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THIRmENTH CONGRESS OF THE EPUE3LIC ) 
First Regular Session 
OF THE PHlLrpPINES 
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SENATE 
S.B. No. 
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Introduced by Senator LUISA “LOT9 P. EJERCITQ EST 
EXPLANATORY NOTE 
The Constitution Article 13 on Health provides: 
“Section 11. 
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 fiamework of the‘government’s general policies and plans. 
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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. 
Foregoing premises considered, early enactment of this bill is highly 
recommended. 
‘‘L 
Senator 


THIRTEENTH CONGRESS OF THE REPUBLI 
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OF THE PHILIPPINES 
) 
First Regular Session 
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SENATE 
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S.B. No. 
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Introduced by Senator LUISA “LOI” P. EJERCITO ESTRADA 
AN ACT 
TO IIMPROVE EMERGENCY MEDICAL SERVICES AND T 
Be it enacted by the Senate and the Hozcse of Repp.esentatives of the Philippines in 
Congress assembled: 
1. Short Title. - This Act shall be known as the “Emergency Medical 
Services and Trauma Care Improvement.” 
EC. 2. Declaration of Policy. 
promote the right to health of the people. 
- It is the policy of the State to protect and 
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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. 
. 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’). 
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 
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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. 
(e) Fees and Assessments. - A contract entered into by the Secretary 
under this section may provide that the Clearinghouse shall charge 


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reasonable fees or assessments in order to decay the costs of 
operating the Clearinghouse. 
Authority To Enter Into Contracts. - The authority of the Secretary 
(D) 
to enter into contracts under this section shall be to such extent or 
in such amounts as are provided in Appropriation Acts. 
. General Duties. - 
(a) In General. - The Secretary shall - 
(1) identifgr 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, Cooperatise Agreements and Contracts. - The Secretary may make 
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. 
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SEG. 6. - Requirements with Respect to Designated Trauma Care Centers. - 
(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 (hereafter in this section 
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 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) specifjr 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) identifjring the nature and cause of severe injuries and if known, 
factors contributing to the injury; 
(c) identifling patient outcomes; 
(d) monitoring trauma care resources (including pre-hospital care) 
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within a regional trauma care system (including relevant 
rehabilitation information); 
(e) identifling patients transferred within a regional trauma system, 
including reasons for such transfer; 
(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 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) Necessq 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 
hrther 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) refbses to consent 
to the examination or treatment. 
(c) Refusul to Consent to Tranger. - 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) rehses 
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)(ia) the patient (or a legally responsible person acting on the 
patient's behalf) requests that the transfer be effected, or 
(ib) 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 
(ii) the transfer is an appropriate transfer (within the meaning of 
subparagraph (d)) to that facility. 
(c) Requiremenf.- 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) Appropriute Transfer. - A transfer to a medical facility is an 
appropriate transfer if-- 
(i) the receiving facility - 


(ia) has available space and qualified personnel for the treatment of 
the patient, and 
(ib) has agreed to accept transfer of the patient and to provide 
appropriate medical treatment, except that a hospital may not 
rehse 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: 
(ibi) the transferring hospital provides the receiving facility 
with appropriate medical records (or copies thereof) of 
the examination and treatment affected at the transferring 
hospital; 
(ibii) the transfer is effected through qualified personnel and 
transportation equipment, as required including the use of 
necessary 
and medically appropriate life s8pport 
measures during the transfer; and 
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(ibiii)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. 


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(D) Certain Stanhrds With Respect to Trauma Care Centers and Systems - 
(1) 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 -- 
(a) take into account existing, national standards concerning such; 
(b) consult with medical and nursing specialty groups, hospital 
associations, emergency medical services directors, concerned 
advocates and other interested parties; 
(c) conduct hearings on the proposed standards after providing adequate 
notice to the public concerning such bearing; and 
(d) beginning in 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 Secretary 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 effectivity of this Act such 
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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. 
uch 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 directors 
and associations, concerned advocates 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 relate to rural areas. 
SEC. 7. Requirement of Annuul 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- - 
(1) 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; 
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(2) specifies the average length of hospital stay by such patients according to 
injury severity groupings during the fiscal year; 
(3) specifies the outcomes, including the disability outcome, of severely injured 
trauma patients and their discharge disposition; 


(4) specifies the total amount of uncompensated trauma care expenditures 
incurred by such facility for such patients for such fiscal year; and 
(5) 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 
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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. IO. Repealing CZazise. - h
y
 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. 
EC. 11. Effectivity Clause.- This Act shall take effect fifteen (1 5 )  days after its 
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publication in at least two (2) newspapers of general circulation. 
Approved, 
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