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This project is designed as a 12 month on-going enhanced training method to increase awareness, advance knowledge, enhance skills, promote safety and build confidence, strengthen patient care, introduce Mental Health 1st Aid Training, increase Opioid OD awareness and Naloxone Admin in the field, as well as to maintain certification and keep our current 10 Emergency Medical Responders; plus train and certify 6-10 new recruits to increase our EMS personnel available to reduce the serious concerns of lack of EMS trained personnel to respond on all calls on a daily basis. The training equipment requested for this Grant project is vital in providing engaged, realistic didactic hands on training with real life simulations that will give EMS provider's skills needed to provide the best patient care for optimum patient outcomes and survival in our Rural community.

Natchitoches Regional Medical Center's (NRMC) (Natchitoches, LA) Supporting Paramedics in Natchitoches (SPIN) project will see NRMC EMS add five (5) paramedics to their staff and purchase the necessary equipment to enhance their current EMS training courses, with an expected 40 EMS personnel trained and 20 EMS personnel certified as a result of the grant funding during the one-year grant period. Natchitoches Parish and NRMC EMS face many socioeconomic challenges, including an imminent crisis from an EMS personnel shortage. As a result, NRMC is in dire need of funding to undertake efforts to bring new EMS staff on board, including through an extensive yet targeted marketing/outreach campaign. Further, working with Bossier Parish Community College (BPCC), three (3) current NRMC EMTs will be enrolled in BPCC's Paramedic program, working their way to become full-time NRMC Paramedics. In addition, the targeted marketing campaign will result in the hiring of at least two (2) additional qualified and competent paramedics. On Dec. 17, 2019, the LA Department of Health approved NRMC as an EMS Education Agency recognized by the LA Bureau of EMS. NRMC is 1 of only 3 EMS Education Training sites in all 32 parishes of central and northern LA. Said approval enabled NRMC to teach refresher courses for EMTs, AEMTs, and Paramedics, and continuing education courses for statewide emergency medical professionals. However, specialized training equipment is needed to more effectively conduct such trainings to meet the highest quality standards. Thus, these grant funds will also support the purchase of such equipment - a training manikin and a chest compression system. This project will have significant benefits not just to NRMC, but to the entire Natchitoches Parish as well.

There are approximately 19,573 citizens of rural Covington County. This county is declared as a rural area by Health Resources and Services Administration, U.S. Department of Agriculture, and U.S. Census Bureau. In 2020, Covington County required 4124 ambulance responses and 3200 transports. The county-owned ambulances responding to these requests is a staff of 30 comprised of EMS drivers, Emergency Medical Technicians, and Paramedics. The Ambulance Service staffs three 12-hour ambulances from 7am to 7pm and two 12-hour ambulances from 7pm to 7am. The average ambulance call is 2 hours long and 40 miles in transport. Over half of the ambulance responses are transported to a level 2 facility in Hattiesburg, Mississippi-30 miles to the south of Collins, were the ambulance service is station. The ambulance call volume annually (4124 in 2020) is roughly equal to the number of individuals living in poverty (4,328 in 2019 census predictions) in Covington County, Mississippi. For the small size, the service is busy. Surrounding Covington County Hospital Ambulance Service, 30 miles in any direction, is a larger, more sophisticated ambulance operation with shorter transport times better equipment and conditions, benefits, advancement, and pay. In the last year with Covid 19 pandemic, two devastating tornadoes, decreasing mental healthcare, and increase volume of substance abuse, Covington County Hospital Ambulance Service is having trouble recruiting EMTs. Recent EMS literature highlights the effects that supervision has on the EMS workforce. Covington County Hospital Ambulance Service shift leaders are good paramedics, but they lack formal supervision training. This may contribute to the turnover and recruitment difficulty. The fleet at Covington County Hospital Ambulance Service is aging. There is not an affordable Certified Ambulance mechanic nearby to provide repairs and preventative maintenance to the vehicles. Currently Covington County Hospital Ambulance Service must outsource billing because of an untrained staff regarding billing and coding. This hinders the fiscal development of the service. The lack of an adequate EMS workforce pipeline, lack of supervision training, deficiencies coding and billing knowledge, and no local ambulance mechanics threatens the sustainability of the ambulance service. It threatens the citizens of Covington County. Covington County Hospital Ambulance Service proposes an educational project to recruit county citizens to participate in EMS Drivers, EMT, or Advanced EMT training. This would create an applicant pool for employment with the Ambulance Service or volunteers with the county fire departments. The educational project would provide formal EMS supervision training and certification to the six paramedics that function as shift leaders; training and certification to three of the management personnel; and training and certification for ambulance mechanics. Covington County Hospital Ambulance Service requests $199,970 to fortify the EMS workforce pipeline for the area. It would ensure uninterrupted emergency services for the citizens of Covington County, Mississippi.

The Lake Health District EMS Training Project will create local training opportunities rarely available in a frontier county. These include emergency medical responder (EMR) and emergency medical technician (EMT) classes; mandatory trainings that will enable current EMTs at all levels to re-certify; and trauma simulation and vehicle extrication training unique to the needs of EMTs in a remote corner of the United States. applicant: Lake Health District, dba Lake District Hospital, Lakeview, Oregon Amount requested: $200,000 Anticipated number of individuals trained: 35, including up to six Lake Health District EMS full-time staff, up to five Lake District Hospital nurses, Lakeview EMS volunteers, and EMTs from other ambulance service districts (ASAs)in Lake County, Oregon Populations served: Residents of Lake County and parts of Klamath County, Oregon; Modoc County, California; and Humboldt County, Nevada. About 7,000 people live in the catchment area, most of whom are blue-collar workers. Many have jobs that take them to remote corners of the ASA, which covers an area the size of Connecticut and Rhode Island combined. Lake County’s median income is 60% of the state’s and nation’s. This makes traveling for trainings required for EMT recertification a financial hardship for some volunteers. Trainings offered: EMR and EMT classes, both of which include naloxone training; critical care transport; pre-hospital trauma life support (PHTLS); Mental Health First Aid; pediatric trauma simulation; vehicle extrication Why extrication: Because the ASA is so remote, ambulances, not fire trucks, carry rescue tools. Lake Health District ambulances have the only rescue tools in 75% of the ASA’s 5,800 square miles. EMTs must operate rescue equipment and treat patients at motor vehicle collision scenes. Goals: This project aims to (1) Recruit and retain EMS personnel; (2) Offer mental health and substance abuse training; and (3) Increase EMTs’ capacity to respond to pediatric traumatic injuries and motor vehicle collisions. Measurable objectives (all end by August 31, 2022): (1) 75% of attendees will pass EMR classes; (2) 75% of attendees will pass EMT classes; (3) 80% of attendees will pass critical care transport training; (4) 90% of attendees will pass PHTLS training; (5) the EMS director will become a certified PHTLS instructor; (6) 20 people will receive naloxone and training; (7) 25% of the EMS roster will complete Mental Health First Aid training; (8) 75% of attendees will pass Mental Health First Aid; (9) 100% of attendees will pass vehicle extrication training; and (10) 100% of medics re-certify in pediatric advanced life support during pediatric trauma simulation training.

The Nauvoo Fire Protection District seeks to reduce the negative impact from increased call volume related to drug abuse by providing a strong infrastructure through public and professional training programs related to emergency care and response. NFPD will provide educational sessions that will result in prompt trained bystander care and the integration of rapid EMS for smooth transition to hospital care by using all levels of provider in the NFPD and neighboring Dallas Rural Fire District area. This will provide a solid infrastructure in a largely underserved area where educational resources are limited.

The Bad River Bad of Lake Superior Tribe of Chippewa Indians, whose homeland is surrounded on three sides by the state of Wisconsin and whose northern border is 38 miles of the Lake Superior shoreline, will use this grant to increase the number of EMS responders available to service our 124,655 acre reservation. A new-hire EMS Coordinator will help recruit a cohort of responders to attend Wisconsin Indianhead Technical College (WITC) EMR/EMT classes, offering support and incentives as needed, including extracurricular trainings, to result in a minimum of 8 newly certified or re-certified EMR/EMTs within a year’s time, with another cohort of 16 mid-course, with 20 additional receiving CPR training, with the expectation that a percentage will continue to complete EMT and higher certification. The Coordinator will set up and run a training schedule for students to practice and customize their schooling. The Coordinator will develop a Bad River EMR/EMT Policies and Procedures Manual which will guide the program into the future. Providing Emergency Medical Responder capabilities in the Bad River Reservation will shorten response and critical prehospital care times and increase survivability outcomes for Bad River Tribal members living in the unceded territory.

Ute Pass Regional Health Service District (UPRHSD) is offering Emergency Medical Service (EMS) learning opportunities for residents of the District and expanding learning opportunities to the rural population with Technology-Enhanced Education (TEE). Through the Leaders in Education Around Rural Need (LEARN) program, rural students will engage in primary and continuing education /advanced EMS certification. This program will allow students to access course material without driving an hour or more to get to a city offering collegiate-level classes. In these rural areas, emergency calls take longer to respond to, and the transport time to definitive intervention for critical patients is extended, necessitating a higher provider level working the calls. The level of new provider training is limited to those residents who can drive over an hour each way for classes, multiple days a week, or who are already trained and can be recruited from outside the District. UPRHSD will continue offering EMS education in partnership with established EMS training Sites, allowing students from the Teller County, CO area to do some classwork closer to home. This year, the LEARN program will equip the UPRHSD classroom to produce podcast-style mini-trainings and incident debriefs, host an interactive Simulation lab for immersive training, record and edit training materials, and live-stream classes to 360 students annually, regardless of their proximity to the building. Learn will provide supplies, equipment, and training on specific medications that will benefit populations at risk for Alcohol or Substance Use Disorder. Principles from social distancing have given the LEARN program ideas on effectively connecting and teaching residents interested in learning and furthering EMS skills.

The population of focus for this program are Emergency Medical Technicians (EMTs), Advanced EMTs (AEMTs), and Paramedics employed by Reno County EMS in Hutchinson, KS, and the Volunteer EMS ambulance services in Pretty Prairie and Haven, KS. Combined, these agencies serve approximately 62,000 people in the third largest county of Kansas. Reno County EMS has two stations located in Hutchinson and one station located in the very rural community of Arlington, which serves several communities in western Reno County. Reno County EMS also provides medical oversight and protocols for Pretty Prairie and Haven EMS. Reno County EMS has identified the following four goals to maximize the impact of the additional education funding: Goal 1, Recertification of EMS Providers Goal 2, Recruit and Graduate EMS Providers Goal 3, Provide Substance Abuse Education to EMS Personnel Goal 4, Provide Mental Health Education to EMS Personnel

The Mercy Health Rural EMS Training Initiative will provide high quality Emergency Medical Services (EMS) training in in the following rural counties/census tracts located in Northwest Ohio: Fulton County (in rural census tract: 040800, Ottawa County (in rural census tract: 050100), and Seneca County. The proposed activities will strengthen the quality and consistency of training of EMS personnel in these rural geographies by delivering continuing education that focuses on the use of hands-on skills using high fidelity manikins with scenarios that mirror common cases and low frequency/high risk procedures. The provided training will be responsive to the needs of the communities in which the EMS personnel serve. Through the grant, Mercy Health will partner with Gorham - Fayette Fire Department in Fulton County, Put-In-Bay EMS in Ottawa County, and Seneca County EMS in Seneca County. The goal is to increase the capacity of rural EMS personnel to provide high quality and consistent emergency medical services in their communities will be achieved by training at least 100 EMS personnel across the three agencies. At least 60 EMS personnel will be trained on care of patients with mental and substance use disorders. At least 60 personnel will also be trained on best practices in the administration of opioid overdose antidotes. The project will result in an infusion of advanced equipment for EMS personnel training, naloxone doses and bag valve masks for overdose treatment, and personal protective equipment such as exhalation filters, and face shields.

The FY2021 EBCI EMS Training project will be utilized to train persons in rural NC to be able to take and successfully pass the required EMS certification examinations. Other credentialed EMS personnel will be able to increase their knowledge and skill level through training not regularly offered in rural locations. The primary populations to be served by the project are persons residing in rural Western North Carolina and its surrounding areas, with an emphasis on the Native American population residing on the Qualla Boundary of the Eastern Band of Cherokee Indians. The goal will be to train at least 40 people in initial EMT education and successfully complete previously started AEMT training. The outcome of the training will be to successfully complete the North Carolina certification examination or the National Registry of EMT's certification examination. There is an additional goal to provide supplemental certifications for already credentialed persons. This being used as recruitment to increase the number of employed EMS professionals in rural EMS agencies. Some of the methods used will be through real-world simulation exercises, guest speakers, critical-care certification review courses, psychological trauma in emergency patients certification courses, and substance/mental health disorders.

As its EMS workforce numbers continue to decline, Lancaster County EMS finds itself battling an opioid epidemic, rapid population increase, and an aging population. Private EMS companies in neighboring counties and retirement have depleted Lancaster County EMS of valuable talent. However, with grant funding, Lancaster has plans for a unique recruiting and training strategy to bolster its workforce to combat the growing turmoil within its borders.

CoxHealth requests $199,917 from SAMHSA for HERO: Helping train EMS in the Rural Ozarks. The HERO Goal for the one-year grant is to increase the number of trained EMS personnel in a rural region through recruitment and education; and retention of existing trained EMS personnel through improved CEU courses in Dade and Douglas counties in Missouri. HERO will serve 49 unduplicated EMS and EMS trainees. CoxHealth, with its partner, Ozarks Technical Community College (OTC) will reach the goal through the following Objectives. 1) By September 14, 2021, HERO will recruit 15 individuals and train them to become certified EMS personnel by August 31, 2022. 2) By February 1, 2022, HERO Program Director will purchase grant-funded equipment and supplies for training and continuing education units. 3) By August 31, 2022, HERO will purchase virtual training supplies and provide 2,528 hours of continuing education to 34 EMS personnel. The HERO geographic catchment area includes Dade and Douglas counties in rural southwest Missouri. The HERO population of focus is high school seniors preparing for graduation, CoxHealth employees seeking job advancement, residents in industries experiencing layoffs and closures, and residents seeking career opportunities beyond the service based industry. Dade and Douglas county residents have higher rates of uninsured, more residents living in poverty compared to the state, and lower levels of education and median household income. The target population was selected due to the residents in these two counties suffering from a vast shortage in EMS providers, high poverty, along with being designated rural and HPSA low income primary care and mental health.

Rural Health Works South Dakota: Addressing the Critical EMT Shortage Rural South Dakota has a critical shortage of emergency medical technicians (EMTs). The proposed program will address this shortage by training 200 rural individuals on crisis intervention (including mental health and substance abuse). Through this program, we will recruit 110 rural community members to cross-train as EMT. We will train 35 high school seniors as EMT. As a result, we will have a strong emergency response network in eastern SD. Rural Health Works South Dakota is a program that combines hospitals, healthcare training professionals, and evaluators to address the healthcare needs in our communities.

San Juan County, a designated rural region in the State of Utah, is home to approximately 15,308 residents, in which 49.9% of the population is American Indian/Alaska Native. San Juan EMS will implement evidence-based curriculum to enhance EMS skills in patient care with cultural competency, mental health and substance abuse. The evidence-based, high-quality curriculum implemented among San Juan EMTs will allow the department to better serve the citizens of San Juan County and enhance competency among San Juan EMTs. San Juan County Emergency Medical Services is a county government agency whose mission is to provide leadership and support to minimize the impact of disasters and other emergencies on the health, safety, and property of the citizens of San Juan County, their businesses and environment through a comprehensive, integrated emergency management program. San Juan County has statistically been one of the poorest counties in the state of Utah. According to the most recent US Census estimates, 22.6% of the county population live below the Federal poverty level, compared to the State of Utah at 9% below the Federal poverty level. San Juan is the largest county in the State of Utah. The county expands across 7,933 square miles where San Juan EMS responds to emergencies in the cities of La Sal, Monticello, Blanding, Bluff, West Water, Mexican Hat and White Mesa. Current US Census data estimates the county has approximately 15,308 residents in which 49.9% are American Indian/Alaska Native, 47.3% White and 5.8% Hispanic. San Juan EMS is requesting $182,426.10 from the Department of Health and Human Services Substance Abuse and Mental Health Services for the Rural Emergency Medical Services Training Grant to enhance technology and professional development of San Juan EMS staff and to enhance community relationships with key stakeholders, including tribal relations. This project will take place solely in San Juan County, Utah and will run from September 2021 to August 2022. This initiative will enhance training services, patient care and sustainability among San Juan EMTs. The project will focus on adequate training delivery and updated equipment to enhance cultural competence, mental health and opioid use prevention, and knowledge and skills among San Juan County EMTs. This initiative will recruit and train new EMTs to increase available responders for 911 emergencies and will build collaboration with community stakeholders and tribal partners. San Juan EMS will implement several strategies to complete all project objectives. This includes collaborating with community partners, seeking input from county mental health and substance abuse coalitions, purchasing innovative EMS equipment and delivering training and course instruction across online, video and face-to-face platforms. Interventions for the project and training curriculum will be implemented by the Project Director and Supervisory Committee through collecting data and measuring objectives. The $182,426.10 request will cover all the project start-up and implementation expenses and project assessment expenses for the duration of the grant and will build upon a three year initiative. We estimate that after our program implementation, 60% of current San Juan EMTs will complete the training curriculum and 50% of the students in the EMT course will pass license requirements.

The Rural Emergency Medical Services Training Project for the Copper River Basin focuses on strengthening reliable and sustainable Emergency Medical Services (EMS) for our vast, rural Alaska region. The project goals address the limited availability of EMS resources, including personnel, instructors, and equipment, which adversely impacts local EMS's ability to respond quickly and efficiently to medical emergencies. The Rural EMS Training Project will train and equip responders to react to complex trauma and emergency medical situations effectively. Our region's EMS personnel serve an area of 20,000+ square miles with a full-time population of around 3,000 residents and nearly 100,000 visitors in the summer due to tourism and fishing. The resident population's racial demographics are 23% Alaska Native, 69% Caucasian, and 8% other. The majority of residents are between 18 and 64 years of age (65%), with only 24% under 18 years of age and 11% 65 years or older. On average, local EMS services respond to 150 to 200 calls annually. The Rural EMS Training Project will provide essential training for providers who will serve 100,000 people annually in the Copper River Basin. With the project focus on recruiting, retaining, and training qualified EMS personnel and overall strengthening EMS resources in our rural region, objectives include training and certifying more new EMS personnel, new local EMS instructors, and recertifying and transitioning all levels of current EMS personnel to meet new, rigorous Alaska State regulations. Currently, our region's active EMS personnel are comprised of 20-22 volunteers and one or two paid FT responders. Due to the lack of local, qualified EMS instructors, EMS training often requires contracted instructors from out of the region on limited availability to provide the appropriate training. This project will increase the number of local EMS instructors by 300%, and will expand the number of active responders by 50% from 24 to 36, including the first-ever homegrown certified paramedic for the region. The project will provide EMS training to 60 unduplicated local residents, which will benefit all current responders and significantly increase the pool of potential recruits for future EMS service. Project staff will provide more than 20 courses, varying from 8 to 80 hours (with Paramedic program training exceeding 1500 hours). Additionally, Basic Life Support and Emergency Medical Responder level certification classes will be offered at the Copper River School District's local high school to develop the next generation of EMS responders. This project's comprehensive course offerings will also enhance local EMS providers’ ability to respond effectively to calls involving mental illness, drug abuse, domestic violence, recognizing/reporting child abuse and neglect, and geriatric emergencies. The Rural EMS Training Project will also provide Copper River Native Association (CRNA) and Copper River Emergency Medical Services Council, Inc. (CREMS) the opportunity to purchase critical supplies and equipment necessary to enhance the quality of EMS training and patient care in the Copper River Basin.

The Sicangu Oyate Ambulance Service Workforce Development Project will provide much needed training and distance learning support to both current and new EMS personnel at the Rosebud Ambulance Service. Emergency medical services in rural American have faced chronic underfunding, difficulty with staff and provider recruitment/retention, and barriers to accessing educational and technical assistance resources from major academic, governmental, and private health sciences research institutions. This project aims to address these key barriers to provide better emergency health services to the Sicangu Lakota Oyate, also known as the Rosebud Sioux Tribe. The Rosebud Sioux Tribe is one of 574 federally recognized American Indian tribes in the United States and one of the seven Lakota tribes of the Ocet Sakowin (known in English as the Great Sioux Nation). The Rosebud Sioux Tribe is a native sovereign nation located on the Rosebud Indian Reservation in southcentral South Dakota with a geographic area of about 1,970 square miles. There are 20 communities located throughout the tribal jurisdiction, which act as political subdivisions. Approximately 85 percent (about 29,705) enrolled tribal members live on the Rosebud Reservation, which makes up the service are for the Rosebud Ambulance Service. The primary project goal will be to deliver 40 hours of Emergency Medical Responder training, 160 hours of Emergency Medical Technician training, 168 hours of advanced EMT training, and 126 hours of Paramedic training to new and existing EMS staff. These trainings will culminate in a minimum of 25 certifications in BLS, EMT, AEMT, and NRP. As part of the EMS training and workforce development, this project will also involved several community trainings on BLS and opioid overdose prevention using naloxone rescue kits. A secondary goal will be to upgrade the onsite training facilities with equipment that support distance learning for EMS staff. The Rosebud Ambulance Service Director will work as the Project Director to oversee implementation of the grant, and a part-time Grant Administrator will be hired to assist with grant implementation, reporting, and closeout

With first responders already being at increased risk for burnout, on the job injury and self-harm behaviors, the 2019 Coronavirus pandemic intensifies the need for education on stress, the impact of stress, how it leads to more debilitating mental health issues and available supports and resources for EMS personnel. Additional education will allow for the continued recruitment of qualified staff and training of current staff for credentialing purposes. Lincoln County Emergency Medical Services (LCEMS) System seeks to expand the current educational program to meet state and national re-credentialing requirements for local paramedics and emergency medical technicians (EMTs) on topics related to behavioral/mental health, toxicology/opioid treatment, psychiatric emergencies, culture of safety, and employee health/wellness. This program expansion would afford LCEMS System the opportunity to educate personnel to recognize when a patient, peer, or they themselves are struggling with the negative effects of stress, focusing on when and how to link to resources and services in order to maintain optimal wellness. This program would include completion of courses such as naloxone administration for opioid overdose treatment, Stress First Aid, International Critical Incident Stress Foundation supported certifications, a locally developed Crisis Intervention Training model focused on local resource linkage, and other courses related to stress management and SAMHSAs eight dimensions of wellness. LCEMS plans to work with area fire and rescue departments to identify and train champions within these ancillary agencies to ensure continuity of the program throughout the LCEMS system. LCEMS would also utilize these educational components to ensure that new hires and new volunteers are trained as a part of their organizational orientation. With the estimation that one in five individuals struggle with mental health issues to a level requiring intervention, this program would seek to successfully link a minimum of 100 first responders during the first year to resources that support optimal wellness and resilience including stress management, behavioral health therapy, nutrition, physical training and fitness, and financial management. The effective development of this program, related policies, procedures, and agency infrastructure will allow LCEMS to better serve the 80,504 individuals estimated to live in Lincoln County by addressing their own health, wellness, and resiliency. The grant implementation team seeks to complete training/certification for both LCEMS system providers and a group of identified mental health professionals to increase staff access to professionals qualified to treat and support the unique needs of First Responders while reducing stigma related with seeking mental health support, enhancing the value of the use of peer support resources offered to employees and volunteers within the LCEMS System, reducing the number of mental health related absences, developing a plan to address mental health crises among system providers, and improving employee and volunteer retention rates.

Through this project, Increasing Access to EMS Critical Care to Meet Critical Health Needs for Underserved Populations in Rural Minnesota and Wisconsin, North Memorial Health Ambulance’s (NMHA) will increase access to Critical Care EMS services for 275,000 individuals throughout rural Minnesota and Western Wisconsin through advanced training for existing EMS first responders and critical care training drills for community partner organizations that provide basic EMS services. The level of care offered to these communities will increase exponentially, especially during the long medical transports required to access higher levels of care outside of their immediate area. Additional training to community-based EMS providers will also address successful mental health and addiction/overdose medical assistance techniques. Skills gained in managing behavioral health and substance use disorder will strengthen the safety net that EMS currently provides in these areas. The project proposes two main goals: • To ensure populations in seven Minnesota/Wisconsin rural districts have access to EMS providers trained in advanced Critical Care techniques that improve health outcomes during frequently experienced emergency situations. • To provide mental health support, overdose and de-escalation training to local and volunteer first responders in all seven rural districts so they can successfully use evidence-based techniques in their practice while addressing the most pressing related needs identified within their communities. To reach these goals, NMHA will support advanced Critical Care training and certification for 25 paramedics, facilitate high fidelity critical care training collaborative drills with at least 8 rural responder organizations utilizing simulation equipment to recreate real-life situations and provide training to 200 community-based first responders in mental health assistance, de-escalation and overdose support. Working with the communities they have served for decades as an EMS provider, NMHA will reach some of the most vulnerable populations in these rural areas who have limited access to health care. Several of the communities, including the whole of 3 counties, have per capita incomes under $23,000 annually, making them among the poorest communities in the areas NMHA serves.

GORDON-WASCOTT EMS IS A RURAL COMBINATION MUNICIPLE AMBULANCE SERVICE WITH 26 MEMBERS ON THE ROSTER RANGING FROM EMERGENCY MEDICAL RESPONDERS TO ADVANCED EMERGENCY MEDICAL TECHNICIANS.

The project will implement programs designed to recruit and train new volunteers to a small, rural based ambulance service in north central Oklahoma, by advertising in both traditional and social media outlets and working with the local school district to identify interested students with a desire to remain in the community and learn new skills. Incentives in the form of post high school scholarships will be made to those who complete training and commit to the service for two years. Additionally, training opportunities, both traditional and innovative, will be made available to existing EMS personnel to encourage them to move to a higher level of EMS certification or to enrich their understanding of and competence with the skills required at their current certification. In person and on line continuing education opportunities will also be provided to make re- certification with state and national agencies easier. Finally, the training program will expand our rural service's ability to effectively care for the significant numbers of mental and substance abuse disorders encountered in emergency situations. All programs will be operated in coordination with the Pawnee Nation of Oklahoma.

South Lincoln EMS Recruiting and Training Program Summary: SLEMS will ramp up recruitment efforts through the use of state-wide online and print newspaper advertisements to find candidates for the IEMT positions that have historically proven difficult to fill; training opportunities will be greatly increased and a mental health component will be added to the curriculum; and lastly, existing EMS staff will be offered an incentive bonus to attain AEMT or IEMT certification. Population: This program will focus on all of the residents of Lincoln County and a portion of the residents in Sublette and Uinta Counties. Total population of all three counties is 49,633 and the average population per square mile for the three counties is 5.53, compared to the national average population per square mile of 87.4. Demographics of our target area are 88.7% White, 7% Hispanic/Latino and 2.7% American Indian or Alaska Native. The majority of the population (94%) primarily speaks English. Residents of Wyoming have a higher rate of asthma, diabetes and COPD than the national average, and are more likely to be smokers. Strategies: SLEMS will expand recruitment for IEMT positions to include state-wide marketing and job fairs; provide training courses that are geared towards specific skill levels; increase the number of training courses offered; ramp up mental health training offered during EMS courses, as well as to all staff on an on-going basis; and incentivize current volunteers and employees to advance their skills and training in order to promote their growth and retention in the organization. Goals: SLEMS has set the following goals: Recruit for open EMS positions by placing state-wide print and online newspaper advertisements; Train individuals to meet State and Federal licensing and certification requirements; Assist trained individuals in obtaining license/certification; Conduct EMS training courses for new and existing EMS and other personnel; Incorporate mental and substance use disorder courses into EMS training curriculum and staff in-services. Objectives: SLEMS has set the following objectives: Recruit one full time paid IEMT Lead Trainer within the first 90 days of funding; Recruit one full time IEMT to conduct regular EMS duties within the first 90 days of funding; Recruit five additional volunteer EMS personnel during funding period; Train up to 60 individuals in the 12-month funding period; Assist up to 20 EMS employees in obtaining/renewing their certifications within one month of their completion of EMS training; Conduct three EMS courses with the capacity to provide training to up to 20 individuals per course; Conduct 8 hours of mental health training per EMS course; and Conduct quarterly staff in-services focused on mental health training with at least 50 employees attending each.

The MiSIREN project will provide training for rural first responders in the Northern Region of the lower peninsula of Michigan, including the three counties in the eastern Upper Peninsula, region commonly referred to as the Thumb, and northern lower peninsula. Eastern Huron Ambulance Service has chosen to partner with the Michigan Rural EMS Network and the Northern Michigan Fire Chiefs Association on this project. The project is an outgrowth of a 2019 Needs Assessment funded by the Staffing for Adequate Fire and Emergency Response (SAFER) program of the Federal Emergency Management Agency and an Office of Rural Health Policy Network Planning Grant. SAMHSA funding will leverage recruitment and retention efforts that are currently underway through a SAFER recruitment and retention implementation grant awarded in December 2019. A SAMHSA training grant will help fill the training demands created through the SAFER recruitment and retention project and increase the competencies related to mental health and substance use disorders for current and new EMS providers. Additionally, we will work with other EMS agencies and fire departments in the catchment area and regional Medical Control Authorities. We will collaborate with the EMS Division of the Michigan Department of Health and Human Services to implement their new SUD curriculum and implement continuing education programs. The MiSIREN project will train a total of 150 unique individuals. The project has three main goals: Goal A: Leverage efforts of the FEMA funded recruitment and retention project to ensure adequate initial certification courses are available to meet increased demand for training. Objective A-1: By September 30, 2022 identify 10 EMS agencies with highest need for assistance with recruitment and demands for certification training. Objective A-2: By March 30, 2022 recruit 75 recruits for participation in EMT courses with 60 successfully completing programs and becoming licensed. Goal B: Increase the capacity of the prehospital medical system. Objective B-1: By December 31, 2021 increase the availability of resources for training of first responders and implementation of system changes. Objective B-3: By August 29, 2022, increase programs to maintain or expand upon the practical skills of EMS personnel in rural areas. Goal C: Increase the competencies of new and existing first responders regarding mental health and substance use disorders. Objective C-1: By August 29, 2022, reduce stigma and barriers to training related to critical stress, mental health, and substance use disorders.

The goal of FY 2021 FM Ambulance project is to substantively expand the reach of rural EMS training to help achieve a fully staffed and well- trained cadre of Emergency Medical Services personnel that proactively support Sanford’s rural health services and clientele across the northern Midwest. The Proposed project is comprised of The SHEMSE training center and eleven rural EMS partners in rural and frontier areas of ND, SD, and MN. The challenges faced by Emergency Medical Service (EMS) providers in the rural and frontier areas of the upper Midwest have been significantly exacerbated by the ongoing COVID-19 pandemic. It has reemphasized the critical need for COVID-19-ready EMS providers to be recruited, trained, and ‘maintained’. As a recipient of a SAMHSA FY 2020 Rural Emergency Medical Services Training Grant, Sanford Health’s EMS Education training center has been working diligently to address these challenges across the existing project’s nine rural and/or frontier partners in the northern Midwest. The strong response SHEMSE has received in FY2020 is the primary driver behind the FY2021 EMS Training project proposed herein. The project will be implemented in two parallel and integrated tracks. Eighty students will be recruited and trained to the EMT certification level, with forty in each class in two successive semesters. Innovative recertification training will be provided to a minimum of 100 current EMT and paramedics, to enable these rural project partner providers to maintain their licensure, as well as their excitement for emergency medicine. This will be integrated with mental health training that incorporates a dual focus on EMS patients and providers. It will include the mental health emergencies that EMS providers may encounter, recognize, assess and treat with their patients, together with the mental health and/or substance use challenges that EMS personnel must manage to maintain their own mental stability and resilience. Specific training on the use of naloxone will be included in both EMT certification and EMT/paramedic recertification training. Mental health training delivery will include SAMHSA-generated modules from the Mountain Plains /Great Lakes Addiction Technology Transfer Center Networks and Mental Health Technology Transfer Center Networks. The project will also access the COVID-19 Behavioral Health Modules produced through Behavior Health Bridge, a Sanford/UND collaboration. The FY 2021 EMS Training project will implement a structured, iterative monitoring and data collection process to drive ongoing project management and to strengthen short- and long-term outcomes. The project director and Project Guidance Team will oversee an adaptive management approach that utilizes required data collection and reporting. The proposed recruitment, training, recertification/mental health training and retention initiatives will result in an increase in emergency medical services personnel at eleven Sanford and other affiliated rural ambulance services or rescue squads across the rural and frontier footprint in Minnesota, North Dakota, and South Dakota.

Based in a bi-county rural and isolated part of coastal northern California, the Rural Emergency Medical Services Training Collaborative (REMSTC) formed to align and expand our local EMS training capacity and to link Mental Health and Substance Abuse education. REMSTC’s strategies are to: 1) Engage and convene all District EMS agencies in collaborative EMS Training rather than working in silos; 2) Expand local certified EMS coursework; and 3) Grow Distant Learning access allowing students remote access to EMS coursework. Our training goals are targeted at recruiting and enticing community members into entry level EMS roles while keeping local EMS First Responders’ licensure and certification current. REMSTC is comprised of five Fire Districts spanning the district. Located in Mendocino County are Redwood Coast and South Coast Fire Protection Districts. In Sonoma County are the North Sonoma Coast, Timber Cove Fire Protection Districts and the Annapolis Volunteer Fire Department. Coast Life Support District (CLSD) is the sole regional ambulance provider and provides two paramedic-staffed ambulances 24/7. There are 135 pre-hospital personnel in total: (9) paramedics, (43) EMTs, (56) firefighters with minimal EMS training, and (26) firefighters with no EMS training. All total, 96% are volunteer. Because the District is sixty miles long, ambulance response times can be 30-40 minutes. Fire EMS personnel are usually first on scene frequently providing initial medical care. Transports to the regional hospitals (none are in the District) are two hours away. Other local partners engaged and committed to improving EMS resilience and Mental Health and Substance Abuse services is the Mendonoma Health Alliance (MHA) offering a diversity of prevention-based and harm reduction services to address Opioid and Substance Use Disorders. Additionally, Redwood Coast Medical Services offering Primary Care, Urgent Care (UC), Dental, and Behavioral Health services. The UC sees over 5,000 patients a year and is an essential EMS partner. The community is comprised of 5,300 full time residents surging to ~11K during the summer and holidays. Currently, a prolonged surge is due to urban flight from the Covid-19 pandemic. With many residents retired, there is a prevalence of chronic diseases (e.g., cardiac, respiratory, hypertension, diabetes and dementia) which strains the limited EMS resources. There is also a growing number of families who speak Spanish at home as well as two Kashia Bands of Pomo Indians on reservations. At the conclusion of this funding cycle, we plan to have a refined program cultivated by data and outcomes analysis that is financially sustainable and a model that can be replicated in other rural communities.

SAMHSA EMS Training TI-21-005 NorthStar Emergency Medical Services (NorthStar), a nonprofit rural emergency medical service, part of MaineHealth d/b/a Franklin Memorial Hospital (FMH) will implement Franklin County, Maine’s Rural Emergency Medical Services Training Project to recruit and train emergency medical services (EMS) personnel in the federally designated rural catchment area of Franklin County (FC), Maine. NorthStar, the sole EMS provider in FC, is part of FMH and also MaineHealth, an integrated not-for-profit health system. Healthy Community Coalition, also a division within the same company, will collaborate to accomplish project goals. Population served is 40,000 and includes EMS personnel, those who could be recruited and trained to serve as EMS personnel, and FC residents. The population like many other rural communities is older, sicker, and poorer. Over 50% of the aging population have more than 3 coexisting chronic illnesses, with 13.7% living below the poverty level. The majority of the population face multiple socioeconomic vulnerabilities. Goals and Objectives include: Goal 1: Increase recruitment, training and retention of EMS personnel in FC, ME by implementing recruitment and training programs. The total unduplicated number of individuals we propose to train with grant funds during the project period is 100. Objectives 1.1: By 7/31/2022, program staff will recruit and train 20 EMS personnel. Objective 1.2: By 5/31/2022, staff will provide EMS career information to 1,000 individuals at 8, state-wide middle/high-schools and career events using face-to-face, virtual and social media platforms. Objective 1.3: By 3/31/2022 NorthStar will provide EMS career information and job-shadowing experiences to 20 University of Maine Farmington students. Objective 1.4: By 6/30/2022, NorthStar will offer Emergency Medical Response training to 20 local fire department, law enforcement officers and volunteer first responders. Objective 1.5: By 7/31/ 2022, NorthStar will strengthen retention strategies to engage 80% of EMS personnel in career expansion programs. Objective 1.6: By 7/31/2022, NorthStar will provide Bridge Program Training to 10 students. Objective 1.7: By 6/15/2022, NorthStar will have conducted a 2-day skills fair/conference. Goal 2: Provide EMS personnel with training to understand, and provide safe, stigma free treatment for mental health and substance use disorders, including Opioid Use Disorder. Objective 2.1: By 6/30/2022, 75% of EMS personnel will have received mental health and substance use disorder training via SAMHSA’s Technology Transfer Centers. Objective 2.2: By 1/31/2022, 75% of EMS personnel will have received Opioid Use Disorder and Naloxone training Objective 2.3: By 11/30/2021, provide four Stigma prevention trainings to reach 75% of EMS personnel. Objective 2.4: By 6/30/2022, 50% of EMS personnel will have received Mental Health First Aid/Trauma Debriefing and Suicide Prevention education. Goal 3: To ensure EMS personnel have the equipment and training tools needed to provide high quality care. Objective 3.1: By 7/31/2022, NorthStar staff will utilize appropriate training equipment in training classes.