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LAWCO EMS Ready will train and equip[ Lawrence County’s Emergency Medical Service to address the particular challenges they face today. This includes personnel shortages, personal safety concerns, the growing number of calls related to substance abuse and behavioral health, and limited opportunities for education and interaction with peers facing similar challenges. LAWCO EMS Ready will serve residents and visitors within the boundaries of Lawrence County, Tennessee. This is a rural community with residents who have lower than Tennessee’s average income, education level, and access to physicians and mental health care providers. LAWCO EMS Ready proposes training for all LCEMS employees from the Opioid Response Network and the Lawrence County Substance Abuse Prevention Coalition. Narcan administration will be provided as needed when new employees join LCEMS. Additional training will prepare 15 EMS staff members for tactical response, and a total of 26 staff members to perform vehicle extrications. The grant also requests funding for PPE specific to those situations. To combat personnel shortages and improve employee skill sets, LAWCO EMS Ready will offer scholarships allowing two EMS graduates to complete EMT/Advanced EMT training; two to earn Paramedic Certification; and two more to earn Critical Care Paramedic Certification. Conference and travel expenses are also included in order to allow LCEMS Director and Assistance Director to benefit from educational opportunities. Shift Supervisors will also attend two of these conferences. A partner in this effort is the Lawrence County Substance Abuse Prevention Coalition, who Lifeline Coordinator helps get patients to SUD treatment. Improved data collection will help LCEMS to follow up on these patients and behavioral health patients who are transported to the local Emergency Room.

Abstract Title: Mississippi Mental Health Intervention for Emergency Services Introduction: Emergency Medical Services (EMS) personnel are suffering opioid addiction and mental health crisis at rates far outpacing other societal groups. EMS personnel are consistently exposed to human suffering, high levels of stress, trauma, and critical incidents, which puts them at increased risk for developing mental health conditions such as addiction, anxiety, depression, and post-traumatic stress disorder (PTSD). In addition to the required activities, the grant will provide mental health training and support to EMS professionals to reduce the prevalence of mental health issues and opioid addiction, thereby ensuring they are better equipped to provide quality care to patients. Target Population: Mississippi has more than 5000 licensed EMS personnel. This grant seeks to provide mental health wellness and opioid prevention education to 10% of the EMS population through face to face and asynchronous course delivery in the first year. Goal: Improve mental health among Mississippi EMS Workforce Objectives: 1. Quantify the level of mental health wellness of Mississippi EMS workforce at the beginning and three months after the conclusion of the treatment. 2. Provide six in-person seminars throughout Mississippi to inform EMS professional how to recognize within themselves and colleagues the signs of mental illness, stress induced maladaptive behaviors, and treatment resources. 3. Produce an asynchronous version of the seminar available on-line at MSCAPM’s learning management system. 4. Use data, results, conclusions, and experience to construct the second-year project to provide industry specific EAPs for the EMS workforce. Methods: Mississippi Center for Advancement of Prehospital Medicine has developed a partnership with physicians with a specialty in psychiatry at Mississippi State Hospital to develop a course specific for educating the EMS personnel on mental health wellness and opioid avoidance strategies. The education course will include a pre and post course mental health assessment tool which will be used to gather data on the mental health wellness of the EMS workforce. The education course will be delivered two times in each of Mississippi’s public health districts in a face-to-face format by physicians from the Mississippi State Hospital. The course will also be PREVIEW Date: May 08, 2023 Workspace ID: WS01105012 Funding Opportunity Number: TI-23-011 recorded, produced, and packaged for asynchronous delivery with integrated mental health assessments. Expected Outcomes: It is expected that the implementation of this comprehensive approach will result in: 1. Improved mental health and well-being among EMS personnel. 2. Reduced incidence of opioid addiction among EMS personnel. 3. Increased awareness and understanding of opioid addiction prevention and treatment among EMS personnel. 4. Enhanced support network for EMS personnel struggling with mental health issues or opioid addiction. Conclusion: The proposed grant project seeks to address the critical issues of mental health and opioid addiction among EMS personnel by implementing a comprehensive approach that includes mental health wellness, education and training on opioid addiction prevention and treatment, and a support network. By addressing these interrelated issues, this project will improve the overall health and well-being of EMS personnel, enhance the quality of care provided to patients, and ultimately improve public health outcomes.

The Missouri Rural Emergency Services Collaborative for Underserved Education EMS Training Program (MO-RESCUE) aims to provide paramedic education for rural EMS providers looking to advance their training and develop a continuing education program for rural Missouri EMS agencies both of which include comprehensive training in mental health and substance use care. The objectives of the MO-RESCUE Training Program are: 1. Train EMS personnel to maintain licenses and certifications relevant to serve in an EMS agency 2. Conduct paramedic training to rural EMS students to qualify them for national registry and Missouri State Licensure 3. Ensure paramedic students are provided curriculum comprehensive to mental health and substance use 4. Create a comprehensive continuing education curriculum which provides training specific to mental health and substance use 5. Acquire needed items for successful training of Rural EMS Learners 6. Develop rural EMS agency specific toolkits containing local resources and public health linkages which can be adapted for each agency.

The goal of this program is to increase the capacity of the Region's EMS agencies to provide critical care transports leading to improve health outcomes for those in the region requiring EMS services. This will be accomplished by recruiting and training up to 36 additional emergency medical personnel in rural Kentucky using the existing National Highway Safety Administration National Emergency Services Education Standards training curriculum and targeting people in rural Kentucky communities who are interested in pursing a career in Emergency Medicine Services.

Rural western and central South Dakota has a critical shortage of emergency medical technicians (EMTs). The purposed program will address this shortage by training 100 new EMTs from rural communities. Additionally, because the region is sparsely populated, opportunities for current EMTs to receive continuing education units (CEUs) are rare, but necessary to maintain their certification. This program will provide easy access to CEUs for 550 rural EMTs. Tripp County will also develop and implement policies for responding to opioid overdoses and establishing linkages to care. As a result, these activities are expected to increase access to emergency medical services in rural South Dakota. Estimated number of people to be served as a result of this grant: 650

Upper Pine River Fire Protection District (UPRFPD) Education Department has expanded Emergency Medical Service (EMS) education for residents of the District and will increase learning opportunities for the rural population with a focus on traditionally underrepresented populations. as defined in a Behavioral Health Disparity Impact Statement. UPRFPD plans to create a rural EMS-centered Motivational interviewing training video that will be posted as a resource through SAMHSA's website. Through the ED program, rural students from the 284 square miles of eastern La Plata and Archuleta Counties in Colorado will engage in primary and continuing education/advanced EMS certification. This program will allow students to access course material without driving 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 can be extended, necessitating a higher provider level working the calls. Some EMS courses are already offered in the District, but many students find the cost of living in the San Juan Basin prohibitively expensive to take on additional education courses. UPRFPD 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 ED program ideas on effectively connecting and teaching residents interested in learning and furthering EMS skills.

The CMH EMS training program will enhance didactic and hands-on training opportunities for EMTs, Paramedics, and Community Paramedics who are located within rural service areas and serve rural populations. Funding will supplement evidence-based training skills and provide enhance technology training through simulation equipment. Training will include a particular focus on addressing substance use disorders and co-occurring mental health conditions through trauma-informed, recovery-based care and treatment. Approximately 70 EMS department employees who serve approximately 10,000 individuals annually through pre-hospital services will be trained through SAMHSA funding. The following goals and objectives will expand recruitment efforts and educational/training resources, and achieve funding purposes to effectively serve rural populations who encounter EMS personnel. The program date is 9/30/23 through 9/29/24. Goal 1: Expand recruitment and training of EMS personnel who will qualify for licensure/certification standards and sufficiently meet service delivery needs. Objective 1-1: Recruit and train 8 EMTs, 4 Paramedics, and 6 Community Paramedics within the first year of funding through in-house training and online resources. Objective 1-2: Assist all trained EMS personnel to meet state licensure requirements and certification standards. Goal 2: Expand training and knowledge of all EMS personnel on substance use disorder and co-occurring mental health disorders through in-house and online resources within 12 months of funding. Objective 2-1: Provide 4 hours of training to all EMS department personnel (projected unduplicated 70 individuals) EMTs, Paramedics, and Community Paramedics through online and in-person resources to expand knowledge of substance use disorder and mental health disorders within first 12 months of funding. Objective 2-2: Within 12 months of funding, train all 70 EMS personnel to provide coordinated care services and warm referrals to other hospital stakeholders and specialties for historically underserved individuals (i.e., home health, social work, SUD, mental/behavioral health, OBGYN, etc.)

The purpose of Heartland Education's R.E.A.C.T. (Rural EMS Access to Critical Training) project is to recruit and train emergency medical services personnel in rural Oklahoma. The goal is to increase the number of prehospital personnel in rural Oklahoma. Additionally, the R.E.A.C.T. project seeks to increase awareness of mental health issues and how to identify and treat potential opioid overdoses. Over the one year project, this will be achieved by offering one Emergency Medical Technician (EMT) course, one Advanced EMT course, and one Paramedic cohort. These will train a total of 26 EMS personnel for rural Oklahoma. The EMT and AEMT courses will be offered via a hybrid technology in a spoke and hub fashion, and via our partnership with the School of EMS, the paramedic program will also be hybrid in nature. This will allow rural EMS providers to select students in their area, however, these students will not need to travel far distances to participate due to the hybrid / online instruction methods. The project will also offer courses related to mental health and opioid awareness in rural areas supported by Heartland. Heartland will also offer continuing education courses to help current EMS providers maintain their certifications. It is estimated that over 300 individuals will benefit from this training.

We are requesting SAMHSA Grant funding to provide additional ALS personnel to our community ambulance service. We currently have two active Advanced EMT’s (AEMT) and two Paramedics. One of our AEMT’s works out of the area weekdays and is only available nights and weekends. Both of our Paramedics are career firefighters and are available when their schedules permit. This year we would like to add 6 additional AEMT’s and 2 Paramedics to our roster. This would allow use to have at least one ALS provider per shift. Our Mission Statement: Brooks Ambulance, Inc. is a 501(c)(3) non-profit, all-volunteer ambulance service dedicated to providing professional and compassionate medical care to our community. We are an emergency transport service with two ambulances that are licensed to the Paramedic level. We are in rural Waldo County, Maine and serve the towns of Brooks, Jackson, Monroe, and Knox a total population of 3,520. We are supported by community donations and bill for our services. We respond to calls in our community of 3,520 with 8 active EMS personnel. All these members of our service have “regular” jobs that take them out of town during the weekdays. This leaves one or sometimes two EMT’s available during the day. Evening and overnight shifts are being covered by a small group of dedicated people that must work the next day. Our community consists of the towns of Brooks, Jackson, Monroe, and Knox a combined population of 3520 residents using 2020 census numbers. We have seen a 7% increase in population in the last 10 years while the county of Waldo has seen an increase of 2.6%. If we divide the project cost of $221,985.00 by 3520 residents the cost annually per resident is $63.00. If we amortize that over 20 years, the cost per resident drops to $3.15 per year. The Brooks Ambulance will establish a training program for current EMT’s and AEMT’s in our dept. This will be an opportunity for 6 trained and licensed EMT’s to advance their licenses to the Advanced EMT or AEMT level. An AEMT in the state of Maine is licensed to provide all of the basic life-saving (BLS) skills that an EMT can perform as well as additional interventions with equipment and medications. We will also train 2 currently licensed AEMT’s to the Paramedic level. In Maine a licensed Paramedic is allowed to perform numerous lifesaving skills as well as administer 40 different medications and operate a host of diagnostic equipment. Training to be a Paramedic requires a substantial commitment on the part of the student. There is 1400 hours of training alone. All this is crammed into a one-year course with classes and clinical studies on nights and weekends. We have several current AEMT’s interested in making the commitment. We will make accommodations for special needs students and will not discriminate against any candidate for any reason. Once we have a minimum number of students, we will complete their training in a one-year period. This training will be provided with a combination of distance learning, classroom and hands on skill training as needed. We will test these students and certify them to a national standard for AEMT’s and Paramedic. That standard is called the National Registry of Emergency Medical Technicians or NREMT. We have established a Tier 2 Naloxone distribution center at our facility and hope to train over three hundred Waldo County firefighters to recognize the signs of overdose and administer Naloxone during an overdose. We will also train these same three hundred firefighters on how to recognize and deal with mental health problems in themselves, their fellow firefighters, EMT’s and in their community. We lack trained personnel to respond to calls, especially during the weekdays from 8:00 am to 4:00 pm. In 2021 we missed 24 calls or 7% of 338 and in 2022 that number was 35 calls or 9% of 364, our total call volume. We are particularly deficient when it comes to ALS support from our service. Over 30% of our call volume are ALS calls.

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 a focus on the US armed forces veteran population. 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. There is a higher-than-average number of veterans in the District. Working with the population of focus will allow the LEARN program to educate veterans who will be volunteer responders and can respond as peer support to EMS or Behavioral Health and Substance Use Disorder calls involving veterans. The traditional EMS training is modeled on driving over an hour each way for classes, multiple days a week. Some EMS courses are already offered in the District, allowing students to do Advanced Emergency Medical Technician labs at the UPRHSD classroom. This allows students from the District to get EMS education closer to home. The LEARN program will equip the UPRHSD classroom live-stream classes to 360 students annually, regardless of their proximity to the building. It will provide supplies, equipment, and training on specific medications that will benefit populations at risk for Mental Health 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.

Our rapidly growing area demands a capable and effective fire and emergency medical services provider. Our District is working to keep pace with a quickly developing residential and commercial base. Our plan is to establish a paramedic-level transport agency (fire-based EMS) within the next 3-5 years. Our program starts with Paramedic training. Within the Period of Performance, we can only train 3 Paramedics; however, these three – distributed appropriately will be able to serve a Community of 16,800 people within 1,300 calls per year. This training is intended to be a beginning push for a larger committed program as a dedicated fixture in the Community. All medical services within the Tooele Valley are limited. Our local Emergency Department and Hospital are only capable of a Trauma 4 response. Helicopter flights are a common transport alternative due to the minimum of a 45-minute ground transport time. Our ambulance service provides an AEMT-level crew with a Paramedic chase vehicle. They try to place Paramedics on the ambulances, but that’s not always the case. To support the need for this grant-funded program, there is no Paramedic-level training program in Tooele County. Emergency Medical Training just came to the local Technical College. Emergency Medical Training has just never been a priority until the County began to grow exponentially. Our program of training a few Paramedics is simply a stop-gap measure until the local University or Technical college picks up the curriculum. To support a growing population, we need a Paramedic Program in Tooele County! Within the guidance for this grant, this is the entire reason for funding. As part of our mission statement, NTFD provides Emergency Medical Services by state and nationally licensed first responders (compensated and volunteer). Our roster includes 14 AEMTs, 8 EMT-Bs and 11 volunteers with no medical training. Upon receipt of grant funding, we will provide Substance Use Disorders (SUD), Co-Occurring Disorders (COD) and mental disorders training. We need to provide this type of training for all our personnel such that they recognize poor behavioral health for themselves and for patients they encounter within their line of work. Online training will be accessed through SAMHSA’s Technology Transfer Center, the Rural Opioid Technical Assistance (ROTA) or the Opioid Response Network (ORN). Training will also include the use of Naloxone in emergency opioid overdose situations. After receiving proper education; EMS personnel will better be able to engage individuals who use substances and/or who suffer mental health conditions. Through motivational interviewing, they will be able to provide patient referrals to better treatment. The focus for this goal provides training for at least 33 firefighters/EMS personnel in a program that is recovery-oriented, trauma informed and equity-based. EMS personnel will work with peer-support specialists in treating those who have undergone overdose reversal to include a warm handoff between members of a health care team and family. EMS personnel will maintain all licenses and certifications In addition to training all staff, our desire within The District is to provide Paramedic-level services. This goal also reveals a larger vision to promote higher education within our first responders. Providing training alone is not enough, these 3 students are expected to obtain licensure through the State of Utah, achieve National Registry certification and graduate with their Associates in Applied Science. This goal meets the grant guidance expectation to provide federal or state licensing and certification requirements. The curriculum is not developed by our District, they will follow National Accreditation Standards that include nearly 1,500 hours of clinical education leading the students to an Associate of Applied Science Degree and potentially a Bachelor of Science Degree in Emergency Healthcare Services.

The Creighton Ambulance Service (CAS) is seeking a grant to augment their training to improve skills and maintain quality patient care. Their goals include recruiting additional EMT's and EMR's next year and provide additional training on substance abuse and mental health issues. Another goal is to recruit a Paramedic or other advanced medical professional to provide medical patient care for emergency patient care and Basic and Advanced Care Life Support transport of patients. Currently CAS is licensed for EMS Basic Service transport of patients. Due to reduction of agencies that provide Advanced Care Life Support (ACLS), we have committed to enhance our mission and provide EMS Advanced Service. This is also a State licensing upgrade which requires additional training and equipment. Our objectives are also to improve patient and caregiver safety. Total budget is in the amount $157,650 with a total of $141,885 federal funds requested with a 10% match of $15,765. These funds will be used for Paramedic salary, advanced monitoring equipment, training of recruited EMT and EMR, and other supplies necessary to obtain ACLS license. Non federal match is in-kind contributions from volunteers, CAS generated funds and outside cooperative source. Creighton Ambulance Service (CAS) is a volunteer ambulance squad that services the community of Creighton, NE and the Creighton Rural Fire District in Knox County, NE. The permanent population for the primary service area is 1873 people located over 240 square miles. CAS is owned by the City of Creighton. However, it is operated by an entirely volunteer squad. The CAS is a very active organization and recorded 244 runs in FY2022-23. The CAS is responsible for responding to all transportation accidents, fires, medical calls, etc. within the service area and assists with mutual aid calls. We serve a very diverse and aging population. The majority of runs are medical issues. However, we have experienced an increasing trend of health issues that include mental health and substance abuse.

Margaretville Hospital will partner with Delaware County, NY Department of Emergency Services and SUNY Cobleskill. Our goal is to provide all levels of EMS training as appropriate to maintain licenses and certifications relevant to serve in an EMS agency; conduct courses that qualify graduates to serve in an EMS agency; and fund specific training to meet New York State licensing/certification requirements. There will be a significant emphasis on behavioral health and substance use disorder training. Margaretville Hospital is a rural Critical Access Hospital, located in Delaware County, whose mission is to provide immediate access to high quality medical care and services to medically underserved areas in the Catskill Mountains. The Margaretville Hospital EMS Training Program will serve the geographic catchment area of Delaware County, NY, which is a HRSA-designated rural county, and parts of Greene and Ulster counties that are also HRSA-designated rural areas that border Delaware County and are serviced by Margaretville Hospital. The fourth largest county in the state with a population of 44,308, Delaware County’s unemployment rate exceeds New York State averages, and according to the 2022 NYS Community Action report, 27.6% of youth under 18 are living in poverty in Delaware County. Delaware County is home to 18 transporting agencies dispatched by Delaware 911 and six basic life support first response agencies. Of the 18 transporting agencies, only five have paid staff, while the remaining 13 are operated by volunteers. The volunteer agencies have an average of six people certified to provide emergency medical treatment by the state. To provide 24/7 coverage, each volunteer would need to commit 28 hours a week, the equivalent of an unpaid part-time job. Our objectives are to offer Certified First Responder (CFR), Advanced Emergency Medical Technician (AEMT), Emergency Medical Technician (EMT), and Certified Lab Instructor (CLI) trainings. Over a one-year period, the CFR class will train 10 people, the AEMT and EMT classes will train 24 students each for a total of 58 people. In addition, five CLIs and three paramedics will be sponsored and trained by SUNY Cobleskill for a grand total of 66 unique individuals. If we are able to increase the number of EMS workers in our catchment area, this will reduce the number of volunteer hours necessary for each EMS worker to perform to provide 24/7 service. With the high rates of unemployment and low levels of income in this rural area, the program will provide educational opportunities that individuals might not otherwise be able to afford and will provide some paid career prospects.

The Wabash General Hospital Emergency Medical Services Training and Enhancement Project (WGH-EMSTEP) will provide EMT and Paramedic training courses, training in addressing substance use and co-occurring mental health disorders, and development of procedures necessary to promote referral linkages for individuals who experience overdose reversal and related crises. The project catchment area is Wabash County in rural Southern Illinois (IL), where Wabash General Hospital (WGH) provides Emergency Medical Services (EMS). The population of focus is the current and prospective EMS workforce affiliated with WGH, including EMTs, Paramedics, and ER nurses, along with first responders who collaborate with WGHD EMS. Wabash County is less diverse than IL as a whole, with small sizes of minority subpopulations underscoring the need for culturally competent, trauma-informed training and an effort to diversify EMS demographics. Amid rising statewide rates of opioid overdoes, WGH has been operating with a shortage of certified EMS personnel. WGH-EMSTEP will address the workforce shortage and the need to enhance training to include content focused on connecting individuals who experience substance use and co-occurring mental health disorders with linkages to treatment and peer support. Goal 1 is to increase the size of the EMT and Paramedic workforce in Wabash County through the implementation of the following objectives: 1. Recruit three cohorts of eight candidates each for 8-week EMT training courses; 2. Recruit one cohort of six candidates for Paramedic training courses; 3. Offer 8-week EMT training courses to three cohorts of eight participants; 4. Launch Paramedic Program for one cohort of six trainees; 5. By month 3, obtain five items of equipment ($5,000+) necessary for EMS training; 6. By month 3, obtain 100% of itemized supplies and teaching materials (less than $5,000 each) necessary for EMS training. Goal 2 is to enhance the ability of local EMT, Paramedic, ER, and first responder personnel to address substance use disorders (SUD) and co-occurring mental health conditions through the implementation of the following objectives: 1. Train 100% of EMT/Paramedic candidates and 100% of current EMS staff and associated personnel in Mental Health First Aid (MHFA); 2. Train 100% of EMT/Paramedic trainees and 100% of current EMS staff and associated personnel in Motivational Interviewing; 3. Train 100% of EMT/Paramedic trainees and 100% of current EMS staff and associated personnel in Screening, Brief Intervention, and Referral to Treatment; 4. By month 3, purchase ten units of Naloxone nasal spray (Narcan) for use during the project period by EMS providers. Goal 3 is to develop and implement procedures and resources to ensure consistent overdose reporting and encourage EMS referrals to treatment, harm reduction services, and peer support. It will be accomplished through the implementation of the following objectives: 1. By month 3, assess reporting, data tracking, referral, and follow-up procedures related to overdose reversal; 2. By month 6, develop and implement procedures aligning WGH and Lawrence County Health Department activities in cases involving overdose reversal to ensure that individuals receive follow-up and referrals; 3. By month 6, develop a list of treatment and peer support specialists in or near Wabash County to be delivered to EMS providers, supporting them in making or promoting appropriate referrals.

The program proposed by Parker County Hospital District Emergency Medical Services (PCHD EMS) approaches the unique challenges of EMS in rural areas by enhancing the skills and knowledge of EMS providers responding to mental health and substance abuse emergencies, increasing the number of trained EMS providers in rural areas, and through community outreach and education. The objectives of the program include: (1) Critical Incident Stress Management (CISM) - CISM training for 18 paramedics will be used to further develop the established mental health peer-to-peer crisis team at PCHD EMS.; (2) Critical Care Paramedic Training - Managing a critical patient for extended transports from rural emergency scenes can pose a service gap for paramedics, due to the need for a higher scope of care to facilitate a positive outcome for the patient. This class will also focus on substance abuse and mental health challenges and provide advanced patient simulation training tailored to the service area.; (3) Emergency Medical Technician - Basic (EMT-B) school - This program will sponsor 24 unduplicated seniors from local high schools to attend EMT school held in Weatherford, Texas during the 2023-2024 school year. This EMT-B course will be supplemented with classes on substance use, addiction, overdose, and withdrawal; with a specialized focus on recognizing and treating overdose. A smart-manikin will also be purchased to meet the advanced training needs of the EMT program.; (4) Dispatch mental health training - PCHD EMS has a goal to send 12 telecommunicators through online emergency mental health dispatcher training. This course will teach the skills to communicate effectively with callers who are struggling with mental health crises while dispatching the appropriate services.; (5) Community outreach and training - PCHD EMS will present a community outreach and education program focused on accidental poisonings/ingestions, and overdoses; and develop and distribute pamphlets that contain information on local and online resources for individuals dealing with a mental illness or substance abuse disorder. The total estimated number of unduplicated individuals PCHD EMS proposes to train with the grant is 669: 18 CISM training, 15 critical care training, 24 EMT school, 12 mental health dispatcher training, and 600 through community outreach. The program's rigorous evaluation plan will ensure that its objectives are met and that it makes a significant contribution to the field of mental health and substance abuse services in rural communities. The training will increase awareness of EMS services and promote healthy behaviors in rural communities, while partnerships and collaborations will enhance the coordination of rural EMS services and improve community resilience.

Summary: The South Lincoln Hospital District (SLHD) Emergency Medical Services (EMS) Training Program will provide training leading to certification as an advanced emergency medical technician (AEMT) or emergency medical responder (EMR) for up to 40 students. SLHD EMS will increase the number of hours of training that EMS students receive on the treatment of patients with behavioral health conditions and/or substance use disorders. Guest speakers will highlight the behavioral health needs of LGBTQI+ individuals and of military personnel, returning military personnel, and veterans. Population: The population of focus for this project is area residents over the age of 21 with a desire to become an EMS employee, as well as medical professionals in need of continuing education credits. This program will serve residents of Lincoln, Uinta, and Sublette Counties, which have a total population of 48,759 and a population density of 4.42. Strategies: SLHD EMS will bring in guest speakers who are subject matter experts in behavioral health topics such as “Question, Persuade, Refer” (QPR), motivational interviewing, and peer support. One-on-one support will be offered each class for those studying for certification examinations. A variety of simulation equipment is being requested or is on hand for realistic classroom simulation of situation seen in the field. Goals: (1) Maintain or increase our roster of EMTs. (2) Increase the number of hours of training offered on working with patients with mental health conditions. (3) Increase the amount and types of training on connecting patients who experience an overdose to treatment and to referral to ongoing peer recovery support. Objectives: (a) Offer 2 courses leading to certification and counting as continuing education between 9/30/23 and 9/29/24. Train up to 40 students between 9/30/23 and 9/29/24. (b) Offer 4 hours of instruction on motivational interviewing to up to 40 students between 9/30/23 and 9/29/24. (c) Offer 1 hour of instruction on “Question, Persuade, Refer” (QPR, an intervention that can be used by anyone who encounters a suicidal individual) to up to 40 students between 1/1/24 and 9/29/24. (d) Offer 1-2 hours of instruction on the behavioral health needs of LGBTQI+ individuals to up to 40 students between 1/1/24 and 9/29/24. (e) Offer 1-2 hours of instruction on the behavioral health needs of active-duty military personnel, returning veterans, and military families by having a guest speaker who is a subject matter expert between 1/1/24 and 9/29/24. (f) Increase the number of hours of training offered on working with patients with mental health conditions from 2 hours per year (or 5 hours per year for students enrolled in an EMT class) to 20 hours per year between 9/30/23 and 9/29/24. (g) Purchase 50 Naloxone nasal spray kits and train all EMS staff, all EMS students, and up to 30 local first responders on their use between 9/30/23 and 9/29/24. (h) Offer 1-2 hours of instruction on peer support resources available locally to up to 40 students between 1/1/24 and 9/29/24, including a presentation by the nearest active Alcoholics Anonymous group if possible. (i) Develop procedures to ensure all overdoses are reported to the state and/or local public health department if those entities begin collection of that information during the project period. (Wyoming does not participate in SUDORS.) The total anticipated unduplicated individuals SLHD EMS proposes to train in a year is 50.

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 9/29,2024 program staff will recruit and train 20 EMS personnel. Objective 1.2: By 9/1/2024, 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 6/30/2024 NorthStar will provide EMS career information and job-shadowing experiences to 20 University of Maine Farmington students. Objective 1.4: By 6/30/2024, 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/ 2024, NorthStar will strengthen retention strategies to engage 80% of EMS personnel in career expansion programs. 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 9/29/2024, 100 EMS personnel will have received mental health and substance use disorder training via SAMHSA’s Technology Transfer Centers. Objective 2.2: By 9/29/2024, 75% of EMS personnel will have received Opioid Use Disorder and Naloxone training Objective 2.3: By 9/29/24, provide four Stigma prevention trainings to reach 75% of EMS personnel. Objective 2.4: By 9/29/2024, 75 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 9/29/2024, NorthStar staff will utilize appropriate training equipment in training classes.

Native Village of Tyonek (NVT), a federal recognized tribe in Alaska, will serve a population of 373 community members and other residents in the area by providing timely responses to emergency medical incidents in the area by increasing the capacity of rural emergency responders. A responder trained and competent will provide any emergency aid necessary to sustain life and minimize impact of physical and behavioral conditions. The strategy is: 1) to assure adequate 24/7/365 coverage by increasing the pool of EMS (Emergency Medical Service) responders by 3 locally trained personnel; 2) to assure competent personnel respond to all EMS calls, six personnel lacking formal certification will be trained to EMT (Emergency Medical Technician) level 1; 3) to assure competent emergency medical response to opioid overdose, all EMS staff will be trained to recognize overdose and administer Narcan (naloxone); 4) to assure emergency responders in this isolated village area trained to the highest level of proficiency possible, existing certified EMS responders will receive upgraded training resulting in an additional three EMS personnel certified as ETT (Emergency Trauma Technicians), EMT-I or EMT-II; 5) to assure that people in the village having a mental health crisis are provided best practice emergency care, all EMTS will received Mental Health First Aid Training. Because Tyonek is a small, close knit Tribal community, recruitment methods focus on "word of mouth" dissemination within the village. Each Tribal Leader and other staff will also participate in spreading the word. Training will be conducted using several resources such as state training materials and trainers as well as approved curriculum. Each trained EMT is also commissioned to keep on training each other and other tribal members as the need for more EMTs becomes evident. With the high rate of suicide as well as impacts of the most recent Coronavirus (COVID-19) pandemic overwhelm the NVT health system, more people may need to get training in Mental Health First Aid. This project, as does other NVT projects, include a strong partnership with Southcentral Foundation (SCF), the Nikiski Fire Department (NFD), and the Cook Inlet Tribal Council (CITC).

The Jersey Community Hospital (JCH) EMS Training Program will provide high quality Emergency Medical Services training to personnel in the JCH training center as well as the rural communities of Jersey, Greene, and Calhoun Counties. The proposed activities will strengthen the quality of the Emergency Medical Service providers' ability to handle all emergency situations as well as elevate our rural hospital to showcase the growing program we have in place and expand services to the community. The provided training will be responsive to the needs of the communities in which the EMS personnel serve with a particular focus on mental health and substance use disorders, and how to care for individuals dealing with these issues. The project goals are as follows: Goal 1- JCH will offer CEU classes at least quarterly. JCH will teach PALS accreditation to 50 individuals. JCH will also host a DT4 EMS training session for surround communities to attend. Goal 2- JCH will conduct an EMT class in January of 2024. The goal is to have 10 participants graduate from the program with EMT certification. Goal 3- JCH will send three staff members to a continuing education conference as well as have one instructor complete courses to become a Level 1 instructor and one instructor complete courses to become a Level 2 instructor. 2 staff members will be certified to teach NAEMT certified courses. Goal 4- JCH will provide a minimum of 2 training sessions each, that will train all EMS personnel on mental health and substance use disorders as well as how to refer to peer counselors and local treatment clinics, and providing naloxone. Goal 5- JCH EMS will purchase necessary supplies to conduct trainings for EMS personnel. Goal 6- All EMS personnel will attend one Mental Health First Aid training provided by Chestnut Health Systems and one motivational interviewing training session provided by the Illinois Critical Access Network (ICAHN). Goal 7- Create an online dashboard that will be accessible by JCH, Jersey County Police Department, Jersey County Sheriff's Department, and Jersey County Health Department to provide data on overdoses in our community. In total the grant will allow Jersey Community Hospital to train at least 150 individuals in our community on life savings techniques.

The Michigan Supporting and Improving Rural EMS Needs (MiSIREN) project will provide training for first responders in rural designated counties of Michigan. The proposed project covers 49 rural counties with a population of over 1.1 million. The applicant and partner organization have extensive experience recruiting and training EMS personnel. Eastern Huron Ambulance Service (EHAS) has worked collaboratively on previous grant-funded projects and regional task forces to strengthen the EMS workforce through recruitment, retention, and training programs. Michigan Rural EMS Network (MiREMS) has worked extensively throughout the state of Michigan to support EMS professionals and first responder agencies. EHAS and MiREMS has received three SAMHSA-funded EMS Training Grants in 2020, 2021 and 2022. The results of the projects include: MiSIREN 1 (2020) 8 EMT classes held- 72 enrolled, 48 licensed 12 CE days- 101 attendees MH/SUD- 52 trained; MiSIREN 2 (2021) EMT classes- 4 current/ 2 starting soon (6 total)- 65 enrolled, 20 licensed so far CE days- 1 held, 5 scheduled - 21 attendees to date; 80 anticipated attendees in scheduled classes SUD- 21 attended in one session; and MiSIREN 3 (2022) EMT classes- 5 scheduled/1 pending- 52 enrolled- all classes still running so no licensed personnel yet No CE days yet SUD- 11 trained. COVID-19 significantly impacted the ability to provide training during 2020 and 2021. Since 2020 EMS agencies have been overwhelmed with personnel shortages and additional burdens on the system due to COVID-19. A marked increase in the cost of living has resulted in it being even more difficult for individuals to afford the cost of initial EMS education and/or continuing education. This funding will enable us to make a significant impact on addressing the needs of struggling EMS agencies and professionals in rural Michigan by expanding our reach to provide this critical training while expanding our focus and the role of EMS on mental health and substance use disorder issues.

VCU Rural EMS Collaborative Abstract Virginia Commonwealth University Healthcare and Hospital Systems (VCUHealth) and two of its programs: Center for Trauma and Critical Care Education (CTCCE) and Injury and Violence Prevention Program (IVPP) – Project Empower (Empower) are collaborating with rural Emergency Medical Services (EMS) and local sexual and domestic violence agencies (SDVAs) across Virginia to launch the Virginia Rural EMS Training Collaborative. This initiative brings these entities together to train volunteer pre-hospital providers on an advanced EMT course with a specialized focus on mental health, substance (ab)use, domestic/intimate partner violence, sexual assault injuries, and healthcare challenges. All applicants that complete the course will become certified A-EMT providers. This will provide critical EMS training in rural areas that rely on volunteer pre-hospital providers and do not have the funding for advanced training. This Collaborative will begin in King and Queen, Louisa, New Kent, and Powhatan counties. All rural designated counties with a HRSA established a need for medical personnel and expertise. The goal is to expand to other rural counties that fall with the catchment area of VCU Health System hospitals and emergency centers. Rural areas lack the funding to offer their mostly volunteer staff access to advance training or specialized training. We will recruit and train personnel from rural communities as well as establish partnerships with local specialized service agencies (SDVAs and community service boards). This will ensure patients identified as substance abusers or survivors of domestic or sexual violence from obtain the appropriate follow-up services. By the end of the grant we will have: • Developed a hybrid-EMT curriculum to be used by rural sites across Virginia. • Train 100 pre-hospital providers in select rural areas. This training will meet state and federal standards for licensing and certification. • Establish partnerships between rural EMS agencies and local SDVAs and community service boards • All trained pre-hospital providers will be trained and have access to Naloxone. • All trained pre-hospital providers will successfully be able to identify, screen, and respond to victims of violence

The “Expanding EMS Capacity in Alaska’s Rural Copper River Region” project seeks to 1. Expand the training and capacity of local EMS resources with special focus on mental and substance use disorders in emergency situations; 2. increase from zero to five the number of active local Community Paramedics; 3. increase from zero to eight the number of local EMS personnel trained and qualified to serve on a Crisis Response Team within a Mobile Integrated Healthcare model of EMS service; 4. increase from zero to five the number of local EMS personnel trained and qualified to administer buprenorphine under medical direction 5. recruit, train, and retain local State Certified EMS providers to increase the number of personnel actively responding to medical, mental health, and substance use disorder emergencies throughout the Copper River Region. The project will focus training active EMS personnel in Motivational Interviewing, Trauma Informed Care, Crisis Response, Verbal De-escalation, CAMS Suicidality framework, Psychological Trauma in Emergency Treatment, Mental Health First Aid, Naloxone training and distribution, as well as completing state-approved EMT recertification courses. This project will provide critical training materials for 15 training workshops, varying from four to 144 hours as well as EMS equipment vital to train EMS personnel and increase the capacity of EMS in the region. By the end of the project period, the unduplicated number of people trained will be 30. In the rural Copper River region, EMS personnel serve an area of 20,000+ square miles with a full-time population of around 2,600 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. Major health problems include cardiovascular disease, diabetes, obesity, hypertension, various cancers, poor nutrition, edentulism, substance abuse (e.g., alcoholism, methamphetamine, and a growing OUD challenge, including prescription drug abuse and heroin), STIs, and orthopedics. Barriers to health care access include poverty, the region’s very rural frontier Alaska location, extreme weather conditions, lack of public transportation, and a complete lack of hospitals, specialty care, or after-hours medical care within a 140-220 mile radius. On average, local EMS services respond to 280-380 911 EMS dispatches annually. The entire region is served by only one centrally located Full-Time paid ALS ambulance crew and one volunteer ambulance crew serving the southeast extremities of the region along with approximately 24 first responders spread throughout the region. This project will provide essential training for providers who will serve 100,000 people annually in the Copper River Basin.

Project Abstract Project Name: East Central Illinois Rural Emergency Medical Services Training Program Project Summary: The East Central Illinois EMS Training Program will meet the unmet needs of over 16,000 people in a twenty-mile radius from the only hospital (CAH) in the rural area. This program will train 40 individuals during the one-year grant period as EMT-Basic, licensed EMS workers. Not only will these individuals be trained as EMS workers, but they will also receive specialized training in assisting those needing emergent care that have OUD/SUD situations. The goal of this program will be to reduce the mortality rate among this population by responding quicker with better trained personnel. Population to be served: Rural Service Area Defined by County, Zip Code, Census Tract and City/Village/Township and Population (9 Zip Codes and Total Population = 16,031. The area is a 20-mile radius from the only hospital in the service area. GOAL 1: Recruit a diverse group of individuals that have an interest in training to be an EMT-Basic employee and/or volunteer and are willing to complete training needed to maintain licenses and certifications relevant to serve in an EMS agency in the rural service area. GOAL 2: Provide EMT-Basic training for individuals that have expressed an interest and passion for working and/or volunteering in EMS services in the rural service area. GOAL 3: Place trained EMT-Basic in the rural service area as either employees and/or volunteers to enhance both the quality and quantity of qualified EMS staff. GOAL 4: Establish tracking systems in coordination with the GAHHS IT Department to provide reporting and other data gathering techniques to determine the effectiveness of the EMS training program and to study once implemented these enhanced services influenced a reduction in the death rate and/or the impact of long-term debilitation on those suffering from SUD/OUD disorders requiring emergent services.

The proposed Opioid Response and Training Program through Bennington Rescue is a series of targeted initiatives to improve the capacity and capabilities of EMS response to substance use disorder and mental health emergencies. This program targets rural Bennington County in the southwest corner of the state of Vermont with an estimated population of 37,235. This program uses a combination of education, equipment, and partnership to improve outcomes. Specific interventions in this program include providing initial EMS education; continuing education to maintain EMS certifications or licenses; targeted education for improving care of patients experiencing substance use disorder and mental health emergencies; equipment purchases to support education and the field care of patients; harm reduction via distribution of naloxone leave behind kits and recovery resource information; field buprenorphine by paramedics to facilitate care after acute opioid withdrawal; and partnerships with peer recovery coaches and medication assisted treatment providers in the community. Bennington Rescue established commitment from partners within the community toward this program including the regional EMS District Medical Advisor (medical director), peer recovery and coaching organization Turning Point Center of Bennington, and mental health and medication assisted treatment provider United Counseling Service.

This award will train Allendale EMS personnel on substance use disorder (SUD) and co-occurring mental health conditions in emergency situations, naloxone use, expand our EMS system to provide trauma-informed and recovery-based community paramedicine care, and support our rural community with mobilized health education, case management and peer support services. Award funding will develop the capacity of the Allendale EMS system with community paramedicine outreach collaborating with local healthcare providers and Pine Hill Health Network (operated by Pine Hill Indian Community Development Initiative), increase EMS personnel with ten (10) new EMTs, two (2) new Paramedics, and two (2) new dispatchers, train twenty-five (25) new Pine Hill peer support specialists, and provide training to maintain relevant licenses and certifications. These activities impact Allendale County and multiple Counties provided mutual aid support; i.e., Barnwell County and northwestern Orangeburg County. This award forges a sustainable path to leverage existing partnerships and mutual care gaps to develop a shared safety net, reaching a catchment area population of 113,000, with an infusion of workforce trained to respond to mental health and SUD crises, fortifying our fragile EMS and health systems.