SIXTEENTH CONGRESS )
REPUBLIC OF THE PHILIPPINES :
First Regular Session

HOUSE OF REPRESENTATIVES

Introduced by Representative Rufus B. Rodriguez and
Representative Maximo B. Rodriguez, Jr.

House Bill No. 3301.

EXPLANATORY NOTE

Article 13 of the Constitution provides that, “The State shall adopt an integrated
and comprehensive approach to health development which shall endeavor to make
essential goods, health and other social services available to all the people at
affordable cost. There shall be priority for the needs of the underprivileged, sick,
elderly, disabled, women and children. The State shall endeavor to provide free
medical care to paupers.”

The Administrative Code, Book 4, Title 9, Section 3 empowers the Department
of Health to define the national health policy and formulate and implement a national
health plan within the framework of the government's general policies and plans.

One of the aspects of medical care delivery systems that the government
should focus on is the trauma care components of such systems. This way, the
number of death and disabilities resulting from incidents of physical trauma can be
substantially reduced by improving these medical care delivery systems,

This bill seeks to improve emergency medical services and trauma care by: (a)
empowering the Department of Health to identify designated trauma centers; (b)
establishing a National Clearinghouse on Emergency Medical Services and Trauma
Care; and (c) providing for standards with respect to trauma care centers.

The immediate enactment of this bill is highly recommended.

RUFI . RODRIGUEZ

. Ub coca JR.

MAXIMO


SIXTEENTH CONGRESS
REPUBLIC OF THE PHILIPPINES )
First Regular Session )

HOUSE OF REPRESENTATIVES

Introduced by Representative Rufus B. Rodriguez and
Representative Maximo B. Rodriquez, Jr.

House BillNo. 3301

TO IMPROVE EMERGENCY MEDICAL SERVICES AND TRAUMA CARE

Be it enacted by the Senate and House of Representatives of the Philippines in
Congress assembled:

SECTION 1. Short Title. - This Act shall be known as the “Emergency Medical
Services and Trauma Care Improvement Act.”

SEC 2. Deciaration of Policy. ~ Itis the policy of the State to protect and promote the
right to health of the people.

SEC 3. Definition of Terms. - As used in this Act:

(a) “Designated Trauma Center’ means a trauma center designated in
accordance with this Act;

(b) “Plan for the Provision of Emergency Medical services” means a plan
for a comprehensive, organized system to provide for the access,
response, triage, field stabilization, transport, hospital stabilization,
definite care, and rehabilitation of patients of all ages with respect to
emergency medical services;

(c) “Trauma Care Component of the Plan for the Provision of Emergency
Medical Services” means a plan for a comprehensive health care
system, within rural and urban areas of the State, for the prompt
recognition, pre-hospital care, emergency medical care, acute surgical,
and medical care, rehabilitation, and outcome evaluation of seriously
injured patients; and

(d) “Secretary” shall mean the Secretary of the Department of Health.

SEC 4. Clearinghouse on Emergency Medical Services and Trauma Care. —
(A) Establishment. - The Secretary shall provide for the establishment
and operation of a National Clearinghouse on Emergency Medical
Services and Trauma Care (hereinafter referred to in this title as
the ‘Clearinghouse’)
(8) Duties. - The Clearinghouse shall —

(1) foster the development of appropriate, modern emergency
medical services and trauma care (including the
development of policies for the notification of family
members of individuals involved in a medical emergency)
through the sharing of information among agencies and
individuals involved in planning, furnishing and studying
such services and care:


(c)

(D)

(2) collect, compile and disseminate information on the
achievements of, and problems experienced by national
and local agencies and private entities in providing
emergency medical services and trauma care and in doing
0, give special consideration of the unique needs of rural
areas:

(3) provide technical assistance relating to emergency
medical services and trauma care to national and local
agencies; and

(4) sponsor workshops and conferences on emergency
medical services and trauma care.

Fees and Assessments. - A contract entered into by the Secretary
under this section may provide that the Clearinghouse shail
charge reasonable fees or assessments in order to defray the
costs of operating the Clearinghouse.

Authority To Enter into Contracts. - The authority of the Secretary
to enter into contracts under this section shall be to such extent or
in such amounts as are provided in Appropriation Acts

SEC 5. General Duties. -

(a)

(b)

(c)

In General. - The Secretary shall —

(1) identify designated trauma centers;

(2) conduct and support research, training, evaluations and
demonstration projects with respect to emergency medical services
and trauma care systems;

(3) provide to national and local agencies technical assistance relating
to emergency medical services and trauma care systems; and

(4) establish guidelines for the development of uniform national and
local data reporting systems as described in Section 6(B)(6).

Grants, Cooperative Agreements and Contracts. - The Secretary may

make grants and enter into cooperative agreements and contracts for

the purpose of carrying out subsection (a).

Consultation and Coordination. - The Secretary shall consult and

coordinate with the appropriate departments and agencies to ensure

that the implementation of this Act will not conflict with their
responsibilities, with respect to emergency services.

SEC 6. - Requirements with Respect to Designated Trauma Care Centers. —

(A) Plan —

(1) Trauma Care Component. - For each fiscal year, each
designated trauma center shall submit the trauma care
component of the plan for the provision of emergency
medical services (hereinafter referred to as the “Plan”) to
the Secretary

(2) Interim Plan. - For each fiscal year, if a designated trauma

center has not completed the plan, it may provide, in lieu of
a completed plan, an interim pian or description of efforts
made toward the completion of the plan.

(B) Requirements of Plan. - Each plan shall —
(1)

contain minimum standards and requirements for the
designation of different categories of trauma centers
(including faclities with specified capabilities and expertise
in the care of the pediatric trauma patient) by such agency
or entity, including standards and requirements for —


(3)

(4)

(5)

(6)

@

(8)

(a) ensuring that such centers will have sufficient
experience and expertise to be able to provide quality
care for victims of injury which, in the case of level 1
or level 2 trauma ceniers, include the number and
types of trauma patients for whom such centers must

provide care;

(b) the resources and equipment needed by such
centers;

(c) the availability of rehabilitation services for trauma
patients; and

(4) the provision of assurances that such centers may

not refuse the transfer of a trauma patient because
the patient is unable to pay for the care that the
patient requires;

contain standards and requirements for the implementation
of regional trauma care systems, including standards and
guidelines or medically directed triage and transportation of
trauma patients;

contain standards and requirements for medically directed
‘riage and transport of severely injured children to facilities
with specified capabilities and expertise in the care of the
pediatric trauma patient;

specific procedures for the evaluation of designated trauma
centers and trauma care systems;

provide that the standards and requirements address the
Special needs and problems of rural communities;

provide for the establishment in the designated trauma
center of a central data reporting and analysis system for-

(a) identifying severely injured trauma patients within
Tegional trauma care systems in their area of
coverage;

(b) identifying the nature and cause of severe injuries
and if known, factors contributing to the injury,

(c) identifying patient outcomes;

(d) monitoring trauma care resources (including pre-

hospital care) within a regional trauma care system
(including relevant rehabilitation information);

(e) identifying patients transferred within a regional
trauma system, including reasons for such transfer;

provide periodic reviews of the transfers and the auditing of
Such transfers determined to be inappropriate:

improve or establish injury prevention programs and
conduct public education activities conceming obtaining


(9)

access to emergency medical services and trauma care;
and,

provide for the coordination and cooperation between the
Department of Health and any other national agency.

(C) Examination and Treatment For Emergency Medical Conditions. —
Transfer policies referred to in this Act shall include the following

requirements:
(1) Medical Screening Requirements. - In the case of a hospital
that has a hospital emergency department, if any individual
comes to the emergency department and a request is made
on the individual's behalf for examination or treatment for a
medical condition, the hospital shall, provide for an
appropriate medical screening examination within the
capability of the hospital's emergency department to
determine whether or not an emergency medical condition
exists or to determine if the individual is in active labor.
(2) Necessary Stabilizing Treatment for Emergency Medical
Conditions and Active Labor. —

(a) In General. - If any individual comes to a hospital
and the hospital determines that the individual has
‘an emergency medical condition or is in active
labor, the hospital must provide either —

(0) within the staff and facilities available at the
hospital, for such further medical
examination and such treatment as may be
required to stabilize the medical condition or
to provide for treatment of the labor; or

(ii) for transfer of the individual to another
medical facility in accordance with
paragraph (3)

(b) Refusal to Consent to Treatment - A hospital shall
be considered to meet the requirement of
subparagraph (a) with respect to an individual if the
hospital offers the individual the further medical
examination and treatment described in such
clause but the individual (or a legally responsible
person acting on the individual's behalf) refuses to
consent to the examination or treatment

(c) Refusal to Consent to Transfer. - A hospital shall

be considered to meet the requirements of
subparagraph (a) with respect to an individual if the
hospital offers to transfer the individual to another
medical faclity in accordance with paragraph (3)
but the individual (or a legally responsible person
acting on individual's behalf) refuses to consent to
the transfer.


(3)

Restricting Transfers Until Patient Stabilizes. —

(a)

(b)

(c)

(4)

@

(ii)

(ili)

i)

General Rule - If a patient at a hospital has an
emergency medical condition which has not been
‘stabilized or is in active labor, the hospital may not
transfer the patient.

Exception - A patient that has not been ‘stabilized or
is inactive labor may be transferred if-

the patient (or a legally responsible person
acting on the patient's behalf) requests that
the transfer be effected; or

a physician, or other qualified medical
personnel when a physician is not readily
available in the emergency department, has
signed a certification that, based on the
reasonable risks and benefits to the patient,
and based on the information available at
the time, the medical benefits reasonably
expected from the provision of appropriate
medical treatment at another medical facility
outweigh the increased risks to the
individual's medical condition from effecting
the transfer; and

the transfer is an appropriate transfer (within
the meaning of subparagraph (d)) to that
facility.

Requirement. if a patient at a hospital has an
emergency medical condition that has been
stabilized, the hospital may transfer the patient but
only by means of an appropriate transfer.

Appropriate Transfer. - A transfer to a medical
facilty is an appropriate transfer it—

the receiving facility —

a. has available space and qualified personnel
for the treatment of the patient, and

b. has agreed to accept transfer of the patient
and to provide appropriate medical treatment,
except that a hospital may not refuse to
accept a transferred patient unless such
hospital does not have the facilities or
personnel available to provide proper care for
such transferred patient, or the hospital has a
full census at that time:


(4)

i. the transferring hospital provides the
receiving facility with appropriate
medical records (or copies thereof) of
the examination and _ treatment
effected at the transferring hospital;

ji. the transfer is effected through
qualified personnel and transportation
equipment, as required including the
use of necessary and medically
appropriate life support measures
during the transfer; and,

ili, the transfer meets such other
requirements as the Secretary may
find necessary in the interest of the
health and safety of the patient
transferred.

Call Schedules. - In the case of a hospital that has an
emergency department, such hospital shall provide a call
schedule that lists the appropriate medical specialists that
will be immediately available for duty to provide ongoing,
definitive treatment to a patient after the initial examination
by the emergency physicians.

(D) Certain Standards With Respect to Trauma Care Centers and Systems —

(1)

(2)

In General. - In carrying out subsection (B), the Secretary
shall adopt standards for the designation of trauma centers,
and for triage, transfer, and transportation policies. In
adopting such standards the Secretary shall —

(a) take into account existing, national standards
conceming such;

(b) consult with medical and nursing specialty groups,
hospital associations, emergency medical services
directors, concemed advocates and other
interested parties;

(c) conduct hearings on the proposed standards after
providing adequate notice to the public concerning
such hearing; and

(a) beginning in fiscal year when this Act shall take
effect, take into account the model plan described
in subsection (e).

Quality of Trauma Care. - The highest quality of trauma
care shall be the primary goal of the Secretary and the
standards adopted under this subsection shalll take this into
consideration.


(3)

Existing Standards - In the case of adopted standards with
respect to trauma care centers and systems prior to the
effectivity of this Act, such trauma care centers shall
demonstrate in the pian that the standards provide for the
highest possible quality of trauma care and that it —

(a) took into account existing national standards in
adopting such standards; and

(b) consulted with medical and nursing specialty
groups, hospital associations, emergency medical
services directors, concemed advocates and other
interested parties.

(E) Model Trauma Care Pian. - Not later than one (1) year after the date of
enactment of this Act, the Secretary shall develop a model plan for the

designation of trauma centers and for triage, transfer, and transportation,

policies that may be adopted for guidance by the State. such plan shall ~

(1)
(2)
(3)

(4)

take into account existing national standards;
take into account existing State plans;

be developed in consultation with medical and nursing
specialty groups, hospital associations, emergency medical
services directors and associations, concemed advocates
and other interested parties; and

include standards for the designation of rural health facilities
and hospitals best able to receive, stabilize, and transfer
trauma patients to the nearest appropriate designated
trauma center, and for triage, transfer, and transportation
policies as they relate to rural areas.

SEC 7. Requirement of Annual Report by Designated Trauma Centers - The
Secretary shall require each designated trauma center to provide to the central data
Teporting system, for each fiscal year, a report that —

a)

(2)
(3)
(4)

(5)

specifies the number of severely injured trauma patients cared for
by such facility by injury severity grouping and nature of the injury
during the fiscal year:

specifies the average length of hospital stay by such patients
according to injury severity groupings during the fiscal year;
specifies the outcomes, including the disability outcome, of
severely injured trauma patients and their discharge disposition;
specifies the total amount of uncompensated trauma care
expenditures incurred by such facility for such patients for such
fiscal year; and

specifies the number of patients transferred in a manner not in
accordance with the provisions of Section 6.

SEC 8. Annuat Report by the Secretary. - The Secretary shall prepare and submit to
the appropriate Committees of Congress an annual report on the activities carried out
pursuant to this Act. Such report may include any recommendations of the Secretary
for appropriate administrative and legislative initiatives and shall include —


(1) an evaluation of the trauma system plans and standards;

(2) recommendations regarding the plans and standards that result in the most
favorable patient outcomes; and

(3) recommendations regarding and, if appropriate, modifications of the model
plan as required by Section 6(e).

SEC 9. Separability Clause. - If any provision or part hereof, is held invalid or
unconstitutional, the remainder of the law or the provision not otherwise affected shall
remain valid and subsisting

SEC 10. Repealing Clause. — Any law, presidential decree or issuance, executive
order, letter of instruction, administrative order, rule or regulation contrary to or
inconsistent with the provisions of this Act is hereby repealed, modified or amended
accordingly.

SEC 11. Effectivity Clause. — This Act shall take effect fifteen (15) days after its
publication in at least two (2) newspapers of general circulation.

Approved,