trated upon the development of prehospital EMS care. It was not until 1990, with the passage of the Federal Trauma Care Systems Planning and Development Act (P.L. 101-590), that a broader approach to trauma systems, one that systematically organizes prehospital care, acute care, and rehabilitation, was promulgated. This legislation, which called for an inclusive approach to trauma systems development, authorized grants to states and regions for planning, implementing, and monitoring statewide trauma care systems. The Division of Trauma and EMS (DTEMS) was established by the Health Resources and Services Administration (HRSA) to serve as a focal point, implement the legislation, and offer technical assistance to states.

The five-year history of P.L. 101-590 was marked by unfulfilled expectations because appropriations fell substantially short of the $60 million authorization, and states had difficulty during and after the second year in procuring matching funds (Hackey, 1995). Federal appropriations ranged from $4.4 million to 4.9 million from 1992 to 1995 (U.S. Executive Office of the President, 1992–1995). DTEMS was dissolved in 1995 when the legislation was not reauthorized, apparently the result of indiscriminate congressional efforts to reduce the federal deficit rather than to rebuke the program (ACS, 1995). There is some evidence that during its years of implementation, the legislation began to achieve its purpose, insofar as many more states began to launch or fully develop trauma care systems. Still, by 1997, only half of the states reported having trauma systems (Bass, 1997; Goodspeed, 1997).

Current Federal and State Funding for Trauma Care Systems

In a recent survey, 49 states and the District of Columbia reported the receipt of $14.5 million in FY 1996 for EMS and trauma systems funding (Goodspeed, 1997). The funds emanated mostly from block and categorical grants to states and regions and were not necessarily targeted to trauma systems development. Funds are distributed by three federal agencies: CDC, NHTSA, and HRSA.3 Actual federal funding appears to be higher than that reported by states, but cannot be known with precision. Under block or formula grant funding, states are not required to report on the amounts that they allocate specifically to trauma system development. Block and formula grants are designed to give wide discretion to states, in contrast to categorical grant programs, such as that jointly administered by HRSA and NHTSA for the EMS-C Program.

3

In FY 1997, the estimated funding for state and regional trauma systems was $11.9 million from the CDC Preventive Health and Health Services Block Grant and $12.5 million from the Emergency Medical Services for Children (EMS-C) Program sponsored by HRSA and NHTSA. An estimate of trauma system funding from the NHTSA Section 402 State and Community Formula Grants was not available.



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