Republic of the Philippines.
HOUSE OF REPRESENTATIVES
Quezon City

SIXTEENTH CONGRESS
First Regular Session

House BillNo.__2681

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, therefore, 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 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

DIOSDAD¢ \CAPAGAL ARROYO GLORIA MACAPAGAL ARROYO
Second District, Camarines Sur Sécond District, Pampanga


Republic of the Philippines
HOUSE OF REPRESENTATIVES
Quezon City

SIXTEENTH CONGRESS
First Regular Session

2681

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 2013."

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
tural 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 technical 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

(8) 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;

(0) 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);

(€) 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 concerning 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 shalll 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

(ji) 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 (I) 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 (4) 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.

(d) Appropriate Transfer - A transfer to a medical facility Ill 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 available 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.

(D) 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 shalll 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,
concerned 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 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).

SECTION 9. Separability Clause. — 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,