American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Trauma and EMS

Trauma Funding

On June 25, 2014, the House passed the Trauma Systems and Regionalization of Emergency Care Reauthorization Act  (H.R. 4080) by voice vote and sent the bill to the Senate. Just prior to the August recess, the Senate attempted to hotline (pass by unanimous consent) the House bill. While no Democrats objected, there were unfortunately Republican holds on the legislation. Under Senate rules, a Senator may place a hold on any piece of legislation for any reason. In addition, there is no obligation for the names of any Senator with a hold to be made public. ACS learned that Sen. Coburn (R-OK) has a hold and his reasons are philosophical—clearing the government dole of unfunded programs and the money potentially associated with them. Specifically, since the trauma programs have not been funded since 2005 and there is no evidence the lack of funding has led to problems with the trauma system, it is an unnecessary program.

The College has been working diligently with Senate Committee on Health, Education, Labor, and Pensions (HELP) staff and the legislation’s champions to lift the holds on the bill and allow for Senate passage. In addition, ACS worked with Oklahoma surgeons to press Coburn to lift his hold over the August recess. In a September 17 meeting between ACS staff and Sen. Coburn, it was made clear that he would not lift his hold on our bill before the end of the year. He has holds on a large number of bills totaling $70 billion and he does not intend to release his hold on any of them.

Trauma bills reintroduced in House

The American College of Surgeons, along with the trauma coalition, succeeded in ensuring that two important trauma bills have been reintroduced in the U.S. House of Representatives.  H.R. 647, the Access to Life Saving Trauma Care for All Americans Act, and H.R. 648, the Trauma Systems and Regionalization of Emergency Care Reauthorization Act, were reintroduced by Reps. Mike Burgess (R-TX) and Gene Green (D-TX).  H.R. 647 reauthorizes language from the Public Health Service Act to fund trauma centers—funding that is set to expire this fiscal year. Meanwhile, H.R. 648 reauthorizes Trauma Care Systems Planning Grants, which support state and rural development of trauma systems, as well as pilot projects for implementing and assessing regionalized emergency care models.

Trauma Definition and Burn Care

The ACS supported legislation to establish a new definition of trauma that would include burn care, H.R. 3548. Traumatic injuries are commonly understood to include burn injuries. However, the current system is riddled with inconsistent definitions of what constitutes “trauma,” which results in gaps in coverage and the provision of care. Congress passed the bill and it was signed into law.

Improve Liability Protections for Trauma Providers

The College supports S. 961/H.R. 36, the Health Care Safety Net Enhancement Act, sponsored by Sen. Roy Blunt (R-MO) and Rep. Charles Dent (R-PA). The Emergency Medical Treatment and Labor Act (EMTALA) mandates that a physician provide care to stabilize a patient who presents at a hospital emergency department, regardless of their ability to pay. The problem is notably severe for surgeons who provide complex, high-risk surgical care for severely injured patients. The poor likelihood of reimbursement and high-liability risk are broadly acknowledged as the key factors contributing to the growing shortage of specialists participating in emergency on-call panels. The Health Care Safety Net Enhancement Act will help to address this growing problem by providing Public Health Service Act liability protections for physicians providing EMTALA-mandated care.

Liability Protections for Volunteers

Introduced in the House by Reps. Marsha Blackburn (R-TN) and Jim Matheson (D-UT), the Good Samaritan Health Professionals Act (H.R. 1733) would provide liability protections to medical professionals who volunteer in a declared disaster. Additionally, Sen. Lisa Murkowski (R-AK) recently introduced companion legislation, S. 2196, in the Senate in part to mark the 50th anniversary of the Alaska earthquake/tsunami.

Rapid medical response in a disaster can greatly decrease loss of life and improve outcomes for patients who desperately need care. However, when a disaster strikes, the needs of victims often overwhelm the services that are available locally. The medical profession has a long history of stepping forward to assist disaster victims. Unfortunately, the Volunteer Protection Act, which was enacted specifically to encourage such actions, failed to address the issue of liability protections for health care providers who cross state lines to aid disaster victims.

Additional ACS Efforts

ACS-Good Samaritan Act

ACS Supports National Task Force to study the impact of Improvised Explosive Devices

ACS Secures GAO Study on Trauma
The U.S. must employ current trauma and EMS systems of care in order to respond to deadly natural disasters such as tornadoes and hurricanes, as well as terrorist attacks, chemical spills, and other health care emergencies. The nation’s existing trauma and emergency medical systems are designed to respond quickly and efficiently to deliver seriously injured individuals to the appropriate trauma center hospital within the “golden hour”—the time period when medical intervention is most effective in saving lives and saving function. Unfortunately, the emergency healthcare system in America is in crisis. Several reports have confirmed that while many states have made great strides in developing effective trauma-care systems, significant gaps in our trauma and emergency healthcare delivery systems still exist. While these reports highlight the problem, there has not been a study examining the details of those gaps in care and how our current healthcare delivery systems could handle the surge capacity associated with a public health emergency or mass-casualty event without notice. In January, the Chairman of the House Energy and Commerce Committee, Chairman Fred Upton (R-MI), and Ranking Member Henry Waxman (D-CA) submitted a letter to the Government Accountability Office (GAO) requesting an assessment of the country’s current Trauma-EMS components.