I 

108TH CONGRESS 

1ST SESSION S. 239

IN THE HOUSE OF REPRESENTATIVES 

JUNE 24, 2003

Referred to the Committee on Energy and Commerce 

AN ACT

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 2003’’.
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1 SEC. 2. FINDINGS. 

2 Congress makes the following findings: 

3 (1) The Federal Government and State govern4 ments have established a history of cooperation in 

5 the development, implementation, and monitoring of 

6 integrated, comprehensive systems for the provision 

7 of emergency medical services. 

8 (2) Trauma is the leading cause of death of 

9 Americans between the ages of 1 and 44 years and 

10 is the third leading cause of death in the general 

11 population of the United States. 

12 (3) In 1995, the total direct and indirect cost 

13 of traumatic injury in the United States was esti14 mated at $260,000,000,000. 

15 (4) There are 40,000 fatalities and 5,000,000 

16 nonfatal injuries each year from motor vehicle-re17 lated trauma, resulting in an aggregate annual cost 

18 of $230,000,000,000 in medical expenses, insurance, 

19 lost wages, and property damage. 

20 (5) Barriers to the receipt of prompt and ap21 propriate emergency medical services exist in many 

22 areas of the United States. 

23 (6) The number of deaths from trauma can be 

24 reduced by improving the systems for the provision 

25 of emergency medical services in the United States. 
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1 (7) Trauma care systems are an important part 

2 of the emergency preparedness system needed for 

3 homeland defense. 

4 SEC. 3. AMENDMENTS. 

5 (a) ESTABLISHMENT.—Section 1201 of the Public 

6 Health Service Act (42 U.S.C. 300d) is amended—

7 (1) in subsection (a)—

8 (A) in the matter preceding paragraph (1), 

9 by inserting ‘‘, acting through the Adminis10 trator of the Health Resources and Services Ad11 ministration,’’ after ‘‘Secretary’’; 

12 (B) by redesignating paragraphs (3) and 

13 (4) as paragraphs (4) and (5), respectively; 

14 (C) by inserting after paragraph (2) the 

15 following: 

16 ‘‘(3) collect, compile, and disseminate informa17 tion on the achievements of, and problems experi18 enced by, State and local agencies and private enti19 ties in providing trauma care and emergency medical 

20 services and, in so doing, give special consideration 

21 to the unique needs of rural areas;’’; 

22 (D) in paragraph (4), as redesignated by 

23 subparagraph (B)—

24 (i) by inserting ‘‘to enhance each 

25 State’s capability to develop, implement, 
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1 and sustain the trauma care component of 

2 each State’s plan for the provision of emer3 gency medical services’’ after ‘‘assistance’’; 

4 and 

5 (ii) by striking ‘‘and’’ after the semi6 colon; 

7 (E) in paragraph (5), as redesignated by 

8 subparagraph (B), by striking the period at the 

9 end and inserting ‘‘; and’’; and 

10 (F) by adding at the end the following: 

11 ‘‘(6) promote the collection and categorization 

12 of trauma data in a consistent and standardized 

13 manner.’’; 

14 (2) in subsection (b), by inserting ‘‘, acting 

15 through the Administrator of the Health Resources 

16 and Services Administration,’’ after ‘‘Secretary’’; 

17 and 

18 (3) by striking subsection (c). 

19 (b) CLEARINGHOUSE ON TRAUMA CARE AND EMER20 GENCY MEDICAL SERVICES.—The Public Health Service 

21 Act (42 U.S.C. 201 et seq.) is amended—

22 (1) by striking section 1202; and 

23 (2) by redesignating section 1203 as section 

24 1202. 
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1 (c) ESTABLISHMENT OF PROGRAMS FOR IMPROVING

2 TRAUMA CARE IN RURAL AREAS.—Section 1202(a) of the 

3 Public Health Service Act, as such section was redesig4 nated by subsection (b), is amended—

5 (1) in paragraph (2), in the matter preceding 

6 subparagraph (A), by inserting ‘‘, such as advanced 

7 trauma life support,’’ after ‘‘model curricula’’; 

8 (2) in paragraph (4), by striking ‘‘and’’ after 

9 the semicolon; 

10 (3) in paragraph (5), by striking the period and 

11 inserting ‘‘; and’’; and 

12 (4) by adding at the end the following: 

13 ‘‘(6) by increasing communication and coordi14 nation with State trauma systems.’’. 

15 (d) REQUIREMENT OF MATCHING FUNDS FOR FIS16 CAL YEARS SUBSEQUENT TO FIRST FISCAL YEAR OF

17 PAYMENTS.—Section 1212 of the Public Health Service 

18 Act (42 U.S.C. 300d–12) is amended—

19 (1) in subsection (a)(1)—

20 (A) in subparagraph (A), by striking 

21 ‘‘and’’ after the semicolon; and 

22 (B) by striking subparagraph (B) and in23 serting the following: 

24 ‘‘(B) for the third fiscal year of such pay25 ments to the State, not less than $1 for each 
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1 $1 of Federal funds provided in such payments 

2 for such fiscal year; 

3 ‘‘(C) for the fourth fiscal year of such pay4 ments to the State, not less than $2 for each 

5 $1 of Federal funds provided in such payments 

6 for such fiscal year; and 

7 ‘‘(D) for the fifth fiscal year of such pay8 ments to the State, not less than $2 for each 

9 $1 of Federal funds provided in such payments 

10 for such fiscal year.’’; and 

11 (2) in subsection (b)—

12 (A) in paragraph (1), by adding ‘‘and’’ 

13 after the semicolon; 

14 (B) in paragraph (2), by striking ‘‘; and’’ 

15 and inserting a period; and 

16 (C) by striking paragraph (3). 

17 (e) REQUIREMENTS WITH RESPECT TO CARRYING

18 OUT PURPOSE OF ALLOTMENTS.—Section 1213 of the 

19 Public Health Service Act (42 U.S.C. 300d–13) is amend20 ed—

21 (1) in subsection (a)—

22 (A) in paragraph (3), in the matter pre23 ceding subparagraph (A), by inserting ‘‘nation24 ally recognized’’ after ‘‘contains’’; 
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1 (B) in paragraph (5), by inserting ‘‘nation2 ally recognized’’ after ‘‘contains’’; 

3 (C) in paragraph (6), by striking ‘‘specifies 

4 procedures for the evaluation of designated’’ 

5 and inserting ‘‘utilizes a program with proce6 dures for the evaluation of’’; 

7 (D) in paragraph (7)—

8 (i) in the matter preceding subpara9 graph (A), by inserting ‘‘in accordance 

10 with data collection requirements developed 

11 in consultation with surgical, medical, and 

12 nursing specialty groups, State and local 

13 emergency medical services directors, and 

14 other trained professionals in trauma care’’ 

15 after ‘‘collection of data’’; 

16 (ii) in subparagraph (A), by inserting 

17 ‘‘and the number of deaths from trauma’’ 

18 after ‘‘trauma patients’’; and 

19 (iii) in subparagraph (F), by inserting 

20 ‘‘and the outcomes of such patients’’ after 

21 ‘‘for such transfer’’; 

22 (E) by redesignating paragraphs (10) and 

23 (11) as paragraphs (11) and (12), respectively; 

24 and 
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1 (F) by inserting after paragraph (9) the 

2 following: 

3 ‘‘(10) coordinates planning for trauma systems 

4 with State disaster emergency planning and bioter5 rorism hospital preparedness planning;’’; 

6 (2) in subsection (b)—

7 (A) in paragraph (1)—

8 (i) in subparagraph (A), by striking 

9 ‘‘concerning such’’ and inserting ‘‘that out10 line resources for optimal care of the in11 jured patient’’; and 

12 (ii) in subparagraph (D), by striking 

13 ‘‘1992’’ and inserting ‘‘2004’’; and 

14 (B) in paragraph (3)—

15 (i) in subparagraph (A), by striking 

16 ‘‘1991’’ and inserting ‘‘2004’’; and 

17 (ii) in subparagraph (B), by striking 

18 ‘‘1992’’ and inserting ‘‘2004’’; and 

19 (3) in subsection (c), by striking ‘‘1990, the 

20 Secretary shall develop a model plan’’ and inserting 

21 ‘‘2003, the Secretary shall update the model plan’’. 

22 (f) REQUIREMENT OF SUBMISSION TO SECRETARY

23 OF TRAUMA PLAN AND CERTAIN INFORMATION.—Section 

24 1214(a) of the Public Health Service Act (42 U.S.C. 

25 300d–14(a)) is amended—
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1 (1) in paragraph (1)—

2 (A) by striking ‘‘1991’’ and inserting 

3 ‘‘2004’’; and 

4 (B) by inserting ‘‘that includes changes 

5 and improvements made and plans to address 

6 deficiencies identified’’ after ‘‘medical services’’; 

7 and 

8 (2) in paragraph (2), by striking ‘‘1991’’ and 

9 inserting ‘‘2004’’. 

10 (g) RESTRICTIONS ON USE OF PAYMENTS.—Section 

11 1215(a)(1) of the Public Health Service Act (42 U.S.C. 

12 300d–15(a)(1)) is amended by striking the period at the 

13 end and inserting a semicolon. 

14 (h) REQUIREMENTS OF REPORTS BY STATES.—The 

15 Public Health Service Act (42 U.S.C. 201 et seq.) is 

16 amended by striking section 1216 and inserting the fol17 lowing: 

18 ‘‘SEC. 1216. [RESERVED].’’. 

19 (i) REPORT BY THE SECRETARY.—Section 1222 of 

20 the Public Health Service Act (42 U.S.C. 300d–22) is 

21 amended by striking ‘‘1995’’ and inserting ‘‘2006’’. 

22 (j) FUNDING.—Section 1232(a) of the Public Health 

23 Service Act (42 U.S.C. 300d–32(a)) is amended to read 

24 as follows: 
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1 ‘‘(a) AUTHORIZATION OF APPROPRIATIONS.—For the 

2 purpose of carrying out parts A and B, there are author3 ized to be appropriated $12,000,000 for fiscal year 2004, 

4 and such sums as may be necessary for each of the fiscal 

5 years 2005 through 2008.’’.

6 (k) CONFORMING AMENDMENT.—Section 1232(b)(2) 

7 of the Public Health Service Act (42 U.S.C. 300d–

8 32(b)(2)) is amended by striking ‘‘1204’’ and inserting 

9 ‘‘1202’’. 

10 (l) INSTITUTE OF MEDICINE STUDY.—Part E of title 

11 XII of the Public Health Service Act (20 U.S.C. 300d–

12 51 et seq.) is amended—

13 (1) by striking the part heading and inserting 

14 the following: 

15 ‘‘PART E—MISCELLANEOUS PROGRAMS’’; 

16 and 

17 (2) by adding at the end the following: 

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

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

20 a contract with the Institute of Medicine of the National 

21 Academy of Sciences, or another appropriate entity, to 

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

23 research. 

24 ‘‘(b) CONTENT.—The study conducted under sub25 section (a) shall—
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1 ‘‘(1) examine and evaluate the state of trauma 

2 care and trauma systems research (including the 

3 role of Federal entities in trauma research) on the 

4 date of enactment of this section, and identify trau5 ma research priorities; 

6 ‘‘(2) examine and evaluate the clinical effective7 ness of trauma care and the impact of trauma care 

8 on patient outcomes, with special attention to high9 risk groups, such as children, the elderly, and indi10 viduals in rural areas; 

11 ‘‘(3) examine and evaluate trauma systems de12 velopment and identify obstacles that prevent or 

13 hinder the effectiveness of trauma systems and trau14 ma systems development; 

15 ‘‘(4) examine and evaluate alternative strategies 

16 for the organization, financing, and delivery of trau17 ma care within an overall systems approach; and 

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

19 systems and trauma centers in preparedness for 

20 mass casualties. 

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

22 of enactment of this section, the Secretary shall submit 

23 to the appropriate committees of Congress a report con24 taining the results of the study conducted under this sec25 tion. 
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1 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 

2 is authorized to be appropriated to carry out this section 

3 $750,000 for each of fiscal years 2004 and 2005.’’. 

4 (m) RESIDENCY TRAINING PROGRAMS IN EMER5 GENCY MEDICINE.—Section 1251(c) of the Public Health 

6 Service Act (42 U.S.C. 300d–51(c)) is amended by strik7 ing ‘‘1993 through 1995’’ and inserting ‘‘2004 through 

8 2008’’. 

9 (n) STATE GRANTS FOR PROJECTS REGARDING

10 TRAUMATIC BRAIN INJURY.—Section 1252 of the Public 

11 Health Service Act (42 U.S.C. 300d–52) is amended in 

12 the section heading by striking ‘‘DEMONSTRATION’’. 

13 (o) INTERAGENCY PROGRAM FOR TRAUMA RE14 SEARCH.—Section 1261 of the Public Health Service Act 

15 (42 U.S.C. 300d–61) is amended—

16 (1) in subsection (a), by striking ‘‘conducting 

17 basic’’ and all that follows through the period at the 

18 end of the second sentence and inserting ‘‘basic and 

19 clinical research on trauma (in this section referred 

20 to as the ‘Program’), including the prevention, diag21 nosis, treatment, and rehabilitation of trauma-re22 lated injuries.’’; 

23 (2) by striking subsection (b) and inserting the 

24 following: 
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1 ‘‘(b) PLAN FOR PROGRAM.—The Director shall estab2 lish and implement a plan for carrying out the activities 

3 of the Program, taking into consideration the rec4 ommendations contained within the report of the NIH 

5 Trauma Research Task Force. The plan shall be periodi6 cally reviewed, and revised as appropriate.’’; 

7 (3) in subsection (d)—

8 (A) in paragraph (4)(B), by striking 

9 ‘‘acute head injury’’ and inserting ‘‘traumatic 

10 brain injury’’; and 

11 (B) in subparagraph (D), by striking 

12 ‘‘head’’ and inserting ‘‘traumatic’’; 

13 (4) by striking subsection (g); 

14 (5) by redesignating subsections (h) and (i) as 

15 subsections (g) and (h), respectively; and 

16 (6) in subsection (h), as redesignated by para17 graph (5), by striking ‘‘2001 through 2005’’ and in18 serting ‘‘2004 through 2008’’.

Passed the Senate June 23, 2003. 

Attest: EMILY J. REYNOLDS, 

Secretary.