Republic of the Philippines
HOUSE OF REPRESENTATIVES
Quezon City

FIFTEENTH CONGRESS
Second Regular Session

House Bill No. 5269

Introduced by Representatives
DIOSDADO MACAPAGAL ARROYO and GLORIA MACAPAGAL ARROYO

AN ACT
TO IMPROVE EMERGENCY MEDICAL SERVICES AND TRAUMA CARE"
EXPLANATORY NOTE

The Constitution, Article 13, Section 11, 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, in 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. A serious focus on one of the aspects of our medical
care delivery systems the government should prioritize is on the component of
trauma care. This is to substantially reduce the number of death and disabilities
resulting from incidents of physical trauma thereby improving our medical care
delivery systems.

This proposed measure seeks to improve emergency medical services
and trauma care by: (1) empowering the Department of Health to identify
designated trauma centers; (2) establishing a National Clearinghouse on

' ‘his is @ counterpart measure filed by the Hon. Miriam Defensor Santiago during the First Regular Session of the present 15

Congress.


Emergency Medical Services and Trauma Care; and (3) providing for standards
with respect to trauma care centers.

In view of this bill's importance, its expeditious passage into law is
therefore requested.

DIOSDADO MACAPRAGAL ARROYO GLORIA MACAPAGAL ARROYO
Second District, Camarines Sur Second District, Pampanga


Republic of the Philippines
HOUSE OF REPRESENTATIVES
Quezon City

FIFTEENTH CONGRESS
Second Regular Session

5269

House Bill No.

Introduced by Representatives
DIOSDADO MACAPAGAL ARROYO and GLORIA MACAPAGAL ARROYO

AN ACT
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 of 2011."

SECTION 2. Declaration of Policy. - It is the policy of the State to protect
and promote the right to health of the people.

SECTION 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,
definitive 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 Health.

SECTION 4. Clearinghouse on Emergency Medical Services and Trauma
Cure. -

(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"

(B) DUTIES - The Clearinghouse shall -

(1) foster the development of appropriate, modem 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;

(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 so doing, 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.

(C) FEES AND ASSESSMENTS - A contract entered into by the
Secretary under this section may provide that the Clearinghouse shall
charge reasonable fees or assessments in order to defray the costs of
operating the Clearinghouse.

(D) 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.

SECTION 5. General Duties. -

(A) IN GENERAL - The Secretary shall -

(1) Identify and establish trauma centers;


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

(3) provide technica assistance to national and local agencies
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)(5),

(B) GRANTS, COOPERATIVE AGREEMENTS, AND CONTRACTS — The
Secretary may male grants, and enter into cooperative agreements and
contracts, for the purpose of carrying out subsection (A).

(C) 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.

SECTION 6. Requirements with Respect to Designated Trauma Care
Centers. -

(A) PLAN - designated trauma center shall submit the trauma care
component of the plan for the provision of emergency medical services
(hereafter in this section referred to as the "Plan’’) to the Secretary

(1) Trauma Care Component - For each fiscal year, each

(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 plan 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
facilities with specified capabilities and expertise in the care of the
pediatric trauma patient) by such agency or entity, including
standards and requirements for -

(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 centers,


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

(d) 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;

(2) 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;

(3) contain standards and requirements for medically directed triage
and transport of severely injured children to facilities with specified
capabilities and expertise in the care of the pediatric trauma patient,

(4) specify procedures for the evaluation of designated trauma
centers and trauma care systems;

(5) provide that the standards and requirements address the
special needs and problems of rural communities;

(6) 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
regional 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

(7) provide periodic reviews of the transfers and the auditing of
such transfers determined to be inappropriate;


(8) improve or establish injury prevention programs and conduct
public education activities conceming obtaining access to
emergency medical services and trauma care; and

(9) 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-

(i) 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 (|) with
respect to an individual if the hospital offers the individual
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 (i)
with respect to an individual if the hospital offers to transfer
the individual to another medical facility in accordance with
paragraph (ii) but the individual (or a legally responsible
person acting on the individual's behalf) refuses to consent
to the transfer.

(3) Restricting Transfers Until Patient Stabilizes -

(a) 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.

(b) Exception - A patient that has not been stabilized or is in
active labor may be transferred if -

(i) the patient (or a legally responsible person acting
‘on the patient's behalf) requests that the transfer be
effected; or (by a physician, or other qualified medical
personnel when a physician is not readily available in
the emergency development, 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

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

(c) 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 facility III
an appropriate transfer if -

(i) the receiving facility -

(aa) has available space and qualified
personnel for the treatment of the patient; and


(bb) 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 availabie to provide proper care for
such transferred patient, or the hospital has a
full census at that time;

(ji) the transferring hospital provides the receiving
facility with appropriate medical records (or copies
thereof) of the examination and treatment affected at
the transferring hospital;

(iii) 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

(iv) the transfer meets such other requirement as the
Secretary may find necessary in the interest of the
health and safety on the patient transferred.

(4) Call Schedules - In the case of a hospital that has a hospital
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.

(0) CERTAIN STANDARDS WITH RESPECT TO TRAUMA CARE
CENTERS AND SYSTEMS. - (1) In General. - In carrying out paragraphs
subsection (2), 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 concerning such;
(b) consult with medical and nursing specialty groups, hospital
associations, emergency medical services, State and local
directors, concerned advocates and other interested parties;

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


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

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

(3) Existing Standards - In the case of adopted standards with respect to
trauma care centers and systems prior to the date of enactment of this
title, such trauma care centers shall demonstrate in the plan that the
standards provide for the highest possible quality of trauma care and that
it-

(a) took into account existing national standards 111 adopting such
standards; and

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

(E) MODEL TRAUMA CARE PLAN - Not later than one (1) year after that
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) take into account existing national standards;
(2) take into account existing State plans;

(3) be developed in consultation with medical and nursing specialty
groups, hospital associations, emergency medical services, State
directors and associations, concerned advocate, and other
interested parties; and

(4) 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 deem
appropriate

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


(A) 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,

(B) specifies the average length of hospital stay by such patients
according to injury severity groupings during the fiscal year,

(C) specifies the outcomes, including the disability outcome, of severely
injured trauma patients and their discharge disposition;

(D) specifies the total amount of uncompensated trauma care
expenditures incurred by such facility for such patients for such fiscal year;
and

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

SECTION 8. Annual Report by 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 from the Secretary for appropriate administrative and
legislative initiatives and shalll 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).

SECTION 9. Separability Ciause. — If any provision or part thereof, is held
invalid or unconstitutional, the remainder of the law of the provision not otherwise
valid aid subsisting.

SECTION 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.

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

Approved,