II 

110TH CONGRESS 

1ST SESSION S. 1873 

To amend the Public Health Service Act to establish demonstration programs 

on regionalized systems for emergency care, to support emergency medicine research, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

JULY 25, 2007 

Mr. OBAMA introduced the following bill; which was read twice and referred 

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

A BILL 

To amend the Public Health Service Act to establish demonstration programs on regionalized systems for emergency care, to support emergency medicine research, 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 ‘‘Improving Emergency 

5 Medical Care and Response Act of 2007’’. 

6 SEC. 2. FINDINGS AND PURPOSES. 

7 (a) FINDINGS.—Congress makes the following find8 ings: 


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1 (1) Emergency medical services play a critically 

2 important role in health care, public health, and 

3 public safety by frequently providing immediate 

4 lifesustaining care and making decisions with limited 

5 time and information. 

6 (2) Between 1993 and 2003, the population of 

7 the United States grew by 12 percent and hospital 

8 admissions increased by 13 percent, yet emergency 

9 department visits rose by more than 25 percent dur10 ing this same period of time, from 90,300,000 visits 

11 in 1993 to 113,900,000 visits in 2003. 

12 (3) The demand for emergency care in the 

13 United States continues to grow at a rapid pace. 

14 (4) In 2003, hospital emergency departments 

15 received nearly 114,000,000 visits, which is more 

16 than 1 visit for every 3 people in the United States, 

17 however, between 1993 and 2003, the number of 

18 emergency departments declined by 425. 

19 (5) Many emergency medical services are highly 

20 fragmented, overburdened, poorly equipped, and in21 sufficiently prepared for day-to-day operations and 

22 response to major disasters. 

23 (6) There are more than 6,000 Public Safety 

24 Answering Points that receive 9–1–1 calls. 


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1 (7) These Public Safety Answering Points are 

2 often operated by police departments, fire depart3 ments, city or county governments, or other local en4 tities, which makes attempts to coordinate efforts 

5 between locations very difficult. 

6 (8) Regionalized, accountable systems of emer7 gency care show substantial promise in improving 

8 the day-to-day system-wide coordination essential to 

9 assure that Public Safety Answering Points, emer10 gency medical services organizations, public safety 

11 agencies, public health agencies, medical facilities, 

12 and others coordinate their activities to ensure that 

13 patients receive the appropriate care at the scene, 

14 are transported to the most appropriate facility in 

15 the shortest time, and receive excellent care at the 

16 destination medical facility. 

17 (9) Regionalized, accountable systems of emer18 gency care also show promise in management of the 

19 special problems of disaster preparation and re20 sponse, including management of patient surge, 

21 tracking of patients, and coordination and allocation 

22 of medical resources. 

23 (10) While there are potentially substantial ben24 efits to be derived from regionalized, accountable 

25 emergency care systems, little is known about the 


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1 most effective and efficient methods of regional 

2 emergency care system development. 

3 (b) PURPOSES.—The purposes of this Act are to de4 sign, implement, and evaluate regionalized, comprehen5 sive, and accountable systems of emergency care that— 

6 (1) support and improve the day-to-day oper7 ations and coordination of a regional emergency 

8 medical care system; 

9 (2) increase disaster preparedness and medical 

10 surge capacity; 

11 (3) include different models of regionalized 

12 emergency care systems, including models for urban 

13 and rural communities; 

14 (4) can be implemented by private or public en15 tities; and 

16 (5) meet quality and accountability standards 

17 for the operation of emergency care systems and the 

18 impact of such systems on patient outcomes. 

19 SEC. 3. DESIGN AND IMPLEMENTATION OF REGIONALIZED 

20 SYSTEMS FOR EMERGENCY CARE. 

21 Part B of title III of the Public Health Service Act 

22 (42 U.S.C. 243 et seq.) is amended by inserting after sec23 tion 314 the following: 


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1 ‘‘SEC. 315. REGIONALIZED COMMUNICATION SYSTEMS FOR 

2 EMERGENCY CARE RESPONSE. 

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

4 the Assistant Secretary for Preparedness and Response, 

5 shall award not fewer than 4 multiyear contracts or com6 petitive grants to eligible entities to support demonstration 

7 programs that design, implement, and evaluate innovative 

8 models of regionalized, comprehensive, and accountable 

9 emergency care systems. 

10 ‘‘(b) ELIGIBLE ENTITY; REGION.— 

11 ‘‘(1) ELIGIBLE ENTITY.—In this section, the 

12 term ‘eligible entity’ means a State or a partnership 

13 of 1 or more States and 1 or more local govern14 ments. 

15 ‘‘(2) REGION.—In this section, the term ‘re16 gion’ means an area within a State, an area that lies 

17 within multiple States, or a similar area (such as a 

18 multicounty area), as determined by the Secretary. 

19 ‘‘(c) DEMONSTRATION PROGRAM.—The Secretary 

20 shall award a contract or grant under subsection (a) to 

21 an eligible entity that proposes a demonstration program 

22 to design, implement, and evaluate an emergency medical 

23 system that— 

24 ‘‘(1) coordinates with public safety services, 

25 public health services, emergency medical services, 

26 medical facilities, and other entities within a region; 


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1 ‘‘(2) coordinates an approach to emergency 

2 medical system access throughout the region, includ3 ing 9–1–1 Public Safety Answering Points and 

4 emergency medical dispatch; 

5 ‘‘(3) includes a mechanism, such as a regional 

6 medical direction or transport communications sys7 tem, that operates throughout the region to ensure 

8 that the correct patient is taken to the medically ap9 propriate facility (whether an initial facility or a 

10 higher-level facility) in a timely fashion; 

11 ‘‘(4) allows for the tracking of prehospital and 

12 hospital resources, including inpatient bed capacity, 

13 emergency department capacity, on-call specialist 

14 coverage, ambulance diversion status, and the co15 ordination of such tracking with regional commu16 nications and hospital destination decisions; and 

17 ‘‘(5) includes a consistent region-wide 

18 prehospital, hospital, and interfacility data manage19 ment system that— 

20 ‘‘(A) complies with the National EMS In21 formation System, the National Trauma Data 

22 Bank, and others; 

23 ‘‘(B) reports data to appropriate Federal 

24 and State databanks and registries; and 


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1 ‘‘(C) contains information sufficient to 

2 evaluate key elements of prehospital care, hos3 pital destination decisions, including initial hos4 pital and interfacility decisions, and relevant 

5 outcomes of hospital care. 

6 ‘‘(d) APPLICATION.— 

7 ‘‘(1) IN GENERAL.—An eligible entity that 

8 seeks a contract or grant described in subsection (a) 

9 shall submit to the Secretary an application at such 

10 time and in such manner as the Secretary may re11 quire. 

12 ‘‘(2) APPLICATION INFORMATION.—Each appli13 cation shall include— 

14 ‘‘(A) an assurance from the eligible entity 

15 that the proposed system— 

16 ‘‘(i) has been coordinated with the ap17 plicable State Office of Emergency Medical 

18 Services (or equivalent State office); 

19 ‘‘(ii) is compatible with the applicable 

20 State emergency medical services system; 

21 ‘‘(iii) includes consistent indirect and 

22 direct medical oversight of prehospital, 

23 hospital, and interfacility transport 

24 throughout the region; 


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1 ‘‘(iv) coordinates prehospital treat2 ment and triage, hospital destination, and 

3 interfacility transport throughout the re4 gion; 

5 ‘‘(v) includes a categorization or des6 ignation system for special medical facili7 ties throughout the region that is— 

8 ‘‘(I) consistent with State laws 

9 and regulations; and 

10 ‘‘(II) integrated with the proto11 cols for transport and destination 

12 throughout the region; and 

13 ‘‘(vi) includes a regional medical di14 rection system, a patient tracking system, 

15 and a resource allocation system that— 

16 ‘‘(I) support day-to-day emer17 gency care system operation; 

18 ‘‘(II) can manage surge capacity 

19 during a major event or disaster; and 

20 ‘‘(III) are integrated with other 

21 components of the national and State 

22 emergency preparedness system; and 

23 ‘‘(B) such other information as the Sec24 retary may require. 


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1 ‘‘(e) PRIORITY.—The Secretary shall give priority for 

2 the award of the contracts or grants described subsection 

3 (a) to any eligible entity that serves a population in a 

4 medically underserved area (as defined in section 

5 330(b)(3)). 

6 ‘‘(f) REPORT.—Not later than 90 days after the com7 pletion of a demonstration program under subsection (a), 

8 the recipient of such contract or grant described in shall 

9 submit to the Secretary a report containing the results of 

10 an evaluation of the program, including an identification 

11 of— 

12 ‘‘(1) the impact of the regional, accountable 

13 emergency care system on patient outcomes for var14 ious critical care categories, such as trauma, stroke, 

15 cardiac emergencies, and pediatric emergencies; 

16 ‘‘(2) the system characteristics that contribute 

17 to the effectiveness and efficiency of the program (or 

18 lack thereof); 

19 ‘‘(3) methods of assuring the long-term finan20 cial sustainability of the emergency care system; 

21 ‘‘(4) the State and local legislation necessary to 

22 implement and to maintain the system; and 

23 ‘‘(5) the barriers to developing regionalized, ac24 countable emergency care systems, as well as the 

25 methods to overcome such barriers. 


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1 ‘‘(g) DISSEMINATION OF FINDINGS.—The Secretary 

2 shall, as appropriate, disseminate to the public and to the 

3 appropriate Committees of the Congress, the information 

4 contained in a report made under subsection (f). 

5 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—There 

6 are authorized to be appropriated to carry out this section 

7 $12,000,000 for each of fiscal years 2008 through 2013.’’. 

8 SEC. 4. SUPPORT FOR EMERGENCY MEDICINE RESEARCH. 

9 Part H of title IV of the Public Health Service Act 

10 (42 U.S.C. 289 et seq.) is amended by inserting after the 

11 section 498C the following: 

12 ‘‘SEC. 498D. SUPPORT FOR EMERGENCY MEDICINE RE13 SEARCH. 

14 ‘‘(a) EMERGENCY MEDICAL RESEARCH.—The Sec15 retary shall support Federal programs administered by the 

16 National Institutes of Health, the Agency for Healthcare 

17 Research and Quality, the Health Resources and Services 

18 Administration, the Centers for Disease Control and Pre19 vention, and other agencies involved in improving the 

20 emergency care system to expand and accelerate research 

21 in emergency medical care systems and emergency medi22 cine, including— 

23 ‘‘(1) the basic science of emergency medicine; 


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1 ‘‘(2) the model of service delivery and the com2 ponents of such models that contribute to enhanced 

3 patient outcomes; 

4 ‘‘(3) the translation of basic scientific research 

5 into improved practice; and 

6 ‘‘(4) the development of timely and efficient de7 livery of health services. 

8 ‘‘(b) IMPACT RESEARCH.—The Secretary shall sup9 port research to determine the estimated economic impact 

10 of, and savings that result from, the implementation of 

11 coordinated emergency care systems. 

12 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 

13 are authorized to be appropriated to carry out this section 

14 such sums as may be necessary for each of fiscal years 

15 2008 through 2013.’’. 

Æ 


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