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.
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.
The Stop the Bleed training event featured an appearance from House Majority Whip Steve Scalise (R-LA), who is still recovering from a gunshot injury sustained in June 2017. When Representative Scalise was injured, his wounds were immediately treated with bleeding control techniques by Representative Wenstrup, who was on the scene at the time.
At press time, the ACS had assisted in training approximately 20 members of Congress (see sidebar) and more than 100 congressional staffers. These individuals left the training program with a better understanding of how to become lifesaving immediate responders and the value of Stop the Bleed training.
Building upon the injury prevention efforts of the COT and its ongoing work with violence prevention, the ACS supported two related pieces of legislation, the STOP School Violence Act, and the Fix NICS (also known as the National Instant Criminal Background Check System) Act.
The STOP School Violence Act provides funding for schools to assist with implementing programs that will help students and teachers identify signs of violence before violent acts take place. The Fix NICS Act would help to ensure that the NICS is fully functioning and contains the most accurate data. Enhancing NICS will help to ensure that firearms stay out of the hands of individuals who are legally forbidden from possessing them. Injury prevention measures, such as the STOP School Violence Act and the Fix NICS Act, are important to help reduce acts of violence and to further secure our nation’s schools and communities.
In advocating for these bills, the ACS issued letters of support highlighting that far too many Fellows of the ACS see the firsthand results of firearm violence in their operating rooms and trauma centers on a daily basis and outlining the COT’s consensus-driven approach to firearm injury prevention.
The STOP School Violence Act and the Fix NICS Act were signed into law on March 23.
The ACS worked with members of the Senate Appropriations Committee to advocate for trauma research language that was included in the fiscal year (FY) 2018 omnibus funding bill—the Consolidated Appropriations Act, H.R. 1625. This language stresses the importance of trauma research and encourages the National Institutes of Health (NIH) to establish a trauma research agenda to minimize the loss of human life, disability, and injury by ensuring that patient-specific trauma care is based on scientifically validated findings.
The Senate Appropriations Committee report language also recognizes the value of having access to high-quality pediatric trauma care and calls upon the Heath Resources and Services Administration (HRSA) to provide a status update on the development of a virtual pediatric trauma center in FY 2019. A virtual pediatric trauma center will provide pediatric patients access to the spectrum of trauma care professionals and will help to address some of the geographic shortfalls in pediatric trauma care. Report language is included with appropriations legislation to guide the administration and departments in support of the committee’s priorities. That language is as follows:
To ensure that our Nation’s trauma response network and workforce remain adequately prepared, the Committee recommends an increased focus by NIH on trauma research, including to establish a NIH-led trauma research agenda coordinated with the extensive, and often groundbreaking, DoD activities on trauma. This research is critical to minimize the loss of human life, disability, and injury by ensuring that patient-specific trauma care is based on scientifically validated findings.*
The ACS has actively advocated for a patient and provider education-focused approach to addressing the opioid epidemic and limiting one-size-fits-all legislative mandates on prescribers. Advocacy efforts include facilitating a meeting for Co-Chair of the ACS Patient Education Workgroup John Daly, MD, FACS, with the congressional Bipartisan Working Group to discuss opioids in November 2017; and submitting official letters to the House Energy and Commerce Committee, the House Ways and Means Committee, the Senate Finance Committee, and the Senate HELP Committee.
Overall, the College’s advocacy efforts on this topic reiterate the ACS Statement on the Opioid Abuse Epidemic, which calls for fully functioning and interoperable prescription drug monitoring programs, the improved ability for prescribers to electronically prescribe opioids, and any opioid-related Continuing Medical Education to be specialty-specific.
Why advocacy matters
On a daily basis, Congress, policymakers, and state legislatures make decisions that have the potential to affect the surgical profession. To have a robust, effective advocacy program, it is essential that all surgeons and Fellows of the ACS join together with a united voice to engage congressional leaders and public officials in support of trauma patients and trauma/surgical priorities.
The ACS DAHP suggests the following activities to support these efforts:
- Attend the Leadership & Advocacy Summit, March 30–April 2, 2019, in Washington, DC
- Learn more, take action, and explore tools and resources available to surgeon advocates online at SurgeonsVoice.org, in addition to engaging via social media (@SurgeonsVoice)
- Host federal/state legislators at your facility/practice
- Site visits
- Trauma facility tours
- Stop the Bleed training courses
- Meet with your member of Congress in your home district or in Washington, DC
The DAHP is available to assist with these efforts and can help you prepare for a successful meeting, event, or facility tour.
*U.S. Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Bill, 2018. S 1771. September 27, 2017. Available at: www.appropriations.senate.gov/imo/media/doc/FY2018%20Labor%20HHS%20Education%20Appropriations%20-%20Report%20115-150.pdf. Accessed April 25, 2018.