SUBCHAPTER X—TRAUMA CARE
Part A—General Authority and Duties of Secretary
Part Referred to in Other Sections
This part is referred to in
§300d. 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) provide to State and local agencies technical assistance; and
(4) sponsor workshops and conferences.
(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) of this section.
(c) Administration
The Administrator of the Health Resources and Services Administration shall ensure that this subchapter is administered by the Division of Trauma and Emergency Medical Systems within such Administration. Such Division shall be headed by a director appointed by the Secretary from among individuals who are knowledgeable by training or experience in the development and operation of trauma and emergency medical systems.
(July 1, 1944, ch. 373, title XII, §1201, as added
Prior Provisions
A prior section 300d, act July 1, 1944, ch. 373, title XII, §1201, as added Nov. 16, 1973,
A prior section 1201 of act July 1, 1944, ch. 373, title XII, formerly §1205, as added Nov. 16, 1973,
Amendments
1996—Subsec. (a).
1993—Subsec. (a).
Subsec. (c).
Effective Date of 1996 Amendment
Amendment by
Congressional Statement of Findings
Section 2 of
"(1) the Federal Government and the governments of the States have established a history of cooperation in the development, implementation, and monitoring of integrated, comprehensive systems for the provision of emergency medical services throughout the United States;
"(2) physical trauma is the leading cause of death of Americans between the ages of 1 and 44 and is the third leading cause of death in the general population of the United States;
"(3) physical trauma in the United States results in an aggregate annual cost of $180,000,000,000 in medical expenses, insurance, lost wages, and property damage;
"(4) barriers to the provision of prompt and appropriate emergency medical services exist in many areas of the United States;
"(5) few States and communities have developed and implemented trauma care systems;
"(6) many trauma centers have incurred substantial uncompensated costs in providing trauma care, and such costs have caused many such centers to cease participation in trauma care systems; and
"(7) the number of incidents of physical trauma in the United States is a serious medical and social problem, and the number of deaths resulting from such incidents can be substantially reduced by improving the trauma-care components of the systems for the provision of emergency medical services in the United States."
§300d–1. Repealed. Pub. L. 103–183, title VI, §601(b)(1), Dec. 14, 1993, 107 Stat. 2238 ; Pub. L. 105–392, title IV, §401(a)(1)(A), Nov. 13, 1998, 112 Stat. 3587
Section, act July 1, 1944, ch. 373, title XII, §1202, as added Nov. 16, 1990,
A prior section 300d–1, act July 1, 1944, ch. 373, title XII, §1202, as added Nov. 16, 1973,
§300d–2. Clearinghouse on Trauma Care and Emergency Medical Services
(a) Establishment
The Secretary shall by contract provide for the establishment and operation of a National Clearinghouse on Trauma Care and Emergency Medical Services (hereafter in this section referred to as the "Clearinghouse").
(b) Duties
The Clearinghouse shall—
(1) foster the development of appropriate, modern trauma care and emergency medical services (including the development of policies for the notification of family members of individuals involved in medical emergencies) 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, State and local agencies and private entities in providing trauma care and emergency medical services and, in so doing, give special consideration of the unique needs of rural areas;
(3) provide technical assistance relating to trauma care and emergency medical services to State and local agencies; and
(4) sponsor workshops and conferences on trauma care and emergency medical services.
(c) Fees and assessments
A contract entered into by the Secretary under this section may provide that the Clearinghouse charge fees or assessments in order to defray, and beginning with fiscal year 1992, to cover, the costs of operating the Clearinghouse.
(July 1, 1944, ch. 373, title XII, §1202, formerly §1203, as added
Prior Provisions
A prior section 300d–2, act July 1, 1944, ch. 373, title XII, §1203, as added Nov. 16, 1973,
A prior section 1202 of act July 1, 1944, was classified to
Another prior section 1202 of act July 1, 1944, was classified to
Amendments
1998—
Effective Date of 1998 Amendment
Amendment by
§300d–3. 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 technologies and the use of new communications technology;
(2) by developing model curricula for training emergency medical services personnel, including first responders, emergency medical technicians, emergency nurses and physicians, and paramedics—
(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 emergency medical services system;
(3) by making training for original certification, and continuing education, in the provision and management of emergency 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 appropriate facilities; and
(5) by evaluating the effectiveness of protocols with respect to emergency medical services and systems.
(b) Special consideration for certain rural areas
In making grants under subsection (a) of this section, the Secretary shall give special consideration to any applicant for the grant that will provide services under the grant in any rural area identified by a State under
(c) Requirement of application
The Secretary may not make a grant under subsection (a) of this section 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.
(July 1, 1944, ch. 373, title XII, §1203, formerly §1204, as added
Prior Provisions
A prior section 300d–3, act July 1, 1944, ch. 373, title XII, §1204, as added Nov. 16, 1973,
A prior section 1203 of act July 1, 1994, was renumbered section 1202 and is classified to
A prior section 300d–4, act July 1, 1944, ch. 373, title XII, §1201, formerly §1205, as added Nov. 16, 1973,
A prior section 300d–5, act July 1, 1944, ch. 373, title XII, §1206, as added Nov. 16, 1973,
A prior section 300d–6, act July 1, 1944, ch. 373, title XII, §1202, formerly §1207, as added Nov. 16, 1973,
Prior sections 300d–7 to 300d–9 were repealed by
Section 300d–7, act July 1, 1944, ch. 373, title XII, §1208, as added Nov. 16, 1973,
Section 300d–8, act July 1, 1944, ch. 373, title XII, §1209, as added Nov. 16, 1973,
Section 300d–9, act July 1, 1944, ch. 373, title XII, §1210, as added Nov. 16, 1973,
Amendments
1998—
1993—Subsec. (c).
Effective Date of 1998 Amendment
Amendment by
Section Referred to in Other Sections
This section is referred to in
Part B—Formula Grants With Respect to Modifications of State Plans
Part Referred to in Other Sections
This part is referred to in
§300d–11. Establishment of program
(a) Requirement of allotments for States
The Secretary shall for each fiscal year make an allotment for each State in an amount determined in accordance with
(b) Purpose
Except as provided in section 300d–33 1 of this title, the Secretary may not make payments under this part for a fiscal year unless the State involved agrees that, with respect to the trauma care component of the State plan for the provision of emergency medical services, the payments will be expended only for the purpose of developing, implementing, and monitoring the modifications to such component described in
(July 1, 1944, ch. 373, title XII, §1211, as added
References in Text
Section Referred to in Other Sections
This section is referred to in
1 See References in Text note below.
§300d–12. 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
(A) for the second fiscal year of such payments to the State, not less than $1 for each $1 of Federal funds provided in such payments for such fiscal year; and
(B) for any subsequent fiscal year of such payments to the State, not less than $3 for each $1 of Federal funds provided in such payments for such fiscal year.
(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
(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 condition of receiving payments under
(b) Determination of amount of non-Federal contribution
With respect to compliance with subsection (a) of this section as a condition of receiving payments under
(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;
(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 Government; and
(3) the Secretary shall, in making such a determination, include only non-Federal contributions in excess of the amount of non-Federal contributions made by the State during fiscal year 1990 toward—
(A) the costs of providing trauma care in the State; and
(B) the costs of improving the quality and availability of emergency medical services in rural areas of the State.
(July 1, 1944, ch. 373, title XII, §1212, as added
Amendments
1993—Subsec. (a)(2)(A).
§300d–13. Requirements with respect to carrying out purpose of allotments
(a) Trauma care modifications to State plan for emergency medical services
With respect to the trauma care component of a State plan for the provision of emergency medical services, the modifications referred to in
(1) specifies that the modifications required pursuant to paragraphs (2) through (10) will be implemented by the principal State agency with respect to emergency medical services or by the designee of such agency;
(2) specifies any public or private entity that will designate trauma care regions and trauma centers in the State;
(3) subject to subsection (b) of this section, contains standards and requirements 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 the pediatric trauma patient), by such entity, including standards and requirements for—
(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 centers; and
(C) the availability of rehabilitation services for trauma patients;
(4) subject to subsection (b) of this section, contains standards and requirements for the implementation of regional trauma care systems, including standards and guidelines (consistent with the provisions of
(5) subject to subsection (b) of this section, contains standards and requirements for medically directed triage and transport of severely injured children to designated trauma centers with specified capabilities and expertise in the care of the pediatric trauma patient;
(6) specifies 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 from each designated trauma center in the State of a central data reporting and analysis system—
(A) to identify the number of severely injured trauma patients within regional 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 relevant 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 designated trauma center in the State; and
(F) to identify patients transferred within a regional trauma system, including reasons for such transfer;
(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 of such system, including policies to ensure that only individuals appropriately identified as trauma patients are transferred to designated trauma centers, and provides for 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; and
(11) 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 centers and systems
(1) In general
The Secretary may not make payments under
(A) take into account national standards concerning such;
(B) consult with medical, surgical, and nursing speciality 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 1992, take into account the model plan described in subsection (c) of this section.
(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 Secretary
The Secretary may not make payments under
(A) in the case of payments for fiscal year 1991 and subsequent fiscal years, the State has not taken into account national standards, including those of the American College of Surgeons, the American College of Emergency Physicians and the American Academy of Pediatrics, in adopting standards under this subsection; or
(B) in the case of payments for fiscal year 1992 and subsequent fiscal years, the State has not, in adopting such standards, taken into account the model plan developed under subsection (c) of this section.
(c) Model trauma care plan
Not later than 1 year after November 16, 1990, 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 national standards, including those of the American College of Surgeons, American College of Emergency Physicians and the American Academy of Pediatrics;
(2) take into account existing State plans;
(3) be developed in consultation with medical, surgical, and nursing speciality groups, hospital associations, emergency medical services State directors and associations, 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.
Standards described in paragraph (4) 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) of this section as a condition of the receipt of a grant under
(July 1, 1944, ch. 373, title XII, §1213, as added
Amendments
1998—Subsec. (a)(8).
1993—Subsec. (a)(4).
Subsec. (a)(8), (9).
Subsec. (a)(10).
Effective Date of 1998 Amendment
Amendment by
Section Referred to in Other Sections
This section is referred to in
§300d–14. Requirement of submission to Secretary of trauma plan and certain information
(a) Trauma plan
(1) In general
For fiscal year 1991 and subsequent fiscal years, the Secretary may not make payments under
(2) Interim plan or description of efforts
For fiscal year 1991, if a State has not completed the trauma care component of the State plan described in paragraph (1), the State may provide, in lieu of a completed such component, an interim component or a description of efforts made toward the completion of the component.
(b) Information received by State reporting and analysis system
The Secretary may not make payments under
(c) Availability of emergency medical services in rural areas
The Secretary may not make payments under
(1) the State involved 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
(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.
(July 1, 1944, ch. 373, title XII, §1214, as added
Section Referred to in Other Sections
This section is referred to in
§300d–15. Restrictions on use of payments
(a) In general
The Secretary may not, except as provided in subsection (b) of this section, make payments under
(1) subject to section 300d–33 1 of this title, for any purpose other than developing, implementing, and monitoring the modifications required by
(2) to make cash payments to intended recipients of services provided pursuant to such section;
(3) to purchase or improve real property (other than minor remodeling of existing improvements to real property) or to purchase major medical or communication equipment, ambulances, or aircraft;
(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) Exception
If the Secretary finds that the purpose described in
(July 1, 1944, ch. 373, title XII, §1215, as added
References in Text
1 See References in Text note below.
2 So in original. The period probably should be a semicolon.
§300d–16. Requirement of reports by States
(a) In general
The Secretary may not make payments under
(1) securing a record and a description of the purposes for which payments received by the State pursuant to such section were expended and of the recipients of such payments; and
(2) determining whether the payments were expended in accordance with the purpose of the program involved.
(b) Availability to public of reports
The Secretary may not make payments under
(c) Evaluations by Comptroller General
The Comptroller General of the United States shall evaluate the expenditures by States of payments under
(July 1, 1944, ch. 373, title XII, §1216, as added
Amendments
1996—Subsec. (a).
1993—Subsec. (c).
Change of Name
Committee on Energy and Commerce of House of Representatives treated as referring to Committee on Commerce of House of Representatives by section 1(a) of
§300d–17. Requirement of submission of application containing certain agreements and assurances
The Secretary may not make payments under
(1) the State submits to the Secretary an application for the payments containing agreements in accordance with this part;
(2) the agreements are made through certification from the chief executive officer of the State;
(3) with respect to such agreements, the application provides assurances of compliance satisfactory to the Secretary;
(4) the application contains the plan provisions and the information required to be submitted to the Secretary pursuant to
(5) the application otherwise 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 part.
(July 1, 1944, ch. 373, title XII, §1217, as added
Section Referred to in Other Sections
This section is referred to in
§300d–18. Determination of amount of allotment
(a) Minimum allotment
Subject to the extent of amounts made available in appropriations Acts, the amount of an allotment under
(1) the amount determined under subsection (b)(1) of this section; and
(2) $250,000 in the case of each of the several States, the District of Columbia, and the Commonwealth of Puerto Rico, and $50,000 in the case of each of the Virgin Islands, Guam, American Samoa, and the Commonwealth of the Northern Mariana Islands.
(b) Determination under formula
(1) In general
The amount referred to in subsection (a)(1) of this section for a State for a fiscal year is the sum of—
(A) an amount determined under paragraph (2); and
(B) an amount determined under paragraph (3).
(2) Amount relating to population
The amount referred to in subparagraph (A) of paragraph (1) for a State for a fiscal year is the product of—
(A) an amount equal to 80 percent of the amounts appropriated under
(B) a percentage equal to the quotient of—
(i) an amount equal to the population of the State; divided by
(ii) an amount equal to the population of all States.
(3) Amount relating to square mileage
The amount referred to in subparagraph (B) of paragraph (1) for a State for a fiscal year is the product of—
(A) an amount equal to 20 percent of the amounts appropriated under
(B) a percentage equal to the quotient of—
(i) an amount equal to the lesser of 266,807 and the amount of the square mileage of the State; divided by
(ii) an amount equal to the sum of the respective amounts determined for the States under clause (i).
(c) Disposition of certain funds appropriated for allotments
(1) In general
Amounts described in paragraph (2) shall, in accordance with paragraph (3), be allotted by the Secretary to States receiving payments under
(2) Type of amounts
The amounts referred to in paragraph (1) are any amounts made available pursuant to 300d–32(b)(3) of this title that are not paid under
(A) the failure of the State to submit an application under
(B) the failure, in the determination of the Secretary, of the State to prepare within a reasonable period of time such application in compliance with such section; or
(C) the State informing the Secretary that the State does not intend to expend the full amount of the allotment made for the State.
(3) Amount
The amount of an allotment under paragraph (1) for a State for a fiscal year shall be an amount equal to the product of—
(A) an amount equal to the amount described in paragraph (2) for the fiscal year involved; and
(B) the percentage determined under subsection (b)(2) of this section for the State.
(July 1, 1944, ch. 373, title XII, §1218, as added
Section Referred to in Other Sections
This section is referred to in
§300d–19. Failure to comply with agreements
(a) Repayment of payments
(1) Requirement
The Secretary may, in accordance with subsection (b) of this section, require a State to repay any payments received by the State pursuant to
(2) Offset of amounts
If a State fails to make a repayment required in paragraph (1), the Secretary may offset the amount of the repayment against any amount due to be paid to the State under
(b) Opportunity for hearing
Before requiring repayment of payments under subsection (a)(1) of this section, the Secretary shall provide to the State an opportunity for a hearing.
(July 1, 1944, ch. 373, title XII, §1219, as added
§300d–20. Prohibition against certain false statements
(a) In general
(1) False statements or representations
A person may not knowingly and willfully make or cause to be made any false statement or representation of a material fact in connection with the furnishing of items or services for which payments may be made by a State from amounts paid to the State under
(2) Concealing or failing to disclose information
A person with knowledge of the occurrence of any event affecting the right of the person to receive any payments from amounts paid to the State under
(b) Criminal penalty for violation of prohibition
Any person who violates a prohibition established in subsection (a) of this section may for each violation be fined in accordance with title 18, or imprisoned for not more than 5 years, or both.
(July 1, 1944, ch. 373, title XII, §1220, as added
§300d–21. Technical assistance and provision by Secretary of supplies and services in lieu of grant funds
(a) Technical assistance
The Secretary shall, without charge to a State receiving payments under
(b) Provision by Secretary of supplies and services in lieu of grant funds
(1) In general
Upon the request of a State receiving payments under
(2) Reduction in payments
With respect to a request described in paragraph (1), the Secretary shall reduce the amount of payments to the State under
(July 1, 1944, ch. 373, title XII, §1221, as added
Prior Provisions
A prior section 300d–21, act July 1, 1944, ch. 373, title XII, §1221, as added Oct. 21, 1976,
§300d–22. Report by Secretary
Not later than October 1, 1995, the Secretary shall report to the appropriate committees of Congress on the activities of the States carried out pursuant to
(July 1, 1944, ch. 373, title XII, §1222, as added
Amendments
1993—
Part C—General Provisions Regarding Parts A and B
§300d–31. Definitions
For purposes of this part and parts A and B of this subchapter:
(1) Designated trauma center
The term "designated trauma center" means a trauma center designated in accordance with the modifications to the State plan described in
(2) State plan regarding emergency medical services
The term "State plan", with respect to 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.
(3) State
The term "State" means each of the several States, the District of Columbia, the Commonwealth of Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Commonwealth of the Northern Mariana Islands.
(4) Trauma
The term "trauma" means an injury resulting from exposure to a mechanical force.
(5) Trauma care component of State plan
The term "trauma care component", with respect to components of the State 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, prehospital care, emergency medical care, acute surgical and medical care, rehabilitation, and outcome evaluation of seriously injured patients.
(July 1, 1944, ch. 373, title XII, §1231, as added
Amendments
1993—Par. (3).
1992—
Effective Date of 1992 Amendment
Amendment by
Section Referred to in Other Sections
This section is referred to in
§300d–32. Funding
(a) Authorization of appropriations
For the purpose of carrying out parts A and B of this subchapter, there are authorized to be appropriated $6,000,000 for fiscal year 1994, and such sums as may be necessary for each of the fiscal years 1995 through 2002.
(b) Allocation of funds by Secretary
(1) General authority
For the purpose of carrying out part A of this subchapter, the Secretary shall make available 10 percent of the amounts appropriated for a fiscal year under subsection (a) of this section.
(2) Rural grants
For the purpose of carrying out section 300d–3 1 of this title, the Secretary shall make available 10 percent of the amounts appropriated for a fiscal year under subsection (a) of this section.
(3) Formula grants
(A) For the purpose of making allotments under
(B) Amounts paid to a State under
(c) Effect of insufficient appropriations for minimum allotments
(1) In general
If the amounts made available under subsection (b)(3)(A) of this section for a fiscal year are insufficient for providing each State with an allotment under
(2) Eligible States
The States referred to in paragraph (1) are States that—
(A) have the greatest need to develop, implement, and maintain trauma care systems; and
(B) demonstrate in their applications under
(3) Rule of construction
Paragraph (1) may not be construed to require the Secretary to make a grant under such paragraph to each State.
(July 1, 1944, ch. 373, title XII, §1232, as added
References in Text
Amendments
1998—Subsec. (a).
1993—Subsec. (a).
1992—Subsec. (a).
Effective Date of 1998 Amendment
Amendment by section 401(a)(2) of
Effective Date of 1992 Amendment
Amendment by
Section Referred to in Other Sections
This section is referred to in
1 See References in Text note below.
§300d–33. Repealed. Pub. L. 103–183, title VI, §601(e), Dec. 14, 1993, 107 Stat. 2239
Section, act July 1, 1944, ch. 373, title XII, §1233, as added Nov. 16, 1990,
Part D—Trauma Centers Operating in Areas Severely Affected by Drug-Related Violence
§300d–41. Grants for certain trauma centers
(a) In general
The Secretary may make grants for the purpose of providing for the operating expenses of trauma centers that have incurred substantial uncompensated costs in providing trauma care in geographic areas with a significant incidence of violence arising directly or indirectly from illicit trafficking in drugs. Grants under this subsection may be made only to such trauma centers.
(b) Minimum qualifications of centers
(1) Significant incidence of treating certain patients
(A) The Secretary may not make a grant under subsection (a) of this section to a trauma center unless the population of patients that has been served by the center for the period specified in subparagraph (B) includes a significant number of patients who were treated for—
(i) trauma resulting from the penetration of the skin by knives, bullets, or any other implement that can be used as a weapon; or
(ii) trauma that the center reasonably believes results from violence arising directly or indirectly from illicit trafficking in drugs.
(B) The period specified in this subparagraph is the 2-year period preceding the fiscal year for which the trauma center involved is applying to receive a grant under subsection (a) of this section.
(2) Participation in trauma care system operating under certain professional guidelines
The Secretary may not make a grant under subsection (a) of this section unless the trauma center involved is a participant in a system that—
(A) provides comprehensive medical care to victims of trauma in the geographic area in which the trauma center is located;
(B) is established by the State or political subdivision in which such center is located; and
(C)(i) has adopted guidelines for the designation of trauma centers, and for triage, transfer, and transportation policies, equivalent to (or more protective than) the applicable guidelines developed by the American College of Surgeons or utilized in the model plan established under
(ii) agrees that such guidelines will be adopted by the system not later than 6 months after the date on which the trauma center submits to the Secretary the application for the grant.
(3) Submission and approval of long-term plan
The Secretary may not make a grant under subsection (a) of this section unless the trauma center involved—
(A) submits to the Secretary a plan satisfactory to the Secretary that—
(i) is developed on the assumption that the center will continue to incur substantial uncompensated costs in providing trauma care; and
(ii) provides for the long-term continued operation of the center with an acceptable standard of medical care, notwithstanding such uncompensated costs; and
(B) agrees to implement the plan according to a schedule approved by the Secretary.
(July 1, 1944, ch. 373, title XII, §1241, as added
Effective Date
Part effective July 10, 1992, with programs making awards providing financial assistance in fiscal year 1993 and subsequent years effective for awards made on or after Oct. 1, 1992, see section 801(b), (d)(1) of
Section Referred to in Other Sections
This section is referred to in
§300d–42. Preferences in making grants
(a) In general
In making grants under
(1) made by a trauma center that, for the purpose specified in such section, will receive financial assistance from the State or political subdivision involved for each fiscal year during which payments are made to the center from the grant, which financial assistance is exclusive of any assistance provided by the State or political subdivision as a non-Federal contribution under any Federal program requiring such a contribution; or
(2) made by a trauma center that, with respect to the system described in
(A) is providing trauma care in a geographic area in which the availability of trauma care has significantly decreased as a result of a trauma center in the area permanently ceasing participation in such system as of a date occurring during the 2-year period specified in
(B) will, in providing trauma care during the 1-year period beginning on the date on which the application for the grant is submitted, incur uncompensated costs in an amount rendering the center unable to continue participation in such system, resulting in a significant decrease in the availability of trauma care in the geographic area.
(b) Further preference for certain applications
With respect to applications for grants under
(July 1, 1944, ch. 373, title XII, §1242, as added
§300d–43. Certain agreements
(a) Commitment regarding continued participation in trauma care system
The Secretary may not make a grant under subsection (a) of
(1) the center will continue participation in the system described in subsection (b) of such section throughout the 3-year period beginning on the date that the center first receives payments under the grant; and
(2) if the agreement made pursuant to paragraph (1) is violated by the center, the center will be liable to the United States for an amount equal to the sum of—
(A) the amount of assistance provided to the center under subsection (a) of such section; and
(B) an amount representing interest on the amount specified in subparagraph (A).
(b) Maintenance of financial support
With respect to activities for which a grant under
(c) Trauma care registry
The Secretary may not make a grant under
(1) the center will operate a registry of trauma cases in accordance with the applicable guidelines described in
(2) in carrying out paragraph (1), the center will maintain information on the number of trauma cases treated by the center and, for each such case, the extent to which the center incurs uncompensated costs in providing trauma care.
(July 1, 1944, ch. 373, title XII, §1243, as added
§300d–44. General provisions
(a) Application
The Secretary may not make a grant under
(b) Limitation on duration of support
The period during which a trauma center receives payments under
(c) Limitation on amount of grant
A grant under
(July 1, 1944, ch. 373, title XII, §1244, as added
§300d–45. Authorization of appropriations
For the purpose of carrying out this part, there are authorized to be appropriated $100,000,000 for fiscal year 1993, and such sums as may be necessary for fiscal year 1994. Such authorization of appropriations is in addition to any other authorization of appropriations or amounts that are available for such purpose.
(July 1, 1944, ch. 373, title XII, §1245, as added
Part E—Miscellaneous Programs
§300d–51. Residency training programs in emergency medicine
(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) of this section only if the applicant involved agrees that training programs under subsection (a) of this section 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 1993 through 1995.
(July 1, 1944, ch. 373, title XII, §1251, as added
§300d–52. State grants for demonstration projects regarding traumatic brain injury
(a) In general
The Secretary, acting through the Administrator of the Health Resources and Services Administration, may make grants to States for the purpose of carrying out demonstration projects to improve access to health and other services regarding traumatic brain injury.
(b) State advisory board
(1) In general
The Secretary may make a grant under subsection (a) of this section only if the State involved agrees to establish an advisory board within the appropriate health department of the State or within another department as designated by the chief executive officer of the State.
(2) Functions
An advisory board established under paragraph (1) shall advise and make recommendations to the State on ways to improve services coordination regarding traumatic brain injury. Such advisory boards shall encourage citizen participation through the establishment of public hearings and other types of community outreach programs. In developing recommendations under this paragraph, such boards shall consult with Federal, State, and local governmental agencies and with citizens groups and other private entities.
(3) Composition
An advisory board established under paragraph (1) shall be composed of—
(A) representatives of—
(i) the corresponding State agencies involved;
(ii) public and nonprofit private health related organizations;
(iii) other disability advisory or planning groups within the State;
(iv) members of an organization or foundation representing traumatic brain injury survivors in that State; and
(v) injury control programs at the State or local level if such programs exist; and
(B) a substantial number of individuals who are survivors of traumatic brain injury, or the family members of such individuals.
(c) Matching funds
(1) In general
With respect to the costs to be incurred by a State in carrying out the purpose described in subsection (a) of this section, the Secretary may make a grant under such subsection only if the State agrees to make available, in cash, non-Federal contributions toward such costs in an amount that is not less than $1 for each $2 of Federal funds provided under the grant.
(2) Determination of amount contributed
In determining the amount of non-Federal contributions in cash that a State has provided pursuant to paragraph (1), the Secretary may not include any amounts provided to the State by the Federal Government.
(d) Application for grant
The Secretary may make a grant under subsection (a) of this section only if 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.
(e) Coordination of activities
The Secretary shall ensure that activities under this section are coordinated as appropriate with other agencies of the Public Health Service that carry out activities regarding traumatic brain injury.
(f) Report
Not later than 2 years after July 29, 1996, the Secretary shall submit to the Committee on Commerce of the House of Representatives, and to the Committee on Labor and Human Resources of the Senate, a report describing the findings and results of the programs established under this section, including measures of outcomes and consumer and surrogate satisfaction.
(g) "Traumatic brain injury" defined
For purposes of this section, the term "traumatic brain injury" means an acquired injury to the brain. Such term does not include brain dysfunction caused by congenital or degenerative disorders, nor birth trauma, but may include brain injuries caused by anoxia due to near drowning. The Secretary may revise the definition of such term as the Secretary determines necessary.
(h) Authorization of appropriations
For the purpose of carrying out this section, there is authorized to be appropriated $5,000,000 for each of the fiscal years 1997 through 1999.
(July 1, 1944, ch. 373, title XII, §1252, as added
Part F—Interagency Program for Trauma Research
Part Referred to in Other Sections
This part is referred to in
§300d–61. Establishment of Program
(a) In general
The Secretary, acting through the Director of the National Institutes of Health (in this section referred to as the "Director"), shall establish a comprehensive program of conducting basic and clinical research on trauma (in this section referred to as the "Program"). The Program shall include research regarding the diagnosis, treatment, rehabilitation, and general management of trauma.
(b) Plan for Program
(1) In general
The Director, in consultation with the Trauma Research Interagency Coordinating Committee established under subsection (g) of this section, shall establish and implement a plan for carrying out the activities of the Program, including the activities described in subsection (d) of this section. All such activities shall be carried out in accordance with the plan. The plan shall be periodically reviewed, and revised as appropriate.
(2) Submission to Congress
Not later than December 1, 1993, the Director shall submit the plan required in paragraph (1) to the Committee on Energy and Commerce of the House of Representatives, and to the Committee on Labor and Human Resources of the Senate, together with an estimate of the funds needed for each of the fiscal years 1994 through 1996 to implement the plan.
(c) Participating agencies; coordination and collaboration
The Director—
(1) shall provide for the conduct of activities under the Program by the Directors of the agencies of the National Institutes of Health involved in research with respect to trauma;
(2) shall ensure that the activities of the Program are coordinated among such agencies; and
(3) shall, as appropriate, provide for collaboration among such agencies in carrying out such activities.
(d) Certain activities of Program
The Program shall include—
(1) studies with respect to all phases of trauma care, including prehospital, resuscitation, surgical intervention, critical care, infection control, wound healing, nutritional care and support, and medical rehabilitation care;
(2) basic and clinical research regarding the response of the body to trauma and the acute treatment and medical rehabilitation of individuals who are the victims of trauma;
(3) basic and clinical research regarding trauma care for pediatric and geriatric patients; and
(4) the authority to make awards of grants or contracts to public or nonprofit private entities for the conduct of basic and applied research regarding traumatic brain injury, which research may include—
(A) the development of new methods and modalities for the more effective diagnosis, measurement of degree of injury, post-injury monitoring and prognostic assessment of head injury for acute, subacute and later phases of care;
(B) the development, modification and evaluation of therapies that retard, prevent or reverse brain damage after acute head injury, that arrest further deterioration following injury and that provide the restitution of function for individuals with long-term injuries;
(C) the development of research on a continuum of care from acute care through rehabilitation, designed, to the extent practicable, to integrate rehabilitation and long-term outcome evaluation with acute care research; and
(D) the development of programs that increase the participation of academic centers of excellence in head injury treatment and rehabilitation research and training.
(e) Mechanisms of support
In carrying out the Program, the Director, acting through the Directors of the agencies referred to in subsection (c)(1) of this section, may make grants to public and nonprofit entities, including designated trauma centers.
(f) Resources
The Director shall assure the availability of appropriate resources to carry out the Program, including the plan established under subsection (b) of this section (including the activities described in subsection (d) of this section).
(g) Coordinating Committee
(1) In general
There shall be established a Trauma Research Interagency Coordinating Committee (in this section referred to as the "Coordinating Committee").
(2) Duties
The Coordinating Committee shall make recommendations regarding—
(A) the activities of the Program to be carried out by each of the agencies represented on the Committee and the amount of funds needed by each of the agencies for such activities; and
(B) effective collaboration among the agencies in carrying out the activities.
(3) Composition
The Coordinating Committee shall be composed of the Directors of each of the agencies that, under subsection (c) of this section, have responsibilities under the Program, and any other individuals who are practitioners in the trauma field as designated by the Director of the National Institutes of Health.
(h) Definitions
For purposes of this section:
(1) The term "designated trauma center" has the meaning given such term in
(2) The term "Director" means the Director of the National Institutes of Health.
(3) The term "trauma" means any serious injury that could result in loss of life or in significant disability and that would meet pre-hospital triage criteria for transport to a designated trauma center.
(4) The term "traumatic brain injury" means an acquired injury to the brain. Such term does not include brain dysfunction caused by congenital or degenerative disorders, nor birth trauma, but may include brain injuries caused by anoxia due to near drowning. The Secretary may revise the definition of such term as the Secretary determines necessary.
(July 1, 1944, ch. 373, title XII, §1261, as added
Amendments
1996—Subsec. (d)(4).
Subsec. (h)(4).
Change of Name
Committee on Energy and Commerce of House of Representatives treated as referring to Committee on Commerce of House of Representatives by section 1(a) of
Traumatic Brain Injury Study; Consensus Conference
Section 4 of
"(a)
"(1)
"(A) In collaboration with appropriate State and local health-related agencies—
"(i) determine the incidence and prevalence of traumatic brain injury; and
"(ii) develop a uniform reporting system under which States report incidents of traumatic brain injury, if the Secretary determines that such a system is appropriate.
"(B) Identify common therapeutic interventions which are used for the rehabilitation of individuals with such injuries, and shall, subject to the availability of information, include an analysis of—
"(i) the effectiveness of each such intervention in improving the functioning of individuals with brain injuries;
"(ii) the comparative effectiveness of interventions employed in the course of rehabilitation of individuals with brain injuries to achieve the same or similar clinical outcome; and
"(iii) the adequacy of existing measures of outcomes and knowledge of factors influencing differential outcomes.
"(C) Develop practice guidelines for the rehabilitation of traumatic brain injury at such time as appropriate scientific research becomes available.
"(2)
"(A) Not later than 18 months after the date of the enactment of this Act [July 29, 1996], the Secretary shall submit to the Committee on Commerce of the House of Representatives, and to the Committee on Labor and Human Resources of the Senate, a report describing the findings made as a result of carrying out paragraph (1)(A).
"(B) Not later than 3 years after the date of the enactment of this Act, the Secretary shall submit to the Committees specified in subparagraph (A) a report describing the findings made as a result of carrying out subparagraphs (B) and (C) of paragraph (1).
"(b)
"(c)
"(d)