One of the key pillars of the American College of Surgeons’ (ACS) federal advocacy agenda is trauma policy. The ACS, through the Division of Advocacy and Health Policy (DAHP), has been a longstanding voice on Capitol Hill for the injured patient and a strong proponent of the work done by the Committee on Trauma (COT). As federal legislators continue to explore ways to improve trauma care and implement the 2016 National Academies of Science, Engineering, and Medicine (NASEM) report, A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths after Injury, it is important to have a strong trauma advocacy agenda and ensure that the ACS has a seat at the table.
Trauma advocacy and policy has a unique role within the ACS because it involves heavy involvement from both the COT and the DAHP. Working closely together, these two areas enable the ACS to craft and implement a well-developed trauma advocacy agenda. These efforts are led primarily through the work of the COT Advocacy Pillar, chaired by Michael Coburn, MD, FACS, and the ACS Legislative Committee, chaired by ACS Regent James W. Gigantelli, MD, FACS. Legislative items are often proposed for support by the COT and directed to the Legislative Committee before action at the state or federal level. This careful coordination was most recently used to support the STOP (also known as the Student, Teachers, and Officers Preventing) School Violence Act. This legislation, which was signed into law in March, provides funding to schools to help address violent attacks.
The ACS also participates in an informal trauma coalition of approximately 20 health care groups and organizations that advocate for trauma-related priorities on Capitol Hill. This coalition represents organizations from the entirety of the health care spectrum (from trauma nurses to trauma centers) and allows for increased advocacy efforts on Capitol Hill.
The end of the debate regarding the repeal of the Affordable Care Act opened the door for Congress to take up smaller and more bipartisan pieces of health care legislation. Several of these legislative proposals have helped to advance a pro-trauma agenda on Capitol Hill, such as legislation to facilitate military-civilian trauma care partnerships, liability reform, and injury prevention efforts. The following is an outline of what is expected throughout the rest of the 115th Congress and provides a summary of ongoing trauma-related legislative activity.
What’s next in 2018
Because 2018 is an election year for all members of the U.S. House of Representatives and one-third of the U.S. Senate, most members of Congress will be looking to finish legislative business before departing for the August in-district work period. Before this recess can happen, Congress has a few remaining items that are likely to see legislative action in 2018.
The Pandemic and All-Hazards Preparedness Act (PAHPA) expires September 30 and is up for reauthorization. Congress is likely to vote on this reauthorization request before the August break. PAHPA is an important piece of legislation because it funds the office of the Assistant Secretary for Preparedness and Response (ASPR) and can be a vehicle to help move other trauma-specific bills through the legislative process.
It is likely that Congress also will act on the opioid epidemic by providing additional funding for opioid-related treatment and prevention and by passing legislation to further address the opioid epidemic. The ACS is actively involved in efforts to address the opioid epidemic and is working to ensure that unnecessary one-size-fits-all restrictions are not placed on prescribers. These restrictions could hinder patient care and provide additional burdens for prescribers. Given the unique nature of trauma, it is important that these patients have access to appropriately prescribed pain medication when needed.
The following is a more in-depth analysis on ACS trauma-related legislative priorities, including their status, expected next steps, and ways ACS Fellows can get involved in the legislative process.
Mission Zero Act
The Mission Zero Act creates a U.S. Department of Health and Human Services (HHS) grant program to cover the administrative costs of embedding military trauma professionals in civilian trauma centers. By facilitating the implementation of military-civilian trauma partnerships, patients will receieve the highest quality of trauma care in times of peace and conflict. This legislation is a step in the direction of implementing the recommendations from the 2016 NASEM report on trauma care mentioned previously. In addition, these partnerships would allow military trauma care teams and providers to gain exposure to treating critically injured patients and increase readiness for when these units are deployed. By building off the goals established in the fiscal year 2017 National Defense Authorization Act through the creation of the Joint Trauma Education and Training Directorate, the Mission Zero Act will assist in achieving and maintaining readiness among military providers, as well as the smooth transition of trauma lessons learned from the military to the civilian setting, by providing the following grant funding for military trauma teams and providers to embed in civilian trauma facilities. Funding would be provided as follows:
- $1 million grant to host military trauma teams at eligible high-acuity Level I trauma centers
- Grants to eligible Level I, II, or III trauma centers to host individual providers ($100,000 for physician or $50,000 for nonphysician providers)
The House of Representatives unanimously passed the Mission Zero Act on February 26. At press time, the bill was awaiting action in the Senate Health, Education, Labor and Pensions (HELP) Committee.
Good Samaritan Health Professionals Act
The Good Samaritan Health Professionals Act (H.R. 1876/S. 781) would provide liability protections to health care professionals when they serve as volunteers in response to a federally declared disaster, such as a hurricane or an earthquake.
Hurricane Katrina highlighted the importance of volunteer, trained health care professionals. During that disaster, more than 33,000 volunteer health care professionals responded to the call for assistance through various emergency response programs. Unfortunately, many volunteers were delayed or turned away because of inconsistent state and federal volunteer protection laws, as well as confusion about the application of these laws.
As of press time, the House Energy and Commerce Committee had unanimously passed the legislation, and it was awaiting a vote from the full House of Representatives and action before the Senate HELP Committee.
PAHPA
The PAHPA was first enacted in 2006 and is up for its second reauthorization for funding. PAHPA was created to improve the nation’s response to public health and medical emergencies and includes the Emergency Care Coordination Center (ECCC). The ECCC has a large level of oversight for implementing the recommendations of the NASEM report on trauma care.
The reauthorization process involves hearings and legislative action within the congressional committees of jurisdiction—the Senate HELP Committee and the House Energy and Commerce Committee—before action by the full House of Representatives and the Senate.
The ACS is advocating for some of the organization’s trauma-related priorities, such as the Mission Zero Act, the Good Samaritan Health Professionals Act, and the legislative framework for a national trauma system to be included in the PAHPA reauthorization package. At press time, the Senate HELP Committee released a draft of the legislation, and the ACS provided comments to the Committee advocating for inclusion of the aforementioned trauma-related priorities.
Stop the Bleed
Stop the Bleed® remains one of the most active programs within the COT/DAHP advocacy agenda. By bringing Stop the Bleed training to congressional offices and state legislatures, it has paved the way for the ACS to build relationships with state, local, and federal legislators across the country while helping to bring this vital program to the public’s attention.
In October 2017, leaders of the ACS hosted Stop the Bleed training for members of Congress. Special guests included Reps. Ami Bera, MD (D-CA); Phil Roe, MD (R-TN); Raul Ruiz, MD (D-CA); and Brad Wenstrup, DPM (R-OH), who provided opening remarks about bleeding control.
The event focused on how early intervention from a Stop the Bleed-trained individual can save the life of someone suffering from a bleeding injury. More than 20 members of Congress and staff came to learn more about the ACS efforts with Stop the Bleed and engaged in hands-on training to learn how to control bleeding. The training sessions were led by ACS Fellows, including ACS Regent Lenworth M. Jacobs, Jr., MD, MPH, FACS; Leonard J. Weireter, MD, FACS; Mark L. Gestring, MD, FACS; John H. Armstrong, MD, FACS; Joseph V. Sakran, MD, MPA, MPH, FACS; and Jack Sava, MD, FACS.
