Trauma Care Systems Planning and Development Act of 2007
PL 110-23 (H.R.727), enacted 05/03/2007

121 STAT. 90 
PUBLIC LAW 110–23—MAY 3, 2007 
Public Law 110–23 
110th Congress 
An Act 
To amend the Public Health Service Act to add requirements regarding trauma 
care, and for other purposes. 
Be it enacted by the Senate and House of Representatives of 
the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Trauma Care Systems Planning 
and Development Act of 2007’’. 
SEC. 2. ESTABLISHMENT. 
Section 1201 of the Public Health Service Act (42 U.S.C. 300d) 
is amended to read as follows: 
‘‘SEC. 1201. ESTABLISHMENT. 
‘‘(a) IN GENERAL.—The Secretary shall, with respect to trauma 
care— 
‘‘(1) conduct and support research, training, evaluations, 
and demonstration projects; 
‘‘(2) foster the development of appropriate, modern systems 
of such care through the sharing of information among agencies 
and individuals involved in the study and provision of such 
care; 
‘‘(3) collect, compile, and disseminate information on the 
achievements of, and problems experienced by, State and local 
agencies and private entities in providing trauma care and 
emergency medical services and, in so doing, give special consid-
eration to the unique needs of rural areas; 
‘‘(4) provide to State and local agencies technical assistance 
to enhance each State’s capability to develop, implement, and 
sustain the trauma care component of each State’s plan for 
the provision of emergency medical services; 
‘‘(5) sponsor workshops and conferences; and 
‘‘(6) promote the collection and categorization of trauma 
data in a consistent and standardized manner. 
‘‘(b) GRANTS, COOPERATIVE AGREEMENTS, AND CONTRACTS.— 
The Secretary may make grants, and enter into cooperative agree-
ments and contracts, for the purpose of carrying out subsection 
(a).’’. 
SEC. 3. CLEARINGHOUSE ON TRAUMA CARE AND EMERGENCY MED-
ICAL SERVICES. 
The Public Health Service Act (42 U.S.C. 201 et seq.) is 
amended— 
(1) by striking section 1202; and 
(2) by redesignating section 1203 as section 1202. 
42 USC 300d–3. 
42 USC 300d–2. 
Trauma Care 
Systems 
Planning and 
Development Act 
of 2007. 
42 USC 201 note. 
May 3, 2007 
[H.R. 727] 
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121 STAT. 91 
PUBLIC LAW 110–23—MAY 3, 2007 
SEC. 4. ESTABLISHMENT OF PROGRAMS FOR IMPROVING TRAUMA 
CARE IN RURAL AREAS. 
Section 1202 of the Public Health Service Act, as redesignated 
by section 3(2), is amended to read as follows: 
‘‘SEC. 1202. ESTABLISHMENT OF PROGRAMS FOR IMPROVING TRAUMA 
CARE IN RURAL AREAS. 
‘‘(a) IN GENERAL.—The Secretary may make grants to public 
and nonprofit private entities for the purpose of carrying out 
research and demonstration projects with respect to improving the 
availability and quality of emergency medical services in rural 
areas— 
‘‘(1) by developing innovative uses of communications tech-
nologies and the use of new communications technology; 
‘‘(2) by developing model curricula, such as advanced 
trauma life support, for training emergency medical services 
personnel, including first responders, emergency medical 
technicians, emergency nurses and physicians, and para- 
medics— 
‘‘(A) in the assessment, stabilization, treatment, 
preparation for transport, and resuscitation of seriously 
injured patients, with special attention to problems that 
arise during long transports and to methods of minimizing 
delays in transport to the appropriate facility; and 
‘‘(B) in the management of the operation of the emer-
gency medical services system; 
‘‘(3) by making training for original certification, and con-
tinuing education, in the provision and management of emer-
gency medical services more accessible to emergency medical 
personnel in rural areas through telecommunications, home 
studies, providing teachers and training at locations accessible 
to such personnel, and other methods; 
‘‘(4) by developing innovative protocols and agreements to 
increase access to prehospital care and equipment necessary 
for the transportation of seriously injured patients to the appro-
priate facilities; 
‘‘(5) by evaluating the effectiveness of protocols with respect 
to emergency medical services and systems; and 
‘‘(6) by increasing communication and coordination with 
State trauma systems. 
‘‘(b) SPECIAL CONSIDERATION FOR CERTAIN RURAL AREAS.—In 
making grants under subsection (a), the Secretary shall give special 
consideration to any applicant for the grant that will provide serv-
ices under the grant in any rural area identified by a State under 
section 1214(d)(1). 
‘‘(c) REQUIREMENT OF APPLICATION.—The Secretary may not 
make a grant under subsection (a) unless an application for the 
grant is submitted to the Secretary and the application is in such 
form, is made in such manner, and contains such agreements, 
assurances, and information as the Secretary determines to be 
necessary to carry out this section.’’. 
SEC. 5. COMPETITIVE GRANTS. 
Part A of title XII of the Public Health Service Act, as amended 
by section 3, is amended by adding at the end the following: 
42 USC 300d–3. 
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121 STAT. 92 
PUBLIC LAW 110–23—MAY 3, 2007 
‘‘SEC. 1203. COMPETITIVE GRANTS FOR THE IMPROVEMENT OF 
TRAUMA CARE. 
‘‘(a) IN GENERAL.—The Secretary, acting through the Adminis-
trator of the Health Resources and Services Administration, may 
make grants to States, political subdivisions, or consortia of States 
or political subdivisions for the purpose of improving access to 
and enhancing the development of trauma care systems. 
‘‘(b) USE OF FUNDS.—The Secretary may make a grant under 
this section only if the applicant agrees to use the grant— 
‘‘(1) to integrate and broaden the reach of a trauma care 
system, such as by developing innovative protocols to increase 
access to prehospital care; 
‘‘(2) to strengthen, develop, and improve an existing trauma 
care system; 
‘‘(3) to expand communications between the trauma care 
system and emergency medical services through improved 
equipment or a telemedicine system; 
‘‘(4) to improve data collection and retention; or 
‘‘(5) to increase education, training, and technical assistance 
opportunities, such as training and continuing education in 
the management of emergency medical services accessible to 
emergency medical personnel in rural areas through telehealth, 
home studies, and other methods. 
‘‘(c) PREFERENCE.—In selecting among States, political subdivi-
sions, and consortia of States or political subdivisions for purposes 
of making grants under this section, the Secretary shall give pref-
erence to applicants that— 
‘‘(1) have developed a process, using national standards, 
for designating trauma centers; 
‘‘(2) recognize protocols for the delivery of seriously injured 
patients to trauma centers; 
‘‘(3) implement a process for evaluating the performance 
of the trauma system; and 
‘‘(4) agree to participate in information systems described 
in section 1202 by collecting, providing, and sharing informa-
tion. 
‘‘(d) PRIORITY.—In making grants under this section, the Sec-
retary shall give priority to applicants that will use the grants 
to focus on improving access to trauma care systems. 
‘‘(e) SPECIAL CONSIDERATION.—In awarding grants under this 
section, the Secretary shall give special consideration to projects 
that demonstrate strong State or local support, including avail-
ability of non-Federal contributions.’’. 
SEC. 6. REQUIREMENT OF MATCHING FUNDS FOR FISCAL YEARS SUB-
SEQUENT TO FIRST FISCAL YEAR OF PAYMENTS. 
Section 1212 of the Public Health Service Act (42 U.S.C. 300d– 
12) is amended to read as follows: 
‘‘SEC. 1212. REQUIREMENT OF MATCHING FUNDS FOR FISCAL YEARS 
SUBSEQUENT TO FIRST FISCAL YEAR OF PAYMENTS. 
‘‘(a) NON-FEDERAL CONTRIBUTIONS.— 
‘‘(1) IN GENERAL.—The Secretary may not make payments 
under section 1211(a) unless the State involved agrees, with 
respect to the costs described in paragraph (2), to make avail-
able non-Federal contributions (in cash or in kind under sub-
section (b)(1)) toward such costs in an amount that— 
42 USC 300d–5. 
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121 STAT. 93 
PUBLIC LAW 110–23—MAY 3, 2007 
‘‘(A) for the second and third fiscal years of such pay-
ments to the State, is not less than $1 for each $1 of 
Federal funds provided in such payments for such fiscal 
years; and 
‘‘(B) for the fourth and subsequent fiscal years of such 
payments to the State, is not less than $2 for each $1 
of Federal funds provided in such payments for such fiscal 
years. 
‘‘(2) PROGRAM COSTS.—The costs referred to in paragraph 
(1) are— 
‘‘(A) the costs to be incurred by the State in carrying 
out the purpose described in section 1211(b); or 
‘‘(B) the costs of improving the quality and availability 
of emergency medical services in rural areas of the State. 
‘‘(3) INITIAL YEAR OF PAYMENTS.—The Secretary may not 
require a State to make non-Federal contributions as a condi-
tion of receiving payments under section 1211(a) for the first 
fiscal year of such payments to the State. 
‘‘(b) DETERMINATION OF AMOUNT OF NON-FEDERAL CONTRIBU-
TION.—With respect to compliance with subsection (a) as a condition 
of receiving payments under section 1211(a)— 
‘‘(1) a State may make the non-Federal contributions 
required in such subsection in cash or in kind, fairly evaluated, 
including plant, equipment, or services; and 
‘‘(2) the Secretary may not, in making a determination 
of the amount of non-Federal contributions, include amounts 
provided by the Federal Government or services assisted or 
subsidized to any significant extent by the Federal Govern-
ment.’’. 
SEC. 7. REQUIREMENTS WITH RESPECT TO CARRYING OUT PURPOSE 
OF ALLOTMENTS. 
Section 1213 of the Public Health Service Act (42 U.S.C. 300d– 
13) is amended to read as follows: 
‘‘SEC. 1213. REQUIREMENTS WITH RESPECT TO CARRYING OUT PUR-
POSE OF ALLOTMENTS. 
‘‘(a) TRAUMA CARE MODIFICATIONS TO STATE PLAN FOR EMER-
GENCY MEDICAL SERVICES.—With respect to the trauma care compo-
nent of a State plan for the provision of emergency medical services, 
the modifications referred to in section 1211(b) are such modifica-
tions to the State plan as may be necessary for the State involved 
to ensure that the plan provides for access to the highest possible 
quality of trauma care, and that the plan— 
‘‘(1) specifies that the modifications required pursuant to 
paragraphs (2) through (11) will be implemented by the prin-
cipal State agency with respect to emergency medical services 
or by the designee of such agency; 
‘‘(2) specifies a public or private entity that will designate 
trauma care regions and trauma centers in the State; 
‘‘(3) subject to subsection (b), contains national standards 
and requirements of the American College of Surgeons or 
another appropriate entity for the designation of level I and 
level II trauma centers, and in the case of rural areas level 
III trauma centers (including trauma centers with specified 
capabilities and expertise in the care of pediatric trauma 
patients), by such entity, including standards and requirements 
for— 
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121 STAT. 94 
PUBLIC LAW 110–23—MAY 3, 2007 
‘‘(A) the number and types of trauma patients for whom 
such centers must provide care in order to ensure that 
such centers will have sufficient experience and expertise 
to be able to provide quality care for victims of injury; 
‘‘(B) the resources and equipment needed by such cen-
ters; and 
‘‘(C) the availability of rehabilitation services for 
trauma patients; 
‘‘(4) 
contains 
standards 
and 
requirements 
for 
the 
implementation of regional trauma care systems, including 
standards and guidelines (consistent with the provisions of 
section 1867 of the Social Security Act) for medically directed 
triage and transportation of trauma patients (including patients 
injured in rural areas) prior to care in designated trauma 
centers; 
‘‘(5) subject to subsection (b), contains national standards 
and requirements, including those of the American Academy 
of Pediatrics and the American College of Emergency Physi-
cians, for medically directed triage and transport of severely 
injured children to designated trauma centers with specified 
capabilities and expertise in the care of pediatric trauma 
patients; 
‘‘(6) utilizes a program with procedures for the evaluation 
of designated trauma centers (including trauma centers 
described in paragraph (5)) and trauma care systems; 
‘‘(7) provides for the establishment and collection of data 
in accordance with data collection requirements developed in 
consultation with surgical, medical, and nursing specialty 
groups, State and local emergency medical services directors, 
and other trained professionals in trauma care, from each des-
ignated trauma center in the State of a central data reporting 
and analysis system— 
‘‘(A) to identify the number of severely injured trauma 
patients and the number of deaths from trauma within 
trauma care systems in the State; 
‘‘(B) to identify the cause of the injury and any factors 
contributing to the injury; 
‘‘(C) to identify the nature and severity of the injury; 
‘‘(D) to monitor trauma patient care (including 
prehospital care) in each designated trauma center within 
regional trauma care systems in the State (including rel-
evant emergency-department discharges and rehabilitation 
information) for the purpose of evaluating the diagnosis, 
treatment, and treatment outcome of such trauma patients; 
‘‘(E) to identify the total amount of uncompensated 
trauma care expenditures for each fiscal year by each des-
ignated trauma center in the State; and 
‘‘(F) to identify patients transferred within a regional 
trauma system, including reasons for such transfer and 
the outcomes of such patients; 
‘‘(8) provides for the use of procedures by paramedics and 
emergency medical technicians to assess the severity of the 
injuries incurred by trauma patients; 
‘‘(9) provides for appropriate transportation and transfer 
policies to ensure the delivery of patients to designated trauma 
centers and other facilities within and outside of the jurisdiction 
Records. 
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121 STAT. 95 
PUBLIC LAW 110–23—MAY 3, 2007 
of such system, including policies to ensure that only individ-
uals appropriately identified as trauma patients are transferred 
to designated trauma centers, and to provide periodic reviews 
of the transfers and the auditing of such transfers that are 
determined to be appropriate; 
‘‘(10) conducts public education activities concerning injury 
prevention and obtaining access to trauma care; 
‘‘(11) coordinates planning for trauma systems with State 
disaster 
emergency 
planning 
and 
bioterrorism 
hospital 
preparedness planning; and 
‘‘(12) with respect to the requirements established in this 
subsection, provides for coordination and cooperation between 
the State and any other State with which the State shares 
any standard metropolitan statistical area. 
‘‘(b) CERTAIN STANDARDS WITH RESPECT TO TRAUMA CARE CEN-
TERS AND SYSTEMS.— 
‘‘(1) IN GENERAL.—The Secretary may not make payments 
under section 1211(a) for a fiscal year unless the State involved 
agrees that, in carrying out paragraphs (3) through (5) of sub-
section (a), the State will adopt standards for the designation 
of trauma centers, and for triage, transfer, and transportation 
policies, and that the State will, in adopting such standards— 
‘‘(A) take into account national standards that outline 
resources for optimal care of injured patients; 
‘‘(B) consult with medical, surgical, and nursing spe-
ciality 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 fiscal year 2008, take into account 
the model plan described in subsection (c). 
‘‘(2) QUALITY
OF
TRAUMA
CARE.—The highest quality of 
trauma care shall be the primary goal of State standards 
adopted under this subsection. 
‘‘(3) APPROVAL BY THE SECRETARY.—The Secretary may not 
make payments under section 1211(a) to a State if the Secretary 
determines that— 
‘‘(A) in the case of payments for fiscal year 2008 and 
subsequent fiscal years, the State has not taken into 
account national standards, including those of the Amer-
ican College of Surgeons, the American College of Emer-
gency Physicians, and the American Academy of Pediatrics, 
in adopting standards under this subsection; or 
‘‘(B) in the case of payments for fiscal year 2008 and 
subsequent fiscal years, the State has not, in adopting 
such standards, taken into account the model plan devel-
oped under subsection (c). 
‘‘(c) MODEL TRAUMA CARE PLAN.— 
‘‘(1) IN GENERAL.—Not later than 1 year after the date 
of the enactment of the Trauma Care Systems Planning and 
Development Act of 2007, the Secretary shall update the 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— 
Deadline. 
Notice. 
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121 STAT. 96 
PUBLIC LAW 110–23—MAY 3, 2007 
‘‘(A) take into account national standards, including 
those of the American College of Surgeons, American Col-
lege of Emergency Physicians, and the American Academy 
of Pediatrics; 
‘‘(B) take into account existing State plans; 
‘‘(C) be developed in consultation with medical, sur-
gical, and nursing speciality groups, hospital associations, 
emergency medical services State directors and associa-
tions, and other interested parties; and 
‘‘(D) 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. 
‘‘(2) APPLICABILITY.—Standards described in paragraph 
(1)(D) shall be applicable to all rural areas in the State, 
including both non-metropolitan areas and frontier areas that 
have populations of less than 6,000 per square mile. 
‘‘(d) RULE OF CONSTRUCTION WITH RESPECT TO NUMBER OF 
DESIGNATED TRAUMA CENTERS.—With respect to compliance with 
subsection (a) as a condition of the receipt of a grant under section 
1211(a), such subsection may not be construed to specify the number 
of trauma care centers designated pursuant to such subsection.’’. 
SEC. 8. REQUIREMENT OF SUBMISSION TO SECRETARY OF TRAUMA 
PLAN AND CERTAIN INFORMATION. 
Section 1214 of the Public Health Service Act (42 U.S.C. 300d– 
14) is amended to read as follows: 
‘‘SEC. 1214. REQUIREMENT OF SUBMISSION TO SECRETARY OF 
TRAUMA PLAN AND CERTAIN INFORMATION. 
‘‘(a) IN GENERAL.—For each fiscal year, the Secretary may 
not make payments to a State under section 1211(a) unless, subject 
to subsection (b), the State submits to the Secretary the trauma 
care component of the State plan for the provision of emergency 
medical services, including any changes to the trauma care compo-
nent and any plans to address deficiencies in the trauma care 
component. 
‘‘(b) INTERIM PLAN
OR DESCRIPTION
OF EFFORTS.—For each 
fiscal year, if a State has not completed the trauma care component 
of the State plan described in subsection (a), the State may provide, 
in lieu of such completed component, an interim component or 
a description of efforts made toward the completion of the compo-
nent. 
‘‘(c) INFORMATION RECEIVED BY STATE REPORTING AND ANALYSIS 
SYSTEM.—The Secretary may not make payments to a State under 
section 1211(a) unless the State agrees that the State will, not 
less than once each year, provide to the Secretary the information 
received by the State pursuant to section 1213(a)(7). 
‘‘(d) AVAILABILITY OF EMERGENCY MEDICAL SERVICES IN RURAL 
AREAS.—The Secretary may not make payments to a State under 
section 1211(a) unless— 
‘‘(1) the State identifies any rural area in the State for 
which— 
‘‘(A) there is no system of access to emergency medical 
services through the telephone number 911; 
‘‘(B) there is no basic life-support system; or 
‘‘(C) there is no advanced life-support system; and 
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121 STAT. 97 
PUBLIC LAW 110–23—MAY 3, 2007 
‘‘(2) the State submits to the Secretary a list of rural 
areas identified pursuant to paragraph (1) or, if there are 
no such areas, a statement that there are no such areas.’’. 
SEC. 9. RESTRICTIONS ON USE OF PAYMENTS. 
Section 1215 of the Public Health Service Act (42 U.S.C. 300d– 
15) is amended to read as follows: 
‘‘SEC. 1215. RESTRICTIONS ON USE OF PAYMENTS. 
‘‘(a) IN GENERAL.—The Secretary may not, except as provided 
in subsection (b), make payments under section 1211(a) for a fiscal 
year unless the State involved agrees that the payments will not 
be expended— 
‘‘(1) for any purpose other than developing, implementing, 
and monitoring the modifications required by section 1211(b) 
to be made to the State plan for the provision of emergency 
medical services; 
‘‘(2) to make cash payments to intended recipients of serv-
ices provided pursuant to this section; 
‘‘(3) to purchase or improve real property (other than minor 
remodeling of existing improvements to real property); 
‘‘(4) to satisfy any requirement for the expenditure of non- 
Federal funds as a condition for the receipt of Federal funds; 
or 
‘‘(5) to provide financial assistance to any entity other 
than a public or nonprofit private entity. 
‘‘(b) WAIVER.—The Secretary may waive a restriction under 
subsection (a) only if the Secretary determines that the activities 
outlined by the State plan submitted under section 1214(a) by 
the State involved cannot otherwise be carried out.’’. 
SEC. 10. REQUIREMENTS OF REPORTS BY STATES. 
The Public Health Service Act (42 U.S.C. 201 et seq.) is 
amended by striking section 1216. 
SEC. 11. REPORT BY SECRETARY. 
Section 1222 of the Public Health Service Act (42 U.S.C. 300d– 
22) is amended to read as follows: 
‘‘SEC. 1222. REPORT BY SECRETARY. 
‘‘Not later than October 1, 2008, the Secretary shall report 
to the appropriate committees of Congress on the activities of the 
States carried out pursuant to section 1211. Such report shall 
include an assessment of the extent to which Federal and State 
efforts to develop systems of trauma care and to designate trauma 
centers have reduced the incidence of mortality, and the incidence 
of permanent disability, resulting from trauma. Such report may 
include any recommendations of the Secretary for appropriate 
administrative and legislative initiatives with respect to trauma 
care.’’. 
SEC. 12. FUNDING. 
Section 1232 of the Public Health Service Act (42 U.S.C. 300d– 
32) is amended to read as follows: 
‘‘SEC. 1232. FUNDING. 
‘‘(a) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of 
carrying out parts A and B, subject to subsections (b) and (c), 
there are authorized to be appropriated $12,000,000 for fiscal year 
42 USC 300d–16. 
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121 STAT. 98 
PUBLIC LAW 110–23—MAY 3, 2007 
2008, $10,000,000 for fiscal year 2009, and $8,000,000 for each 
of the fiscal years 2010 through 2012. 
‘‘(b) RESERVATION
OF FUNDS.—If the amount appropriated 
under subsection (a) for a fiscal year is equal to or less than 
$1,000,000, such appropriation is available only for the purpose 
of carrying out part A. If the amount so appropriated is greater 
than $1,000,000, 50 percent of such appropriation shall be made 
available for the purpose of carrying out part A and 50 percent 
shall be made available for the purpose of carrying out part B. 
‘‘(c) ALLOCATION OF PART A FUNDS.—Of the amounts appro-
priated under subsection (a) for a fiscal year to carry out part 
A— 
‘‘(1) 10 percent of such amounts for such year shall be 
allocated for administrative purposes; and 
‘‘(2) 10 percent of such amounts for such year shall be 
allocated for the purpose of carrying out section 1202.’’. 
SEC. 13. RESIDENCY TRAINING PROGRAMS IN EMERGENCY MEDICINE. 
Section 1251 of the Public Health Service Act (42 U.S.C. 300d– 
51) is amended to read as follows: 
‘‘SEC. 1251. RESIDENCY TRAINING PROGRAMS IN EMERGENCY MEDI-
CINE. 
‘‘(a) IN GENERAL.—The Secretary may make grants to public 
and nonprofit private entities for the purpose of planning and 
developing approved residency training programs in emergency 
medicine. 
‘‘(b) IDENTIFICATION AND REFERRAL OF DOMESTIC VIOLENCE.— 
The Secretary may make a grant under subsection (a) only if 
the applicant involved agrees that the training programs under 
subsection (a) will provide education and training in identifying 
and referring cases of domestic violence. 
‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of 
carrying out this section, there is authorized to be appropriated 
$400,000 for each of the fiscal years 2008 though 2012.’’. 
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121 STAT. 99 
PUBLIC LAW 110–23—MAY 3, 2007 
LEGISLATIVE HISTORY—H.R. 727: 
HOUSE REPORTS: No. 110–77 (Comm. on Energy and Commerce). 
CONGRESSIONAL RECORD, Vol. 153 (2007): 
Mar. 27, considered and passed House. 
Mar. 29, considered and passed Senate. 
SEC. 14. STATE GRANTS FOR CERTAIN PROJECTS. 
Section 1252 of the Public Health Service Act (42 U.S.C. 300d– 
52) is amended in the section heading by striking ‘‘DEMONSTRA-
TION’’. 
Approved May 3, 2007. 
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