FOURTEENTH CONGRESS OF THE REPUBLIC 
) 
) 
7 
JLJL, -3 
I\ !~;, : 1 2 
OF THE PHILIPPINES 
First Regular Session 
) 
S E N A T E  
~~~~~~~~~~ 
BV 
Senate Bill No. 623 
INTRODUCED BY SEN. JINGGOY EJERClTO ESTRADA 
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 
JERCITO ESTRADA 


: i.3 & !’;I 
o~F::,,~ 
$ , j ~  
“+ i-ii: ~~~~~~A~ 
. .  
FOURTEENTH CONGRESS OF THE REPUBLIC 
) 
7 
JUI. -3 ilr :12 
OF THE PHILIPPINES 
1 
First Regular Session 
) 
S E N A T E  
Senate Bill No. 6 2 3 
~~ 
INTRODUCED BY SEN. JINGGOY EJERCITO ESTRADA 
-~ 
~ 
AN ACT 
TO IMPROVE EMERGENCY MEDICAL SERVICES AND TRAUMA CARE 
Be if enacted by the Senate and House of Representatives of the Philippines in 
Congress assembled: 
SECTION I. Short Title. - This Act shall be known as the “Emergency 
Medical Services and Trauma Care Improvement Act.” 
SEC 2. Dedaration of Policy. - It is 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: 
“Designated Trauma Center” means a trauma center designated in 
accordance with this Act; 
“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; 
“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 
“Secretary” shall mean the Secretary of the Department of Health. 
SEC 4. 
Clearinghouse on Emergency Medical Services and Trauma 
Cam. - 
Establishment. - The Secretary shall provide for the 
establishment and operation of a National Clearinghouse on 
(A) 


Emergency Medical Services and Trauma Care (hereinafter 
referred to in this title as the 'Clearinghouse'). 
Duties. - The Clearinghouse shall - 
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: 
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; 
provide technical assistance relating to emergency 
medical services and trauma care to national and local 
agencies; and 
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 decay the costs of operating the Clearinghouse. 
Authority To Enter lnto 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. 
(C) 
(D) 
SEC 5. General Duties. - 
(a) 
In General. - The Secretary shall - 
(I) 
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(6)(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 Coordinafion. - 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. 
(c) 
SEC 6. - Requireme nts with Respect to Designated Trauma Care 
Centers. - 
(A) Plan- 
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 (hereafter in this section 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. 
(1) 
(2) 
(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; 
the resources and equipment needed by such 
centers; 
the availability of rehabilitation services for trauma 
patients; and 
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; 
(b) 
( 4  
(dl 
(2) 


(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; 
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; 
movide for the establishment in the desianated 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; 
( 4  
identifying patient outcomes; 
( 4  
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, including reasons for such 
transfer: 
(e) 
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. 
(7) 
(9) 
provide for the coordination and cooperation between 
the Department of Health and any other national agency. 
(C) Examinafion and Treafmenf For Emergency Medical Conditions. - 
Transfer policies referred to in this Act shall include the following 
requirements: 
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 
(1) 


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 - 
(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 
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. 
(ii) 
(b) 
(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 facility in accordance with 
paragraph (3) but the individual (or a legally 
responsible person act on tire individual's behalf) 
refuses to consent to the transfer. 
(3) 
Restricting Transfers Until Patient Stabilizes. - 
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 in active labor may be transferred if- 
(a) 
(b) 
(0 
the patient (or a legally responsible 
person acting on the patient's behalf) 
requests that the transfer be effected; or 
(ii) 
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 
(iii) 
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- 
( 4  
(d) 
(i) 
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 
affected 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 
health and safety of 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 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 
In General. - In carrying out paragraphs 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 - 
Systems - 
(1) 
(a) 
take into account existing, national standards 
concerning such; 
consult with medical and nursing specialty 
groups, 
hospital 
associations, 
emergency 
medical services directors, concerned advocates 
and other interested parties; 
(b) 
( 4  
conduct hearings on the proposed standards 
after providing adequate notice to the public 
concerning such bearing; and 
beginning in fiscal year when this Act shall take 
effect, take into account the model plan 
described in subsection (e). 
(d) 
Qualify 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 - 
(2) 
(3) 
(a) 
took into account existing national standards in 
adopting such standards; and 
consulted with medical and nursing specialty 
groups, 
hospital 
associations, 
emergency 
medical services directors, concerned advocates 
and other interested parties. 
(b) 
(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 - 
(1) 
(2) 
take into account existing national standards; 
take into account existing State plans; 
(4) 
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 
(3) 
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, trdnsfer, 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 - 
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. 
(1) 
(2) 
(3) 
(4) 
(5) 
SEC 8. Annual Repoti 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 patent 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 otheiwise 
affected shall remain valid and subsisting. 
SEC I O .  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,