FOURTEENTH CONGRESS OF THE REPUBLIC ) 
OF THE PHILIPPINES 
1 
8 FEB 20 
3:': 
" > 
First Regular Session 
) 
Introduced by Senator Miriam Defensor Santiago 
EXPLANATORY NOTE 
The Constitution, Article 13, Section 11, provides: 
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 kee 
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. 


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FOURTEENTH CONGRESS OF THE REPUBLIC ) 
OF THE PHILIPPINES 
) 
First Regular Session 
) 
Introduced by Senator Miriam Defensor Santiago 
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 2008.” 
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. DeBnition 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 rnral 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. - 
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(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, 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 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; 
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(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)(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 (hereafrer 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; 
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(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 rehse 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 injwy; 
(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; 
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(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) 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) Rehsal to Consent to Treatment - A hospital shall be 
considered to meet the requirement of subparagraph (1) with respect to an 
individual if the hospital offers the individual further medical examination 
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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 personel 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. 
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appropriate transfer if - 
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(bb) has agreed to accept transfer of the patient and 
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to provide appropriate medical treatment, except that a 
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hospital may not refuse to accept a transferred patient 
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unless such hospital does not have the facilities or 
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personnel available to provide proper care for such 
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transferred patient, or the hospital has a full census at that 
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time; 
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(ii) the transferring hospital provides the receiving facility 
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with appropriate medical records (or copies there00 of the 
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(iii) the transfer is effected through qualified personnel and 
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transportation equipment, as required including the use of 
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necessary and medically appropriate life support measures during 
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the transfer; and 
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physicians. 
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(D) CERTAIN STANDARDS WITH RESPECT TO TRAUMA CARE 
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CENTERS AND SYSTEMS. - (1) In General. - In carrying out paragraphs subsection 
(d) Appropriate Transfer - A transfer to a medical facility in an. 
(i) the receiving facility - 
(aa) has available space and qualified personnel for 
the treatment of the patient; and 
examination and treatment affected at the transferring hospital; 
(iv) the transfer meets such other requirement 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 ongoing, 
definitive treatment to a patient after the initial examination by the emergency 


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(2), the Secretary shall adopt standards for the designation of trauma centers, and for 
triage, transfer, and transpokation 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) to ok into account existing national standards in 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; 
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(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 t e nearest 
appropriate designated trauma center, and for triage, transfer, and transportation 
policies as they relate to rural areas. 
SECTION 1.Reguivement 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 Secretmy. - 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 
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(3) recommendations regarding and, if appropriate, modifications of the 
model plan as required by section 6 (E). 
SECTION 9. Separabilitj 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, 
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