRETARY.— 

2 ‘‘(1) GENERAL AUTHORITY.—For the purpose of 

3 carrying out part A, the Secretary shall make avail4 able 10 percent of the amounts appropriated for a fis5 cal year under subsection (a). 

6 ‘‘(2) RURAL GRANTS.—For the purpose of car7 rying out section 1202, the Secretary shall make 

8 available 10 percent of the amounts appropriated for 

9 a fiscal year under subsection (a).’’. 

10 SEC. 13. RESIDENCY TRAINING PROGRAMS IN EMERGENCY 

11 MEDICINE. 

12 Section 1251 of the Public Health Service Act (42 

13 U.S.C. 300d–51) is amended to read as follows: 

14 ‘‘SEC. 1251. RESIDENCY TRAINING PROGRAMS IN EMER15 GENCY MEDICINE. 

16 ‘‘(a) IN GENERAL.—The Secretary may make grants 

17 to public and nonprofit private entities for the purpose of 

18 planning and developing approved residency training pro19 grams in emergency medicine. 

20 ‘‘(b) IDENTIFICATION AND REFERRAL OF DOMESTIC

21 VIOLENCE.—The Secretary may make a grant under sub22 section (a) only if the applicant involved agrees that the 

23 training programs under subsection (a) will provide edu24 cation and training in identifying and referring cases of 

25 domestic violence. 


hsrobinson on PROD1PC76 with BILLS
46 

•S 657 RS

1 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—For the 

2 purpose of carrying out this section, there is authorized to 

3 be appropriated $400,000 for each of the fiscal years 2008 

4 though 2012.’’. 

5 SEC. 14. STATE GRANTS FOR CERTAIN PROJECTS. 

6 Section 1252 of the Public Health Service Act (42 

7 U.S.C. 300d–52) is amended in the section heading by 

8 striking ‘‘DEMONSTRATION’’. 


hsrobinson on PROD1PC76 with BILLS

hsrobinson on PROD1PC76 with BILLS
Calendar No. 98 

110TH CONGRESS 

1ST SESSION S. 657 

A BILL 

To amend the Public Health Service Act to add repurposes. quirements regarding trauma care, and for other 

MARCH 29, 2007 

Reported with an amendment 


hsrobinson on PROD1PC76 with BILLS