II 

108TH CONGRESS 

1ST SESSION S. 239

To amend the Public Health Service Act to add requirements regarding 

trauma care, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

JANUARY 29, 2003

Mr. FRIST (for himself, Mr. KENNEDY, Mr. ENZI, Mrs. MURRAY, Mr. ROBERTS, and Mr. GRAHAM of South Carolina) 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 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’’. 

6 SEC. 2. FINDINGS. 

7 Congress makes the following findings: 

8 (1) The Federal Government and State govern9 ments have established a history of cooperation in 
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1 the development, implementation, and monitoring of 

2 integrated, comprehensive systems for the provision 

3 of emergency medical services. 

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

5 Americans between the ages of 1 and 44 years and 

6 is the third leading cause of death in the general 

7 population of the United States. 

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

9 of traumatic injury in the United States was esti10 mated at $260,000,000,000. 

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

12 nonfatal injuries each year from motor vehicle-re13 lated trauma, resulting in an aggregate annual cost 

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

15 lost wages, and property damage. 

16 (5) Barriers to the receipt of prompt and ap17 propriate emergency medical services exist in many 

18 areas of the United States. 

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

20 reduced by improving the systems for the provision 

21 of emergency medical services in the United States. 

22 (7) Trauma care systems are an important part 

23 of the emergency preparedness system needed for 

24 homeland defense. 
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1 SEC. 3. AMENDMENTS. 

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

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

4 (1) in subsection (a)—

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

6 by inserting ‘‘, acting through the Adminis7 trator of the Health Resources and Services Ad8 ministration,’’ after ‘‘Secretary’’; 

9 (B) by redesignating paragraphs (3) and 

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

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

12 following: 

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

20 subparagraph (B)—

21 (i) by inserting ‘‘to enhance each 

22 State’s capability to develop, implement, 

23 and sustain the trauma care component of 

24 each State’s plan for the provision of emer25 gency medical services’’ after ‘‘assistance’’; 

26 and 
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1 (ii) by striking ‘‘and’’ after the semi2 colon; 

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

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

5 end and inserting ‘‘; and’’; and 

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

7 ‘‘(6) promote the collection and categorization 

8 of trauma data in a consistent and standardized 

9 manner.’’; 

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

11 through the Administrator of the Health Resources 

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

13 and 

14 (3) by striking subsection (c). 

15 (b) CLEARINGHOUSE ON TRAUMA CARE AND EMER16 GENCY MEDICAL SERVICES.—The Public Health Service 

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

18 (1) by striking section 1202; and 

19 (2) by redesignating section 1203 as section 

20 1202. 

21 (c) ESTABLISHMENT OF PROGRAMS FOR IMPROVING

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

23 Public Health Service Act, as such section was redesig24 nated by subsection (b), is amended—
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1 (1) in paragraph (2), in the matter preceding 

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

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

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

5 the semicolon; 

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

7 inserting ‘‘; and’’; and 

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

9 ‘‘(6) by increasing communication and coordi10 nation with State trauma systems.’’. 

11 (d) REQUIREMENT OF MATCHING FUNDS FOR FIS12 CAL YEARS SUBSEQUENT TO FIRST FISCAL YEAR OF

13 PAYMENTS.—Section 1212 of the Public Health Service 

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

15 (1) in subsection (a)(1)—

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

17 ‘‘and’’ after the semicolon; and 

18 (B) by striking subparagraph (B) and in19 serting the following: 

20 ‘‘(B) for the third fiscal year of such pay21 ments to the State, not less than $1 for each 

22 $1 of Federal funds provided in such payments 

23 for such fiscal year; 

24 ‘‘(C) for the fourth fiscal year of such pay25 ments to the State, not less than $2 for each 
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1 $1 of Federal funds provided in such payments 

2 for such fiscal year; and 

3 ‘‘(D) for the fifth 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 (2) in subsection (b)—

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

9 after the semicolon; 

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

11 and inserting a period; and 

12 (C) by striking paragraph (3). 

13 (e) REQUIREMENTS WITH RESPECT TO CARRYING

14 OUT PURPOSE OF ALLOTMENTS.—Section 1213 of the 

15 Public Health Service Act (42 U.S.C. 300d–13) is amend16 ed—

17 (1) in subsection (a)—

18 (A) in paragraph (3), in the matter pre19 ceding subparagraph (A), by inserting ‘‘nation20 ally recognized’’ after ‘‘contains’’; 

21 (B) in paragraph (5), by inserting ‘‘nation22 ally recognized’’ after ‘‘contains’’; 

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

24 procedures for the evaluation of designated’’ 
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1 and inserting ‘‘utilizes a program with proce2 dures for the evaluation of’’; 

3 (D) in paragraph (7)—

4 (i) in the matter preceding subpara5 graph (A), by inserting ‘‘in accordance 

6 with data collection requirements developed 

7 in consultation with surgical, medical, and 

8 nursing specialty groups, State and local 

9 emergency medical services directors, and 

10 other trained professionals in trauma care’’ 

11 after ‘‘collection of data’’; 

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

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

14 after ‘‘trauma patients’’; and 

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

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

17 ‘‘for such transfer’’; 

18 (E) by redesignating paragraphs (10) and 

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

20 and 

21 (F) by inserting after paragraph (9) the 

22 following: 

23 ‘‘(10) coordinates planning for trauma systems 

24 with State disaster emergency planning and bioter25 rorism hospital preparedness planning;’’; 
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1 (2) in subsection (b)—

2 (A) in paragraph (1)—

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

4 ‘‘concerning such’’ and inserting ‘‘that out5 line resources for optimal care of the in6 jured patient’’; and 

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

8 ‘‘1992’’ and inserting ‘‘2004’’; and 

9 (B) in paragraph (3)—

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

11 ‘‘1991’’ and inserting ‘‘2004’’; and 

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

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

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

15 Secretary shall develop a model plan’’ and inserting 

16 ‘‘2003, the Secretary shall update the model plan’’. 

17 (f) REQUIREMENT OF SUBMISSION TO SECRETARY

18 OF TRAUMA PLAN AND CERTAIN INFORMATION.—Section 

19 1214(a) of the Public Health Service Act (42 U.S.C. 

20 300d–14(a)) is amended—

21 (1) in paragraph (1)—

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

23 ‘‘2004’’; and 

24 (B) by inserting ‘‘that includes changes 

25 and improvements made and plans to address 
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1 deficiencies identified’’ after ‘‘medical services’’; 

2 and 

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

4 inserting ‘‘2004’’. 

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

6 1215(a)(1) of the Public Health Service Act (42 U.S.C. 

7 300d–15(a)(1)) is amended by striking the period at the 

8 end and inserting a semicolon. 

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

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

11 amended by striking section 1216 and inserting the fol12 lowing: 

13 ‘‘SEC. 1216. [RESERVED].’’. 

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

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

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

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

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

19 as follows:

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 2004, 

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

24 years 2005 through 2008.’’.
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1 (k) CONFORMING AMENDMENT.—Section 1232(b)(2) 

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

3 32(b)(2)) is amended by striking ‘‘1204’’ and inserting 

4 ‘‘1202’’. 

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

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

7 51 et seq.) is amended—

8 (1) by striking the part heading and inserting 

9 the following: 

10 ‘‘PART E—MISCELLANEOUS PROGRAMS’’; 

11 and 

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

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

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

15 a contract with the Institute of Medicine of the National 

16 Academy of Sciences, or another appropriate entity, to 

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

18 research. 

19 ‘‘(b) CONTENT.—The study conducted under sub20 section (a) shall—

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

22 care and trauma systems research (including the 

23 role of Federal entities in trauma research) on the 

24 date of enactment of this section, and identify trau25 ma research priorities; 
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1 ‘‘(2) examine and evaluate the clinical effective2 ness of trauma care and the impact of trauma care 

3 on patient outcomes, with special attention to high4 risk groups, such as children, the elderly, and indi5 viduals in rural areas; 

6 ‘‘(3) examine and evaluate trauma systems de7 velopment and identify obstacles that prevent or 

8 hinder the effectiveness of trauma systems and trau9 ma systems development; 

10 ‘‘(4) examine and evaluate alternative strategies 

11 for the organization, financing, and delivery of trau12 ma care within an overall systems approach; and 

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

14 systems and trauma centers in preparedness for 

15 mass casualties. 

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

17 of enactment of this section, the Secretary shall submit 

18 to the appropriate committees of Congress a report con19 taining the results of the study conducted under this sec20 tion. 

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

22 is authorized to be appropriated to carry out this section 

23 $750,000 for each of fiscal years 2004 and 2005.’’. 

24 (m) RESIDENCY TRAINING PROGRAMS IN EMER25 GENCY MEDICINE.—Section 1251(c) of the Public Health 
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1 Service Act (42 U.S.C. 300d–51(c)) is amended by strik2 ing ‘‘1993 through 1995’’ and inserting ‘‘2004 through 

3 2008’’. 

4 (n) STATE GRANTS FOR PROJECTS REGARDING

5 TRAUMATIC BRAIN INJURY.—Section 1252 of the Public 

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

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

8 (o) INTERAGENCY PROGRAM FOR TRAUMA RE9 SEARCH.—Section 1261 of the Public Health Service Act 

10 (42 U.S.C. 300d–61) is amended—

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

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

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

14 clinical research on trauma (in this section referred 

15 to as the ‘Program’), including the prevention, diag16 nosis, treatment, and rehabilitation of trauma-re17 lated injuries.’’; 

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

19 following: 

20 ‘‘(b) PLAN FOR PROGRAM.—The Director shall estab21 lish and implement a plan for carrying out the activities 

22 of the Program, taking into consideration the rec23 ommendations contained within the report of the NIH 

24 Trauma Research Task Force. The plan shall be periodi25 cally reviewed, and revised as appropriate.’’; 
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1 (3) in subsection (d)—

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

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

4 brain injury’’; and 

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

6 ‘‘head’’ and inserting ‘‘traumatic’’; 

7 (4) by striking subsection (g); 

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

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

10 (6) in subsection (h), as redesignated by para11 graph (5), by striking ‘‘2001 through 2005’’ and in12 serting ‘‘2004 through 2008’’.

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