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The Coalition for American Trauma Care is a nonprofit association of national health and professional organizations that seeks to improve care for the seriously injured patient through improved delivery of trauma care services, research and rehabilitation activities. The Coalition also supports efforts to prevent injury from occurring. Injury is one of the most important public health problems facing the United States today. It is the leading cause of death for Americans from age 1 through age 34. More than 145,000 people die each year from injury, 88,000 from unintentional injury such as car crashes, fires, and falls, and 56,000 from violence-related causes. Over 85 children and young adults die from injuries in the U.S. every day translating into 30,000 deaths annually. Injury is also the most frequent cause of disability. Millions of Americans are non-fatally injured each year leaving many temporarily disabled and some permanently disabled with severe head, spinal cord, and extremity injuries. Because injury so often strikes the young, injury is also the leading cause of years of lost work productivity and, at an estimated $224 billion in lifetime costs each year, trauma is our nation's most costly disease. Trauma Care Systems - The Coalition is extremely disappointed that Congress failed to appropriate any funding for the Health Resources and Services Administration's Trauma-EMS program in FY 2007 and urges the Subcommittee to provide $12 million in funding for FY 2008. Congress is in the process of re-authorizing the program (H.R. 727; S. 657) at a level of $12 million for FY 2008. In recent days both the House Energy and Commerce Committee and the Senate Health, Education, Labor and Pensions Committees approved their respective bills unanimously. The Trauma-EMS program, administered by HRSA for five years, from FY 2001- 2005, provided critical national leadership which leveraged additional scarce state dollars to strengthen trauma systems so that seriously injured individuals, wherever they live, receive prompt emergency transport to the nearest appropriate trauma center within the "golden hour." Receiving appropriate, quality trauma care within one hour of injury saves lives and provides the best chance for a good recovery. Achieving this result takes coordination, commitment of staff, development and implementation of standards of care, a process for designating trauma centers, and evaluation. No other program in the federal government addresses this critical aspect of the nation's emergency response infrastructure. According to the Trauma-EMS Systems Program Assessment Rating Tool (PART) released by the OMB, "the Trauma Care program has demonstrated success in assisting States in adopting statewide standardized triage protocols and designating trauma centers. Studies indicate with some consistency that improving organized systems of trauma care, specifically States designating trauma centers and adopting standardized triage protocols, leads to measurable decreases in mortality due to trauma." Despite this progress, only eight states have fully developed trauma systems; twelve states do not even have the authority to designate trauma centers. In a recent Harris Poll, large majorities of the American public said they valued trauma centers and systems as highly as having a police or fire department in their community. We therefore request that you reinstate funding for this vital, life saving program. National Center for Injury Prevention and Control -- The Coalition supports $168 million in funding in FY 2008 for the National Center for Injury Prevention and Control which is currently funded at $138 million. The Coalition is exceedingly pleased with the support CDC has provided for the National Evaluation of the Effect of Trauma Center Care on Mortality. The results of this study, published in the January 26, 2006 New England Journal of Medicine, were that care at a trauma center lowers by 25 percent the risk of death for injured patients compared to treatment received at non-trauma centers. The NCIPC supports a range of injury prevention activities and through evaluation has proven their effectiveness in many areas. Just two examples of these: reduction of the more than 20,000 head injuries that occur every year by encouraging the use of bicycle helmets and reduction of burn-related injuries through smoke detector implementation programs. Traumatic Brain Injury (TBI) -- Traumatic brain injury is a leading cause of trauma-related disability. Brain injury is a silent epidemic that compounds every year, but about which still little is known. The Coalition is opposed to the proposed elimination of this important program in the President's FY 2008 budget request and urges you to provide a total of $30 million for the Traumatic Brain Injury (TBI) Act, as follows: $9 million for CDC to strengthen state and local data collection activities, improve linkage of persons with TBI to services, increase public education and awareness, and conduct public health research related to TBI. Within the $30 million, the Coalition also supports $15 million for the HRSA TBI State Grant Program to ensure that every state, territory and American Indian Consortia can coordinate and maximize resources to serve their TBI population and provide training and technical assistance to grantees. Also within the $30 million total, $6 million is needed for the HRSA Protection and Advocacy Program for population-based allotments to all States to ensure adequate and appropriate assistance to individuals with brain injury in exercisng their rights and accessing public service systems. Children's EMS - The Coalition is opposed to the proposed elimination of this program in the President's FY 2008 budget request and urges you to provide $25 million in FY 2008. While this amount represents a 25 percent increase for this program, it has been flat-funded for six years causing an erosion in available resources due to inflation. Children currently account for up to 30 percent of all emergency department visits and 10 percent of ambulance runs annually, but many facilities lack the specialized equipment needed to care for them. Moreover, many emergency personnel do not have the necessary education or training to provide optimal care to children. In order to assist local communities in providing the best emergency care to children the Children's EMS program needs to continue and continue at a level that allows resources to keep pace with inflation. Preventive Health/Health Services Block Grant (PHHS) -- The Coalition is deeply disappointed that Congress cut funding in FY 2006 for this program by $32 million, or 24 percent, and that the President has proposed to eliminate funding in FY 2008. The Coalition urges you to restore funding to the FY 2005 of $131 million when the Subcommittee marks up its FY 2008 bill. The PHHS Block Grant provides flexible funding to states to allow them to address specific health problems identified under the Healthy People 2010 assessment process. The funding allows states to take innovative approaches to address significant health issues and complements, not duplicates, some of CDC's other program activities. In addition, the PHHS Block Grant is the largest single source of federal funding for support of basic state Emergency Medical Services' (EMS) infrastructure -- the first line of defense against death and disability resulting from severe injury. Rural EMS Training and Equipment Program -- The Coalition urges you to provide $900,000 in funding for the Rural EMS Training and Equipment Program. This program was eliminated in FY 2006 and needs not only restoration, but expansion in FY 2008. Rural areas are in critical need of emergency medical services training and equipment. Recent national events have continued to draw attention to the need for communities to have strong emergency medical systems in place. Unfortunately, while the need for effective emergency medical care may have increased, the number of individuals able to provide these services has declined. This is a particular problem in rural areas where the majority of EMS personnel are unpaid volunteers. As rural economies continue to suffer, it has become progressively more difficult for rural EMS providers to recruit and retain these personnel. As a consequence, emergency medical squads are becoming smaller. The rural EMS training and equipment program awards competitive grants to State EMS Offices, State Offices of Rural Health, local government, and state or local ambulance providers to improve emergency medical services in rural areas. The funds can be used to: Recruit emergency and volunteer medical service personnel; Train emergency medical service personnel in emergency response, injury prevention, safety awareness, and other topics relevant to the delivery of emergency medical services; Fund specific training to meet Federal or State certification requirements; Develop new ways to educate emergency health care providers through the use of technology enhance educational methods (such as distance learning); Acquire emergency medical services equipment including cardiac defibrillators; Acquire personal protective equipment for emergency medical services personnel; and Educate the public concerning cardiopulmonary resuscitation, first aid, injury prevention, safety awareness, illness prevention, and other related emergency preparedness topics. The Coalition for American Trauma Care is both deeply disappointed and alarmed by the President's FY 2008 budget which proposes elimination of all funding for four programs specifically designed to build infrastructure to ensure that trauma and emergency medical services are available and appropriate to need: HRSA's Trauma-EMS systems program; HRSA's Traumatic Brain Injury program; HRSA's Children's EMS program and CDC's Preventive Health and Health Services Block Grant. If these cuts are enacted, the results would be devastating for emergency care in the U.S. for everyone and particularly for children and those who have suffered head injury. The burden of injury in America has been well documented by numerous IOM reports a