Abstract
Mortality die to trauma has increased substantially to force the policymakers look towards it with a modern outlook. Modern facilities’ and training is required to look at trauma and trauma care centers. As more and more hospitals are closing down their trauma care facilities, it is important for the federal government to provide greater impetus to form special facilities that may handle the epidemic nature of trauma deaths.
The enactment of Improvement of Trauma Care Act, 2014 has created a modern outlook of the policy makers towards faculties providing trauma care, especially towards burn facilities. The law enacted would allow burn centers to be a part of the federal trauma fund and provide better care towards burn-injured patients.
Introduction
The aim of the paper is to understand the scope and importance of a new enacted or proposed legislation in the Congress. The paper discusses Improving Trauma Care Act of 2014. This is a law passed by the Congress in 2014 and was initially proposed on November 20, 2013 by Representative Bill Johnson.
This law is important for an advanced nursing practitioner as this will help to understand the law related to emergency trauma care that may be required in case of a mass emergency. This law modernizes the definition of trauma and takes trauma medical care to the next level. Further, an advanced nursing staff must be aware of the trauma facility that are to be provided, and in what circumstances under the law, they could provide the correct treatment to the patient.
This paper initially discusses a brief historical background of the proposed bill, and then provides a sociocultural, economic, and political background of the legislature. Then the paper addresses the difficulties that the legislation may face and the tactics that has to be employed to push it forward. Further discussion on the stakeholders involved in the law is discussed in the paper.
Improving Trauma Care Act of 2014
In 2014, Improving Trauma Care Act was made into a law. Representative Bill Johnson proposed the bill in 2013. The bill aimed to amend the caregiving facilities for trauma patients and trauma related research programs as stipulated in the Public Health Service Act. The aim of the act was to amend the Public Health Service Act and redefine ‘trauma’ in Title 42. The new definition includes injuries from “thermal, electrical, chemical, or radioactive force” (Upton, 2014, para. 3).
It is believed that the legislation will help burn trauma centers to provide complete trauma care to the patients and help them apply for grant under Federal Program. In order to undertake an analysis of the health care act it is necessary to understand the definition of trauma as presented by the new bill.
Trauma is defined as any injury caused from exposure to “mechanical force” or other external agents such as “thermal, electrical, chemical, or radioactive force” (Upton, 2014, para. 3). Hence, the treatment for any such form of injury must be done in similar fashion with proper trauma treatment of the patients. The next section will discuss the background of the law and its various implications.
Background
Historical
Various forms of injuries caused by gunshots, fire, crash, etc. may cause injuries causing trauma. Previous definitions of trauma were shortsighted and overlooked burn injuries due to bomb or chemical explosion, or fire as trauma (Improving Trauma Care Act of 2014, 2014). The definition of trauma as enacted in the previous trauma care bills were complicated, incomplete, and insufficient. Due to vagueness of the definition, application of trauma care was limited.
According to the definition of trauma as stipulated in Tittle 42 of the US Code, section 300d-31(4) is “injury resulting from exposure to a mechanical force” (Upton, 2014, para. 5). This definition clearly misses out the trauma caused by burn injuries. A second definition of trauma presented in the 42 United States Code, section 300d-61(h)(3) states that trauma is “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” (Upton, 2014, para. 5).
The contradiction and complication created by the two definitions creates an unclear situation. The inconsistency between these two definitions hinders applicability of the law. Hence, treatment of trauma for burned victims becomes a different issue, as this was not covered in the initial bill. This limits the workability of burn centers that were earlier not eligible for the federal funds on trauma care.
This bill is a landmark step towards trauma care, especially for victims of burns. This act will be further taken forward with the proposed bill Trauma Systems and Regionalization of Emergency Care Reauthorization Act, 2014 that aims to include the requirements of American Burns Association for trauma care.
Economic
The main reason to enact this bill was to modernize the definition of trauma that was contradictory and vague. The American Burn Association supported Johnson’s Improving Trauma Act, 2014, which they believed would modernize the definition of trauma and include, burn injuries in it (American Burn Association , 2014).
This legislation is an important step for providing medical care to burn trauma patients, as burn centers will be able to apply for funds under the trauma and emergency care provision of the Affordable Care Act (American Burn Association , 2014). Earlier the resources available for the purpose of burn trauma care was limited. However, with the new act, an increased flow of resources will generate immense return and economies of scale in the public health and safety sector (American Burn Association , 2014).
Sociocultural
In order to provide trauma care and especially for burns it is important to understand the sociocultural implication of the act. Trauma is one of the primary causes of death under 44 years of age (American Burn Association, 2014). Trauma causes more death under the aforementioned age group than AIDS and stroke combined (American Burn Association, 2014).
More than 3300 people die of trauma, solely from road accidents. Burns too form a significant part of the injuries caused (American Burn Association, 2014). Around half a million people are estimated to be involved in burn accidents and of these, more than thirty thousand are admitted in burn centers (American Burn Association, 2014).
Trauma centers are important for Americans as it is estimated that forty-five million Americans lack trauma care facility when it is necessary (American Burn Association, 2014). The problem is more with people from states like Arizona, New Mexico, Texas, Louisiana, Mississippi, North Dakota, Montana, Wyoming, Idaho, New Hampshire, and Alabama where there are no burn centers (American Burn Association, 2014; Poovey, 2007).
Trauma care facilities and burn care facilities are few in rural areas. It is estimated that only 10 percent of the hospitals have the support base to run a trauma care center and a large part of the country does not have proper trauma care facility. For burn victims, few centers (only 2 percent of total hospitals) that provide faculties for trauma care. Hence, this bill will provide the ground for many hospitals to seek financial aid under the Affordable Care Act to develop burn trauma centers.
The act will help burn centers to upgrade and help the possibility of new burn centers in rural and urban areas. Further, modernization of the definition of trauma would enable trauma centers to treat victims facing different kinds of injuries from mechanical as well other forms as long as they were life threatening and may have caused certain disability.
Political and Legislative
The federal government’s policy on healthcare indicates that the government is focused on countering possible problems from mass attack of bioterrorists and is not prepared to counter blast terrorism that would require treating traumatized burnt victims. More US hospitals were shutting down their burn centers making the nation incapable to handle a mass blast casualty (Poovey, 2007).
Inclusion of treatment of trauma patients from mass burn casualties was evident during 9/11. Hence, inclusion and creation of trauma centers adapt to deal with trauma patients. The inclusion of burn trauma patients will extend the federal government coverage of patients facing burnt trauma from mass terrorist attack. Hence, there has been many legislations and political pressure to bring forth changes in the Public Health Service Act and include the fire burn victims under trauma care.
In 2014 alone, Mr. Johnson’s bill was not the only bill that was proposed to bring about changes in the definition and treatment of trauma. Other related bills that have been proposed and are being discussed are Senator Reed’s bill, also called Improving Trauma Care Act (S. 2406) and Trauma Systems and Regionalization of Emergency Care Reauthorization Act, 2014. All these three acts aimed at bringing the burnt patients under trauma care.
The Trauma Systems and Regionalization of Emergency Care Reauthorization Act actually demarcate the amount of fund that will be allocated for the trauma care by the government during emergency (US. Govt., 2014). Further, the bill also seeks to include the standards and requirements as stipulated by the American Burn Association to be included while modifying the state plan for the trauma patients (US. Govt., 2014).
Difficulties and Tactics
Representative Bill Johnson from Ohio congressional district proposed the bill. He had won the elections twice, once in 2010 and then in 2012. The bill was proposed in 2013 and Johnson went on to achieve a stand on the healthcare facilities of the American people, even though he opposed many of the options under Obamacare (Upton, 2014).
Johnson introduced the bill in the House of Representatives on November 20, 2013. The debate and discussions that were held in-between to pass the bill were usually based on the argument of a need to alter the definition of ‘trauma’ in the Patient Health Act and the inclusion of fire victims.
Different lobbies and association backed the bill, especially the American Burn Association, American Association of the Surgery of Trauma, American College of Emergency Physicians, America’s Essential Hospitals, American College of Surgeons, American Trauma society, etc. (Reed’s New Trauma Law to Have a Key Impact on Improving Burn Care, 2014; Upton, 2014; American Burn Association, 2014).
All these organizations joined to form a unified voice for the trauma care community, actively vocalizing the need to amend the previous definition of trauma, and increasing trauma facility to the burnt victims.
Stakeholders
For any bill [proposed in the Congress, there are groups and associations who support or oppose it. These groups may gain or loose if the bill is enacted and hence feel strongly about it and use all possible means, under their power, to propel or counter it. In case of the Improved Trauma Act, many organizations had vocally supported the bill and had put forth a joint letter to the Congress to pass the bill.
The association is that of the professional medical practitioners. The stakeholders who would gain from the enacted bill are doctors, nurses, hospitals, and trauma care centers. Of course, the patients and the American people is the body that would gain the most. The stakeholders who would be benefitted from the bill are the emergency medical practitioners like doctors and nurses, the trauma care centers, hospitals, burn centers, and the patients.
The other congressional representatives and senators who support the bill and have forwarded similar proposals are Senator Reed and Representative Michael C. Burgess. Senator Reed’s Improving Trauma Act 2014 adds burn injuries under the federal trauma funds (Reed’s New Trauma Law to Have a Key Impact on Improving Burn Care, 2014).
The stakeholders who would directly benefit from the bill is burn care centers. These centers are few in number and are not well equipped to handle a mass burn-trauma situation like 9/11 (Ortiz-Pujols et al. 2011).
Hence, addition of the burn injury in the list of trauma and enactment of the law with the new definition of trauma will ensure trauma care’s inclusion in the Affordable Care Act under which the burn care centers can seek financial help from the government (Affordable Care Act, 2014). The bill is believed to be beneficial for most American citizens in case of mass trauma.
Positive and Negative Effect of the Legislation
The legislation will have two effects on the trauma patient first financial and then medical benefit. The financial benefits will be derived by hospitals, trauma care centers, and burn centers. These places will now have the financial backing from the federal government to support burn care centers. Trauma centers are few in number vis-à-vis deaths in the US due to trauma every year. Hence, this would facilitate to gain financial support from the government towards improving public health facilities.
The second positive effect would be for the overall medical care facility for trauma patients. Trauma care centers are few in the country and burn centers are even less. This bill will help the trauma centers to incorporate burnt patients under their umbrella, and help burn patients to recuperate.
Hence, this will benefit the patients tremendously. Further, the trauma centers will be an asset in case of mass burn trauma as was faced during the 9/11 attack. Modernization and updating of the old law was necessary as it prevented better treatment provided to the trauma patients. The beneficiaries of the law are the doctors, nurses, patients, and the hospitals. The bill ensures that trauma care in the US will be greatly improved by the law.it will improve the response of the public health system to mass emergencies.
The law will have a negative effect of the bill are not apparent yet as this has only expanded the definition of trauma and is expected to be cutinized more fully. However, this bill does provide an extensive insight into the trauma care facility in the US.
Trauma related Law in other Countries
Trauma care laws are present in many countries but assume different shape and form. It is in place in most developed countries but in less developed countries the trauma care laws are absent and are often merged with road accident laws. Hence, it is difficult to distinguish road accident traumas with traumas from natural or man made disasters. Japan has a disaster management law but does not have a trauma care law and has less trauma centers than the US.
Suggested Changes
The act solely aims at changing the definition of trauma and inclusion of burnt trauma in the definition. This is definitely a very helpful alteration to the older version of the law. However, it remains silent on the inclusion of the trauma care within the Affordable Care Act (Affordable Care Act, 2014).
An overt inclusion of the trauma care within the Affordable Care Act will help in ensuring greater financial and infrastructural benefit for the trauma care centers and help in coping with future disasters. Further, the bill remains silent on the expansion of research in the area and the cost consideration of the bill on the health cost of government. The next step would be to provide a proper appraisal of the trauma care facilities in the US and the kind of aid they would require to counter mass trauma situations.
Further, trauma care law should be incorporated for the facilities for children and women, and better care for people encountering a life-threatening situation. The inclusion of emergency trauma care for mass trauma is necessary that would allow research and training of medical care specialists to handle an epidemic situation.
Funding for trauma care is necessary as two trauma care bodies, Trauma Care Systems Planning Grants and the Regionalization of Emergency Care Systems Pilot Project, have received no fund from federal government since 2005 (Moye & Rammer, 2014). As trauma has become of the increasing causes of mortality worldwide and in the US, special care must be taken in order to incorporate treatment of trauma patient under the Affordable Health Care Act.
References
Affordable Care Act. (2014). Retrieved from White House.
American Burn Association. (2014).
American Burn Association (2014). 2014 Legislative Advocacy Agenda.
Improving Trauma Care Act of 2014. Retrieved Library of Congress.
Moye, C., & Rammer, S. (2014). Sen. Reed Sets Sights on Overdue Trauma System Funding Legislation Following New Trauma Law to Improve Burn Care. Retrieved from American College of Surgeons. Web.
Ortiz-Pujols, S. M., Thompson, K., Sheldon, G. F., Fraher, E. P., Ricketts, T. C., & Cairns, B. A. (2011). Burn care: Are there sufficient providers and facilities? Retrieved from American College of Surgeons.
Poovey, B. (2007). Hospitals Are Shutting Down Burn Centers. Retrieved from The Washington Post.
Reed’s New Trauma Law to Have a Key Impact on Improving Burn Care. (2014). Retrieved Jack Reed – United States Senator for Rhodes Island.
US. Govt. (2014). Trauma Systems and Regionalization of Emergency Care Reauthorization Act. Retrieved from U.S. Government Printing Office.
Upton, F. (2014). Improving Trauma Care Act of 2014. Retrieved from U.S. Government Printing Office.