[Congressional Record Volume 155, Number 53 (Monday, March 30, 2009)]
[House]
[Pages H4084-H4086]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                             WAKEFIELD ACT

  Mr. PALLONE. Mr. Speaker, I move to suspend the rules and pass the 
bill (H.R. 479) to amend the Public Health Service Act to provide a 
means for continued improvement in emergency medical services for 
children, as amended.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                                H.R. 479

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Wakefield Act''.

     SEC. 2. FINDINGS AND PURPOSE.

       (a) Findings.--Congress makes the following findings:
       (1) There are 31,000,000 child and adolescent visits to the 
     Nation's emergency departments every year.
       (2) Over 90 percent of children requiring emergency care 
     are seen in general hospitals, not in free-standing 
     children's hospitals, with one-quarter to one-third of the 
     patients being children in the typical general hospital 
     emergency department.
       (3) Severe asthma and respiratory distress are the most 
     common emergencies for pediatric patients, representing 
     nearly one-third of all hospitalizations among children under 
     the age of 15 years, while seizures, shock, and airway 
     obstruction are other common pediatric emergencies, followed 
     by cardiac arrest and severe trauma.
       (4) Up to 20 percent of children needing emergency care 
     have underlying medical conditions such as asthma, diabetes, 
     sickle-cell disease, low birth weight, and bronchopulmonary 
     dysplasia.
       (5) Significant gaps remain in emergency medical care 
     delivered to children. Only about 6 percent of hospitals have 
     available all the pediatric supplies deemed essential by the 
     American Academy of Pediatrics and the American College of 
     Emergency Physicians for managing pediatric emergencies, 
     while about half of hospitals have at least 85 percent of 
     those supplies.
       (6) Providers must be educated and trained to manage 
     children's unique physical and psychological needs in 
     emergency situations, and emergency systems must be equipped 
     with the resources needed to care for this especially 
     vulnerable population.
       (7) Systems of care must be continually maintained, 
     updated, and improved to ensure that

[[Page H4085]]

     research is translated into practice, best practices are 
     adopted, training is current, and standards and protocols are 
     appropriate.
       (8) The Emergency Medical Services for Children (EMSC) 
     Program under section 1910 of the Public Health Service Act 
     (42 U.S.C. 300w-9) is the only Federal program that focuses 
     specifically on improving the pediatric components of 
     emergency medical care.
       (9) The EMSC Program promotes the nationwide exchange of 
     pediatric emergency medical care knowledge and collaboration 
     by those with an interest in such care and is depended upon 
     by Federal agencies and national organizations to ensure that 
     this exchange of knowledge and collaboration takes place.
       (10) The EMSC Program also supports a multi-institutional 
     network for research in pediatric emergency medicine, thus 
     allowing providers to rely on evidence rather than anecdotal 
     experience when treating ill or injured children.
       (11) The Institute of Medicine stated in its 2006 report, 
     ``Emergency Care for Children: Growing Pains'', that the EMSC 
     Program ``boasts many accomplishments . . . and the work of 
     the program continues to be relevant and vital''.
       (12) The EMSC Program is celebrating its 25th anniversary, 
     marking a quarter-century of driving key improvements in 
     emergency medical services to children, and should continue 
     its mission to reduce child and youth morbidity and mortality 
     by supporting improvements in the quality of all emergency 
     medical and emergency surgical care children receive.
       (b) Purpose.--It is the purpose of this Act to reduce child 
     and youth morbidity and mortality by supporting improvements 
     in the quality of all emergency medical care children 
     receive.

     SEC. 3. REAUTHORIZATION OF EMERGENCY MEDICAL SERVICES FOR 
                   CHILDREN PROGRAM.

       Section 1910 of the Public Health Service Act (42 U.S.C. 
     300w-9) is amended--
       (1) in subsection (a), by striking ``3-year period (with an 
     optional 4th year'' and inserting ``4-year period (with an 
     optional 5th year'';
       (2) in subsection (d)--
       (A) by striking ``and such sums'' and inserting ``such 
     sums''; and
       (B) by inserting before the period the following: ``, 
     $25,000,000 for fiscal year 2010, $26,250,000 for fiscal year 
     2011, $27,562,500 for fiscal year 2012, $28,940,625 for 
     fiscal year 2013, and $30,387,656 for fiscal year 2014'';
       (3) by redesignating subsections (b) through (d) as 
     subsections (c) through (e), respectively; and
       (4) by inserting after subsection (a) the following:
       ``(b)(1) The purpose of the program established under this 
     section is to reduce child and youth morbidity and mortality 
     by supporting improvements in the quality of all emergency 
     medical care children receive, through the promotion of 
     projects focused on the expansion and improvement of such 
     services, including those in rural areas and those for 
     children with special health care needs. In carrying out this 
     purpose, the Secretary shall support emergency medical 
     services for children by supporting projects that--
       ``(A) develop and present scientific evidence;
       ``(B) promote existing and innovative technologies 
     appropriate for the care of children; or
       ``(C) provide information on health outcomes and 
     effectiveness and cost-effectiveness.
       ``(2) The program established under this section shall--
       ``(A) strive to enhance the pediatric capability of 
     emergency medical service systems originally designed 
     primarily for adults; and
       ``(B) in order to avoid duplication and ensure that Federal 
     resources are used efficiently and effectively, be 
     coordinated with all research, evaluations, and awards 
     related to emergency medical services for children undertaken 
     and supported by the Federal Government.''.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from New 
Jersey (Mr. Pallone) and the gentleman from Louisiana (Mr. Scalise) 
each will control 20 minutes.
  The Chair recognizes the gentleman from New Jersey.


                             General Leave

  Mr. PALLONE. Mr. Speaker, again, I ask unanimous consent that all 
Members may have 5 legislative days in which to revise and extend their 
remarks on the bill.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from New Jersey?
  There was no objection.
  Mr. PALLONE. I yield myself such time as I may consume.
  Mr. Speaker, I rise in support of H.R. 479, the Wakefield Act. Every 
year, more children between the ages of 1 and 19 die due to injury than 
all other forms of illness. Though we have made huge advances in our 
system to provide rapid interventions and transport for adults, there 
has been only limited focus on the specialized needs of children.
  Recognizing this gap in knowledge, Congress created the Emergency 
Medical Services for Children grant program in 1984, which is designed 
to ensure state-of-the-art emergency medical care for ill or injured 
children and adolescents.
  The bill before us today reauthorizes this vital public health care 
program that covers the entire spectrum of emergency medical care. It 
also allows grants awarded under the EMSC program to be 4 years, with 
an optional fifth year, which is an increase of 1 year over current 
law.

                              {time}  1545

  I would like to thank my colleague from Utah, Representative 
Matheson, for his hard work on this issue. We passed this bill out of 
the House of Representatives last Congress, and I urge us to pass it 
again this year.
  Mr. Speaker, I reserve the balance of my time.
  Mr. SCALISE. Mr. Speaker, I rise in support of H.R. 479, the 
Wakefield Act.
  This legislation was introduced by Representative Jim Matheson, and 
was passed by the House last Congress. The bill reforms the Public 
Health Service Act to improve emergency medicine services for children.
  The Wakefield Act would authorize grants to States and medical 
schools to purchase equipment for children requiring trauma or critical 
care. About 31 million children and adolescents visit emergency rooms 
every year, and more than 90 percent of them are seen in general 
hospitals, not in children's hospitals that are best equipped to treat 
them.
  The bill also requires the Secretary of Health and Human Services to 
support projects that are based on scientific evidence, promote 
innovative technology, and provide information on health outcomes, 
including cost effectiveness. I urge my colleagues to support H.R. 479.
  Mr. MATHESON. Mr. Speaker, I am pleased to rise today in support of 
my legislation. H.R. 479, the Wakefield Act, which seeks to reauthorize 
the Emergency Medical Services for Children (EMSC) program.
  Unfortunately, today the hospital emergency department has become the 
fundamental source of our health care delivery system for both primary 
and emergency care. Due to this trend, it's easy to forget that 
emergency medicine is actually a relatively new specialty. Emergency 
rooms were first established in the 1970s as medical personnel 
returning from the Vietnam War sought to put to use the battlefield 
medicine they had learned. Skills initially developed to save wounded 
soldiers were translated to saving victims of car crashes and trauma.
  That genesis in battlefield medicine, however, failed to account for 
the very different physical, developmental, and physiological traits of 
children. By the early 1980s, doctors were seeing marked disparities in 
survival rates among adults and children with similar injuries.
  Created in 1984, the EMSC program sought to address those disparities 
in children's emergency care. The program has driven fundamental 
changes in America's emergency medical system and brought vital 
resources and attention to a neglected population. Since it was 
established, child injury death rates have dropped 40 percent. With the 
aid of research and attention from the EMSC program and others, 
pediatric emergency medicine was developed, and was ultimately 
established as a separate medical subspecialty in 1992.
  This year we are proud to celebrate the 25th anniversary of the EMSC 
program. The EMSC program provides seed money to every state and 
territory to carry out activities designed to improve children's 
emergency care. States may use those funds to ensure that hospitals and 
ambulances are stocked with appropriate equipment and supplies; to 
provide pediatric training to paramedics; to improve systems, such as 
transfer agreements among facilities; and much more. The program also 
supports the National EMSC Resource Center, an information 
clearinghouse that provides materials and technical support to states 
and institutions. The Pediatric Emergency Care Applied Research Network 
links pediatric emergency providers across the nation to perform 
research on injury and illness among children. The National EMSC Data 
Analysis Resource Center--based in my district at the University of 
Utah--assists states to collect, analyze, and utilize EMSC data.
  The EMSC program's authorization expired in September 2005. In summer 
2006, the Institutes of Medicine released a report entitled, 
``Emergency Care for Children: Growing Pains,'' which documented both 
the value of the EMSC program and the gaps that remain in providing 
quality emergency care for all children. The report found that, 
although children represent 27 percent of all emergency department 
visits, only about 6 percent of emergency departments have all of the 
supplies deemed essential for managing pediatric emergencies, and only 
half of hospitals have at least 85 percent of those supplies. The 
report described the EMSC program as ``well positioned to assume [a] 
leadership role'' in addressing deficiencies in emergency care for

[[Page H4086]]

children and recommended funding the program at $37.5 million per year.
  H.R. 479, the Wakefield Act, has bipartisan, bicameral support. The 
bill is also endorsed by over 50 organizations, including the American 
Academy of Pediatrics, the American College of Emergency Physicians, 
the American Medical Association, the Emergency Nurses Association, and 
many more. I would like to thank Energy and Commerce Committee Chairman 
Waxman and his staff for working with me and my staff to move this 
legislation forward.
  Last year, the House passed this bill on a vote of 390-1. I urge 
every Member to support this important legislation once again--
together, we can work to ensure that our nation's children have the 
best possible medical care during emergencies.
  Mr. KING of New York. Mr. Speaker, today I rise in strong support of 
H.R. 479, the Wakefield Act, which will reauthorize the Emergency 
Medical Services for Children program for an additional four years.
  Since its establishment in 1985, the Emergency Medical Services for 
Children program, also known as EMSC, has provided grants to all fifty 
states, the District of Columbia, and five U.S. territories to ensure 
that every child in America has access to quality, appropriate care in 
a health emergency. The EMSC program has improved the availability of 
child-appropriate equipment in ambulances and emergency departments, 
supported hundreds of programs to prevent injuries, and provided 
thousands of hours of training to EMTs, paramedics, and other emergency 
medical care providers.
  In my home state, New York's EMSC program is working to provide 
ongoing assessment and improvement of medical care for critically ill 
or injured children. The state EMSC Advisory Committee continually 
meets to discuss plans for designating health care resources to 
optimally serve the needs of critically ill or injured pediatric 
patients. This Committee is currently designing a road map of 
resources, standards, and roles for hospitals within the state and for 
the statewide EMS system as a whole. The plan will improve the state's 
ability to bring children to the hospitals that are best equipped to 
treat them as well as establish a general set of interfacility 
guidelines.
  Kids are not just small adults. Methods to treat children in 
emergencies vary greatly from methods used with adults in the same 
situations. The EMSC program is an integral part of preparing our 
nation's healthcare providers and giving them the tools they need to 
treat children in an emergency. This is especially significant at a 
time in our history that disaster preparedness, both due to natural 
disasters as well as potential terrorist attacks, is so important.
  I would like to thank Representative Matheson for his leadership on 
this issue, as well as Representatives Castor and Reichert for their 
continued support. I urge my colleagues on both sides of the aisle to 
support this imperative bill.
  Mr. SCALISE. Mr. Speaker, I have no speakers. I yield back the 
balance of my time.
  Mr. PALLONE. Mr. Speaker, I yield back the balance of my time, and 
ask for passage of the bill.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentleman from New Jersey (Mr. Pallone) that the House suspend the 
rules and pass the bill, H.R. 479, as amended.
  The question was taken.
  The SPEAKER pro tempore. In the opinion of the Chair, two-thirds 
being in the affirmative, the ayes have it.
  Mr. BROUN of Georgia. Mr. Speaker, on that I demand the yeas and 
nays.
  The yeas and nays were ordered.
  The SPEAKER pro tempore. Pursuant to clause 8 of rule XX and the 
Chair's prior announcement, further proceedings on this motion will be 
postponed.

                          ____________________