HOUSE OF REPRESENTATIVES:

Republic of the Philippines RECEIVED
HOUSE OF REPRESENTATIVES pare: 46
Quezon City
Tw:
SEVENTEENTH CONGRESS ey:

First Regular Session

- 720 RISISTRATION UNIT
Hone E— BULLS 4X) iNDEX SERVICE

Introduced by Congresman Alfredo D. Vargas III

EXPLANATORY NOTE

As stipulated in Article XIII, Section 11 of the Constitution, it is the
responsibility of the State “to adopt and integrate a 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.”

Furthermore, Book IV, Title IX, Chapter 3 of the Administrative Code
authorizes the Department of Health to define the national health policy and
formulate and implement a national health plan in accordance with the
government's general policies and plans.

According to the Department of Health (2014), trauma will be the second
leading cause of death in five to 10 years. This is due to the lack of medical
professionals, poor access to medical facilities, high cost of care, and lack of
hospital infrastructures and equipment.

Therefore, it is vital for the State to immediately prioritize the
improvement of trauma care in the Philippines. This bill seeks to achieve this by
mandating the Department of Health to:

(1) Identify designated trauma centers

(2) Establish and operate a National Clearinghouse on Emergency Medical
Services and Trauma Care; and

(3) Provide for the standards with respect to trauma care centers and
delivery systems.

Through this initiative, we are giving victims of physical trauma a better

chance of survival from disability or death. Thus, the immediate passage of this
bill is urged.

‘ALFREDO D. VARGAS III


Republic of the Philippines
HOUSE OF REPRESENTATIVES
Quezon City

SEVENTEENTH CONGRESS
First Regular Session

720

House Bill No.

Introduced by Congressman Alfredo D. Vargas

AN ACT
TO IMPROVE EMERGENCY MEDICAL SERVICE 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 ImprovementAct of 2016”.

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;

(©) “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 Health.


SECTION 4.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”

(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 on 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 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.

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,

(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
center, include the number and types of trauma patients
for whom such centers must provide care;

(b) The resources and eqi

ment 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 patients;

(4) Specify procedures for the evaluation of designated trauma
centers and trauma care systems;

(5) Ensure 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 inju
known, factors contributing to the injury;

s, and if

(0) 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 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
individuals 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 ~

() 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

(i) 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 (1)
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.

(©) 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 Transfer 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

a

fe 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 -

10}

‘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

‘The transfer is an appropriate transfer (within
the meaning of subparagraph (d) to that facility.

(6) Requirement - if a patient at a hospital has an emergency

medical condition that has been stal

zed, the hospital

may transfer the patient but only by means of an
appropriate transfer.

(@) Appropriate Transfer - A transfer to a medical facility IIl is
an appropriate transfer if -

o

‘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;


(ii)_The transferring hospital provides the receiving
facility with appropriate medical records (or
copies thereof of the examination and treatment
affected at the transferring hospital;

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;

(© Conduct hearings on the proposed standards after
providing adequate notice to the public concerning such
hearing; and

(@) Beginning in the fiscal year when this Act shall take effect,
take into account the model plan described in subsection
().

(3) 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.


(4) 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 and 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;

(©) 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
©.

SECTION 9. Separability Clause. - If any provision of this Act shall be held
unconstitutional or invalid, the other provisions not otherwise affected shall remain
in full force and effect.

SECTION 10 Repealing Clause. - All other laws, decrees, executive orders,
proclamations and other executive issuances which are inconsistent with or
contrary to the provisions of this Act are hereby amended or repealed 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,