FIFTEENTH CONGRESS )
REPUBLIC OF THE PHILIPPINES —)
First Regular Session )

HOUSE OF REPRESENTATIVES.

House Bill No. _ 1675

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

EXPLANATORY NOTE

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

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

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

This bill seeks to improve emergency medical services and trauma cae
by: (a) empowering the Department of Health to identity designated traun
centers; (b) establishing a National Clearinghouse on Emergency Medea
Services and Trauma Care; and (c) providing for standards with respect,
trauma care centers. 0

The immediate enactment of this bill is highly recommended.

RUFUS B. RODRIGUEZ

MAXIMO B. RODRIGUEZ, JR


FIFTEENTH CONGRESS )
REPUBLIC OF THE PHILIPPINES )
First Regular Session )

HOUSE OF REPRESENTATIVES,

House BillNo. _ 1675

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

AN ACT
TO IMPROVE EMERGENCY MEDICAL SERVICES AND TRAUMA CARE

Be it enacted by the Senate and House of Representatives of the

Philippines

Congress assembled: hilippines in
SECTION 1. Short Title. - This Act shall be known as the “Em,

Medical Services and Trauma Care Improvement Act.” rergency

SEC 2. Declaration of Policy. — It is the policy of the St,
and promote the right to health of the people. ‘ate to protect

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

(a) “Designated Trauma Center” means a trauma center des;
in accordance with this Act; T designateg

(b) “Plan for the Provision of Emergency Medical servi
plan for a comprehensive, organized system to pi
access, response, triage, field stabilization, tran:
stabilization, definite care, and rehabilitation of pati
with respect to emergency medical services;

Ces” means a
rovide for the
SPort, hospital
lents of all ages

(©) “Trauma Care Component of the Plan for the
Emergency Medical Services” means a plan for a co;
health care system, within rural and urban areas of the Stee
the prompt recognition, pre-hospital care, emergeney mojo”
care, acute surgical, ‘and medical care, rehabiligior
‘outcome evaluation of seriously injured patients; ang "3%

Provision of

(2) “Secretary” shall mean the Secretary ofthe Department of Heal,


SEC 4. Clearinghouse on Emergency Medical Services and Trauma

Care. —

a)

(8)

(c)

(0)

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’).

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;

(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 so, 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 shall 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)

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).

(b) 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.

) 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 —


(2)

(3)

4)

(6)

©

(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

(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 triage 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-

@) 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;

© identifying patient outcomes;

2) monitoring trauma care resources (including

pre-hospital care) within a regional trauma care


(7)

(8)

(9)

system (including relevant rehabilitation

information);

) 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 concerning
obtaining 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)

(2)

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.

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 —

@ 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


(b)

()

Gi)

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

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.

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 facility 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)

@

qi)

General Rule - \f 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 in active 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


©

(a)

(1)

0)

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
facility is an appropriate transfer if—

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:

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;

ii, 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,

iii, the transfer meets such other
requirements as the Secretary may
find necessary in the interest of the


(4)

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.

(0) Certain Standards With Respect to Trauma Care Centers and

Systems —

a)

(2)

(3)

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, _ concerned
advocates and other interested parties;

© conduct hearings on the proposed standards
after providing adequate notice to the public
conceming such hearing; and

@ 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 shall
take this into consideration.

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 plan 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, _ concerned
advocates and other interested parties.

(E) Model Trauma Care Plan. - 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 —

a)
(2)
(3)

@)

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,
concerned 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 reporting system, for each fiscal year, a report that —

a)

(2)

(3)

@)

6)

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. Annual 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.