Improving Trauma Care Act 2014
Health care policies are amongst the most important agenda in the administration of a nation. With the right health laws and policies in place the government can provide a wide range of health care benefits to its people. However, with changing times, amendment and constant up-gradation is required. It is true for both medical as well as legal definitions. Improving Trauma Care Act is one such amendment in the Public Health Laws of the federation. The following paper is a research on the reasons to make this amendment and what may be its impact in the health care scenario
Improving Trauma Care Act 2014
A situation that leaves an individual feeling overwhelmed or without support is called Trauma (Torres, n.d,). Trauma care is a very important aspect when it comes to dealing with cases of extreme emergency. The Public Service Health Act has a very limited definition of trauma and trauma care. Trauma may be caused due to any number of reasons both physical as well as emotional. However, in the broader sense of the term, trauma is referred to have been caused due to an external physical entity causing harm to the body. Trauma care is a specialized line in medicine and requires qualified professionals to handle cases of trauma. Trauma care units are specialized units created for this very purpose. However trauma is a universal issue irrespective of the victim’s stature or nationality. Any individual may face a traumatic situation. Legal understanding is necessary to make health services better at handling trauma (Smillie, 1943). Improving Trauma Care Act of 2014 is an amendment to the existing Public Service Health Act of 1944. It adds to the definition of trauma as defined in the act originally. The following paper is a discussion of the Improving Trauma Care Act 2014 and how it amends the trauma care laws in the public health services.
Definition of Trauma was ascertained through consultation of various medical studies done on patients in various hospitals throughout the United States. Also the Public Service Health Act was studied to understand the difference between the medical and legal interpretation of the Trauma state. Medical researches took samples from patients in a particular age group to ascertain the condition and cause, using parameters like mortality caused due to trauma and the causes of these trauma. The motive of the study was to find the most concise definition of the word Trauma and how it needs to be addressed in legal terminology.
It was found through research of legal literature and medical journals that the legal definition of the word Trauma only included trauma caused due to severe injury caused by an external mechanical force. It was found that there was a need to extend the definition of the word trauma in the existing Act to include factors other than external mechanical forces that cause severe injuries leading to trauma.
Trauma as defined in the medical terminology is the state of physical and emotional health of an individual who has experienced severe injury, where an injury is term used for damage to any biologically living being causing harm to the being as a result (Deaconess Trauma Services, 2004). An injury may be caused due to any external factor, voluntary or involuntary in nature, leading to damage to damage to the body, which may result in improper functioning or permanent failure of biological processes in the body. Injuries to the body may be caused due to physical forces that can be mechanical, chemical, thermal, electrical or radioactive in nature. All such forces may lead to deep seated damages to the biological mechanisms when such forces impact the body or a part of the body, resulting into situations where the life of the affected individual may be threatened. A Trauma situation may be caused due to events like severe wounds causing blood loss, severe burns, severing of an appendage, loss of sight, internal hemorrhage etc. (Haut, Kalish, Efron, Haider, Stevens, Kieninger, Cornwell and Chang, 2010).
Trauma care centers are medical centers and hospitals equipped with special staff skilled in treating patients suffering from traumatic injuries and equipment used for their treatment. However not all hospitals can be termed as medical trauma centers. In order for a medical facility to be termed as a trauma center, it needs to be accredited by the American College of Surgeons and an on-site review by Verification Review Committee (Deaconess Trauma Services, 2004). Trauma centers may be segregated on the basis of their capabilities into different levels. These segregations can be on the basis of the equipment and the skill of the staff. At higher levels trauma centers may also employ doctors and surgeons specialized in treatments like neurosurgery, etc. (Palmer, 2007). Trauma patients are in a very delicate situation and the staff attending to them must put in a lot of effort to treat their patients out of the trauma (Palmer, 2007). There are hazards involved in trauma care as well. Hazards may include untimely delivered medical attention, hindrance in medical procedures, wrong identification of a trauma patient as a non-trauma patient etc. (Rae, 2007). These hazards may lead to death of the patient. Every trauma center therefore must keep guidelines ready for their trauma care specialists to act upon an emergency situation and identify a traumatic condition as it develops (Deaconess Trauma Services, 2004).
Public Health Service Act of 1944 is a United States federal law captured under Title 42 of the United States Code, Chapter 6A, and deals with Public Health and Welfare under Public Health Services (78th U.S. Congress, 1944). The law is a defining factor in the public health service domain and is a moving code for public health services to research health service issues and implement measures to promote public health. These services include Public Health Programs, awareness programs, research directives and health care in emergency situations. The law defines the term Trauma as a state of injury caused by any severe external mechanical force. Researches show that the leading causes of death due to trauma include injuries caused due to motor vehicle accidents, assaults with weapon or falls from heights (Eid and Abu-Zidan, 2014). However, with advent of industrialization, increased occupational hazards and change in lifestyle, the legal definition falls short in describing other factors that may cause a state of Trauma.
In medical terms physical trauma may be caused due to many extrinsic agents. These not only include mechanical agents but also other agents that may cause severe physical injury to an individual. The first amongst these extrinsic agents is heat.
Exposure to or impact of heat on the body may cause inflammation, burning of the skin as well as damage to the internal organs, leading to loss of function or complete debilitation of body parts. Electrical shock is another cause for internal as well as external injuries. Burn wounds are difficult to heal and exposure to atmospheric elements may worsen the wound considerably.
Electric shock may damage the nervous system of an individual causing cognitive impairment or loss of one or more senses. In addition to these effects electrical shock may produce severe burning in the affected area.
Certain chemical agents are very harmful for health. Consumption, inhalation or direct contact may cause injuries to the body systems almost instantaneously. These agents may include acids, acrid and poisonous gases, reactive solids and minerals that can cause atrophy in living tissues.
Radioactivity is another modern day hazard. It is a natural phenomenon shown by certain elements in nature. This phenomenon causes production of radiations that are harmful to living tissues. Radiations cause ionization and disintegration of living cells causing them to be permanently damaged or turning into tumors. These tumors may be cancerous and become life threatening to the victim.
Trauma centers require highly sophisticated equipment to provide medical attention to patients suffering from trauma caused due to all of these extrinsic agents. Specialized doctors are required to treat patients with such trauma. However, since the legal definition and the medical definitions do not coincide with each other, trauma caused due to extrinsic agents other than mechanical force are not looked upon as trauma in the legal sense. Although medically the severity is understood and infrastructure exists for the treatment of such patients, policies do not bind these treatments legally and therefore these treatments do not come under the purview of the law.
Public Health Service Act defines trauma to be caused due an injury resulting from an external mechanical force (Gostin, 2008). Other factors that are medically recognized to cause trauma are not included in this definition, which limits the effectiveness of legal actions in cases of trauma. The direct impact also affects the staff that attend to cases of trauma therefore adding to the importance of medico-legal involvement in a medico-legal case of major trauma. Also the lack of a complete definition makes it difficult to pass legislature in cases of which the cause of trauma is not mechanical in nature.
Hence there was a need of addition or modification in the definition of the word trauma to include other factors that would cause physical trauma. It is necessary to define issue for it to be addressed completely in terms of the most recent available information. Doing so increases the ability to produce better planning and policy making capabilities. Therefore the Improving Trauma Care Act of 2014 bill was taken into consideration by the 113th Congress of the United States of America. The Act amended the definition of trauma as previously mentioned in the Public Service Health Act. This amendment added other medically recognized factors for cause of trauma. These terms include thermal, electrical, chemical, radioactive, and other extrinsic agents. The present definition of trauma according to the Improving Trauma Care Act reads as the follows:
“The term `trauma' means an injury resulting from exposure to--
(A) A mechanical force; or
(B) Another extrinsic agent, including an extrinsic agent that is thermal, electrical, chemical, or radioactive.''.
(Speaker of the House of Representatives, 113th Congress of the United States of America)
The new definition supports the medical perspective of the factors causing physical trauma, giving the perspective a legal support. This amendment is a part of series of amendments that are to come in the medico-legal structure. With the amendments in the definition of trauma, committees and health standard association may now add standards of medical care for trauma patients who suffer injury because of causes such as severe burning caused due to heat, electrical shock, poisoning, deterioration and corrosion due exposure to harmful chemical substances, or degradation caused due radioactive exposure. It is in many ways, in line with the medical definition of the trauma state and therefore is liable to effect policies related to trauma care facilities, professionals working for such facilities and trauma care services
Conclusion & Recommendations
Health is one of the most important aspects of a person’s life. For this very reason, health care assumes a very important role in public welfare as well as State welfare. The health of a nation depends a lot on the medical laws and policies that its government puts into place for its people. These policies control and compliment the medical services and directs them to provide medical facilities to citizens with constant improvement. The US Public Welfare policies have been in place for decades and these policies have evolved with new innovations and breakthroughs in medical sciences. Also, these policies have promoted both public health as well as efforts to maintain and improve public health at large.
Although the Improving Trauma Care Act of 2014 may not be based on a medical breakthrough, it relates to a crucial medical service, the care of patients under major trauma and enhances its functioning thereof. An addition to the definition of trauma in the United States’ code of law may culminate into increased efforts in trauma care along with improvements in the Trauma Care Centers function. The biggest benefit of this amendment lies in the fact that the legal and medical definitions of physical trauma now align to each other at higher degree. The present definition of trauma widens the scope for health service authorities to create policies for patients who suffer severe injury from external causes other than mechanical impact.
Although Improving Trauma Care Act is highly beneficial move and it may set example for standards for trauma care across the world, medical laws must be analyzed and amendments should be made to accommodate recent and proven medical facts into such laws so as to help medical services in developing and providing better health services and health standards.
It is also the duty of every person to help improve health standards and conditions on their own by helping medical authorities with regular feedback of the policies that put forward for public health care. The revision in definition of the term Trauma may lead to many reforms in medico-legal practices as well as revisions in certifications of units equipped and certified as Trauma Centers. It is recommended that medically proven definitions must be incorporated into medico-legal law where ever possible and necessary. This may help in providing better jurisdiction as well promotion of better health care.
78th U.S. Congress (May 23, 1944). "H.R. 4624, Public Health Service Act, May 23, 1944". Chapter 373, cited 58 U.S. Stats. 682. U.S. Capitol Visitor Center.
Deaconess Trauma Services (2004). Definition of the Trauma Patient. Practice Guideline. Deaconess. Evansville. Indiana. Retrieved from http://www.deaconess.com/pdfs/trauma/trauma-guidelines/introduction/definitiontraumapatient.aspx
Eid, H.O., Abu-Zidan F.M. (2014). Pedestrian Injuries-Related Deaths: A Global Evaluation. World J Surg. 2014 Nov 6. PMID: 2537368
Gostin, L. O. (2008). "Box 8: The Federal Presence in Public Health". Public Health Law: Power, Duty, Restraint, Revised and Expanded (2nd Ed.). University of California Press. p. 156. ISBN 0520253760.
Haut ER, Kalish BT, Efron DT, Haider AH, Stevens KA, Kieninger AN, Cornwell EE, Chang DC (2010). Spine immobilization in penetrating trauma: more harm than good? J Trauma. 2010 Jan; 68(1):115-20; discussion 120-1. doi: 10.1097/TA.0b013e3181c9ee58. PMID: 20065766
Improving Trauma Care Act of 2014 (H.R. 3548; Pub. L. 113–152)
MacKenzie E.J., Rivara F.P., Jurkovich G.J., Nathens A.B., Frey K.P., Egleston B.L., Salkever D.S., Scharfstein D.O. (2006). A national evaluation of the effect of trauma-center care on mortality. N Engl J Med. 2006 Jan 26; 354 (4):366-78. PMID: 16436768
Palmer, C (2007). "Major trauma and the injury severity score--where should we set the bar?" Annual proceedings / Association for the Advancement of Automotive Medicine. Association for the Advancement of Automotive Medicine 51: 13–29. PMC 3217501. PMID 18184482.
Rae, O.J. (May 2007). "The Orchard Sports Injury Classification System (OSICS) version 10". Clin J Sport Med. 17 (3): 201–4. doi:10.1097/jsm.0b013e318059b536. PMID 17513912.
Smillie, W. G. (1943). "The National Board of Health, 1879-1883" American Journal of Public Health and the Nation's Health. 33(8):925-930.
Torres, S. (n.d,) "Support the Reauthorization of the Trauma Systems Regionalization of Emergency Care Act". Trauma Center Association of America.