The American College of Surgeons (ACS) Committee on Trauma’s (COT) advocacy portfolio continues to grow, with several legislative wins tallied in 2019 that have fueled continued efforts at the start of 2020. Lawmakers on Capitol Hill and in capitals across the country look to the ACS as a leader in trauma care. The Division of Advocacy and Health Policy (DAHP) actively promotes the research and work of the COT on Capitol Hill to advance trauma care and achieve the goal of zero preventable deaths.
MISSION ZERO takes center stage
In an effort to develop strategies for improving the U.S. trauma system, the ACS, the U.S. Department of Defense, and other leading health care organizations sponsored a National Academies of Sciences, Engineering, and Medicine (NASEM) report, A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths after Injury. This report outlines 11 recommendations for filling the gaps in the nation’s trauma system, including federal leadership, coordination between military and civilian health leaders, stronger collaboration between states, steps to address variances in trauma care, and a national trauma research plan with dedicated funding for clinical trials.
Based on these recommendations the ACS COT continued to develop civilian-military partnerships and advocate for their advancement. From this effort, the MISSION ZERO Act was born. This bill took the recommendations of the NASEM report to create a U.S. Department of Health and Human Services (HHS) grant program to cover the administrative costs of embedding military trauma professionals in civilian centers. In 2016, following the Dallas, TX, police shootings, MISSION ZERO was introduced by Reps. Michael Burgess (R-TX) and Gene Green (D-TX) and Sens. Johnny Isakson (R-GA) and Tammy Duckworth (D-IL). Since the beginning of the 115th Congress, the House of Representatives passed the MISSION ZERO Act five separate times with broad bipartisan support.
In 2019, this individual bill was added to the Pandemic and All-Hazards Preparedness and Advancing Innovation Act (PAHPAI) as the Military and Civilian Partnership for the Trauma Readiness Grant Program. PAHPAI passed both chambers and was signed into law (P.L. 116-22) June 24, 2019. House and Senate rules dictate a two-step process for establishing and funding agency programs. Now that this grant program has been authorized, the Appropriations Committees must provide budget authority to HHS to establish the grants. PAHPAI authorized $11.5 million to fund the program, but Appropriations Committees still need to appropriate those funds, explicitly allocating those funds to HHS’ Assistant Secretary for Preparedness and Response.
Requests for funding, or appropriations requests, are due to the Appropriations Committees in March and April. Often referred to as “appropriations season,” members of the committee hear requests from organizations and legislators from other committees advocating for programs they support. The ACS, along with a coalition of trauma stakeholders, sent letters to committee to House and Senate leadership asking for full funding for the MISSION ZERO grants in the fiscal year 2021 Labor, Health and Human Services, Education and Related Agencies appropriations package.
Member sponsorship is crucial in demonstrating a program’s wide support and need for funding. Take a moment to contact your member of Congress and ask them to support funding for MISSION ZERO.
To further raise awareness about MISSION ZERO with lawmakers and their staff, the ACS Division of Advocacy and Health Policy, in partnership with the Military Health System Strategic Partnership, hosted a briefing on Capitol Hill. Patrick V. Bailey, MD, MLS, FACS, ACS Medical Director of Advocacy, moderated a panel of Fellows who shared the history of these parentships and demonstrated the benefit of MISSION ZERO to both the military and civilian sector. The panelists included the following:
- Eric Elster, MD, FACS, CAPT, MC, USN, Department of Surgery at Uniformed Services University of the Health Sciences and the Walter Reed National Military Medical Center, Bethesda, MD
- Margaret Knudson MD, FACS, professor of surgery, University of California San Francisco; and Medical Director of the Military Health System Strategic Partnership American College of Surgeons
- Todd E. Rasmussen, MD, FACS, Colonel USAF MC, professor of surgery and associate dean, Uniformed Services University and Walter Reed National Military Medical Center
- Thomas M. Scalea, MD, FACS, MCCM
The Honorable Francis X. Kelly Distinguished Professor in Trauma Director, Program in Trauma, University of Maryland School of Medicine; physician-in-chief, Shock Trauma Center, and system chief for critical care services, University of Maryland Medical System, Baltimore
Stop the Bleed® and the Prevent BLEEDing Act
STOP THE BLEED® continues to gain exposure on Capitol Hill through the Prevent Bleeding Loss with Emergency Devices (BLEEDing) Act. As a direct result of a STOP THE BLEED® training on Capitol Hill and the College’s efforts to educate lawmakers about the importance of bleeding control, Reps. Alcee L. Hastings (D-FL) and Brad Wenstrup, MD (R-OH), introduced the Prevent BLEEDing bill in 2019. This legislation would provide funding to states to install bleeding control kits and offer training and is a critical step toward empowering civilians to take lifesaving action when the need arises.
Sens. Bob Menendez (D-NJ) and John Boozman (R-AR) recently agreed to introduce the same bill in the Senate, further demonstrating bipartisan support for the program and providing a chance for senators to cosponsor. Take a moment to write your member of Congress about STOP THE BLEED® programs in your state and ask for their support of Prevent BLEEDing.
Hospital-based violence intervention programs
Reps. Dutch Ruppersberger (D-MD) and Adam Kinzinger (R-IL) introduced legislation February 11 aimed improving hospital-based violence intervention programs (HVIP). H.R. 5855, the Bipartisan Solution to Cyclical Violence Act of 2020, expands on previously introduced legislation by providing new grant funding to create HVIP programs and to expand successful programs. The legislation also requires research on best practices, which will play a critical role in documenting the success of these programs and will create a road map for hospitals to follow.
HVIPs are multidisciplinary programs that identify patients at risk of repeat violent injury and link them with hospital- and community-based resources that address underlying risk factors for violence, such as mental illness and social determinants. Data indicate the HVIPs reduce violent injury recidivism, as well as hospital costs, but more research is needed to better target these efforts and help spread them to areas of need.