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The purpose of this EMS training project is to develop an EMS training and education curriculum for state and national replication, with a training focus on providing care for people with active substance use disorders during pregnancy. The program aims to ensure locally that the district has the EMS staff capacity to support the residents in the rural county. The project includes supporting the recruitment and training of EMS personnel, supporting courses and training to qualify graduates to serve in an EMS agency or for federal or state licensure or certification, ensuring EMS personnel are trained in mental health and substance use disorders, including use of motivational interviewing, connecting individuals who have undergone overdose reversal to treatment, and providing referrals to peer support resources. The project will also purchase Naloxone and train EMS personnel on the use of Naloxone, and ultrasound equipment, for response to emergency situations. At minimum forty-five personnel from LCAD will be trained annually on continuing education courses. Additionally, the program will provide at minimum twenty-four scholarships for rural EMS providers in Lincoln County looking to advance their skillsets with an additional twelve receiving a specialized focus of training on maternal health. Overall, the program aims to ensure the 59,574 residents of Lincoln County have access to quality care by having all levels of EMS providers serve the rural county. The number of individuals receiving education for the proposed project is to be ninety individuals. The catchment area is challenged with service gaps and barriers that include a decreasing applicant pool for future EMS workforce, an increasing utilization of EMS for behavioral health calls, the new frequency and severity of prehospital obstetric events, and an overall limited health care service environment. LCAD is partnering with the following entities: St. Charles County Ambulance District, Mehlville Fire Protection District, Missouri EMS Association, and the National Association of Mobile Integrated Healthcare Providers. Each partner has extensive experience with training projects as they each have historical experience as training entities. Goal 1: LCAD’s Training Program will elevate the current EMS workforce in Lincoln County by supporting their educational goals to advance their skillsets and careers, retaining local EMS personnel with a higher scope of practice. Objectives: 1. By September 29, 2026, 90 EMS personnel from LCAD will be provided a minimum of 50 hours of continuing education units to maintain EMS licenses and certifications. 2. By September 29, 2026, 12 Paramedics at LCAD will have completed a Community Paramedic course and receive a state endorsement for their Paramedic license. 3. By September 29, 2026, 12 Paramedics at LCAD will complete a Fundamentals of Critical Care Transport course. They will receive certification at this post paramedic certification. Goal 2: LCAD’s Training Program includes a particular focus on behavioral health so that EMS personnel can respond to the increasing overdose crisis. Objectives: 1. By September 29, 2026, 90 LCAD EMS personnel will complete the newly developed training plan, inclusive of training on mental and substance use disorders, trauma-informed care, recovery-based care, peer support, Naloxone in emergency opioid overdose situations, and motivational interviewing. 2. By December 31, 2024, LCAD will develop procedures on providing a warm-hand off referral to a peer support specialist, a treatment facility, or harm reduction services. 3. By December 31, 2024, LCAD will purchase Naloxone for community distribution. Goal 3: LCAD will develop an EMS training and education curriculum with a focus on providing care for people with active substance use disorders during pregnancy. Objectives: 1. By September 29, 2025, the new curriculum will be developed and prepared for testing during Year 2.

The Big Bear Valley (BBV) Emergency Medical Services (EMS) Training Program is targeting the designated rural Big Bear Valley Region of Southern California. The overarching goal of the BBV EMS Training Program is to create a better prepared local EMS workforce in addressing the needs of individuals with substance use disorders (SUD) and co-occurring disorders (COD) substance use and mental disorders. The Big Bear Valley is located in a mountainous region of San Bernardino County, which is the largest county by area in the contiguous United States. This rural community is geographically isolated, with fewer than 20,000 full-time residents. With over 40% of those under the age of 24 living in poverty, the region is at high risk for substance use disorder. According to the Bear Valley Community Healthcare District (BVCHD) —the lead of this program, the numbers of patients presenting with overdoses continues to increase. Over 10% of BVCHD’s Emergency Department patient visits were opioid use/substance use disorder related and nearly 97% were residents of this rural community. There is a shortage of emergency medical support (EMS) staffing throughout San Bernardino County and with the geographic isolation of Big Bear, this shortage is even more pronounced. The BBV EMS Training Program is targeting the following goals and objectives: Goal 1: To train EMS personnel serving the Big Bear Valley in addressing SUD and COD substance use and mental health disorders. Objective 1.1: By the end of the first quarter, there will be a training calendar developed in coordination with the local EMS providers, the Bear Valley Unified School District, and partnering Public Safety Academies. Objective 1.2: By the end of year one, all training activities/lessons will have been developed with many being made available utilizing distance-learning systems. Objective 1.3: By the end of year one, all training activities/lessons will have been completed at least once. Objective 1.4: By the end of year two, all training activities will have been completed at least twice over the course of the two-year grant. Goal 2: To increase the number of EMS personnel refreshed in the use of Naloxone (Narcan) in the field Objective 2.1: By the end of year one, 40% of EMS personnel will be refreshed in the use of Naloxone (Narcan). Objective 2.2: By the end of year two, 75% of EMS personnel will be refreshed in the use of Naloxone (Narcan). Goal 3: To increase the number of community-based organizations and residents trained in the use of Naloxone (Narcan) and in possession of Naloxone (Narcan). Objective 3.1: By the end of year one, 50 individuals from community-based organizations or the community, in general will have received training in the use of Naloxone (Narcan). Objective 3.2: By the end of year two, a total of 100 individuals from community-based organizations or the community, in general, will have received training in the use of Naloxone (Narcan). Objective 3.3: By the end of year two, a total of 100 individuals from community-based organizations or the community, in general, will have Naloxone (Narcan) for use. Goal 4: To increase the number of individuals qualified to serve in an EMS agency. Objective 3.1: After completion of the program, 40 local high school students will have completed training to become Certified Nursing Assistants. This training will provide a strong foundation for individuals interested in EMS employment. Upon completion of the first year, and second year of the BBV EMS Training Program, a total of 80 unduplicated EMS staff who are serving the rural community of the Big Bear Valley will be trained in mental and substance use disorders and trauma -informed, recovery-based care for people with such disorders in emergency situations

The purpose of Union Ambulance District’s (UAD) Training Program is to recruit and train EMS personnel in its rural county. The goal of the project is to advance the skills of EMS personnel in Franklin County to enhance their capabilities when responding to mental health crises and substance use disorder emergencies by providing an evidence-based Training Program that incorporates addressing substance use disorder and co-occurring disorders. UAD will expand its existing training program through partnerships with EMS agencies to ensure EMS personnel receive ongoing continuing education and scholarships for specialized training so that they can advance their skillsets and careers. The proposed project will include evidence-based training and provide enhanced technology training through simulation equipment. At minimum thirty-five personnel from UAD will be trained annually with continuing education courses. Additionally, the program will provide at minimum thirty scholarships for rural EMS providers in Franklin County looking to advance their skillsets. Overall, the program aims to ensure the 104,858 residents of Franklin County have access to quality care by having all levels of EMS providers serve the rural county. The number of individuals receiving education for the proposed project is to be seventy-five individuals. The catchment area is challenged with service gaps and barriers that include a decreasing EMS workforce, an overutilization of EMS specially with behavioral health calls, an aging population with co-morbidities and chronic illnesses that require a higher scope of practice workforce, and an overall limited health care service environment. UAD is partnering with the following entities: Rock Township Ambulance District, St. Charles County Ambulance District, Mehlville Fire Protection District, Washington County Ambulance District, and Mineral Area College. Goal 1: UAD’s Training Program will provide CEUs to the current EMS workforce in Franklin County to maintain licenses so that the current workforce can continue to serve as local EMS personnel. Objectives: 1. By December 31, 2024, UAD will hire 1 Project Director and 3 Field Training Officers to implement UAD’s Training Program. 2. By September 29, 2026, 34 EMS personnel from Union Ambulance District will be provided a minimum of 50 hours of continuing education units to maintain EMS licenses and certifications. 3. By September 29, 2026, UAD will provide a minimum of 500 hours for on-duty learning. Goal 2: UAD’s Training Program includes a particular focus on behavioral health so that EMS personnel can respond to the increasing overdose crisis. Objectives: 1. By September 29, 2025, 34 EMS personnel from Franklin County will complete UAD’s Training Program inclusive of training on mental and substance use disorders, trauma-informed care, recovery-based care, peer support, Naloxone in emergency opioid overdose situations, and motivational interviewing. 2. By December 31, 2024, UAD will develop procedures on providing a warm-hand off referral to a peer support specialist, a treatment facility, or harm reduction services. 3. By December 31, 2024, UAD will leverage the program to obtain Naloxone and purchase emergency medical services equipment. Goal 3: UAD’s Training Program will elevate the current EMS workforce in Franklin County by assisting their educational needs to serve as a Paramedic, Community Paramedic, or Critical Care Paramedic, retaining local EMS personnel with a higher scope of practice. Objectives: 1. By September 29, 2026, 10 EMTs in Franklin County will have enrolled in Paramedic course. 2. By September 29, 2026, 10 Paramedics in Franklin County a complete a Community Paramedic course and receive a state endorsement for their Paramedic license. 3. By September 29, 2026, 10 Paramedics in Franklin County will complete a Fundamental of Critical Care Transport course.

This award continues training 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 established under the 2023 announcement. Funding will continue developing the capacity of our EMS system with mobilized integrated health/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 24 new EMT graduates each year (48 graduates by the end of year 2 of this award, or 58 trained EMTs as a result of Year 2023 and Year 2024 awards) essential to the stability of the four County area, and provide training to maintain relevant licenses and certifications to credentialed EMTs and Paramedics. Funding also continues community education in naloxone use, CPR and AED, and other emergency techniques vital during EMS arrival wait times. Funding also increases mental health training to EMS and for EMS staff to maximize work performance without fear of reprimand, wrongfully deemed 'unfit for duty' or termination, as well as established First Responder-specific mental health/SUD treatment transition in a "step up" for admission into and "step down" after release from a treatment facility. These activities impact Allendale County, Barnwell County, Bamberg County and Orangeburg County. This grant award provides a sustainable path to leverage existing partnership and mutual care gaps to develop a shared safety net, a catchment area population of approximately 125,000, with an infusion of workforce trained to respond to mental health and SUD crises, fortifying and/or restructuring our fragile EMS and health systems.

Clark County Fire District 3 proposes to promote advancement in EMS by improving our EMS training capabilities through the use of technology, current standard of care equipment, and providing additional patient centric provider education on patients with substance abuse or mental health issues. This program will address the needs of several separate populations; EMS professions looking to gain entry into EMS, maintaining current public, interagency, and CCFD3 personnels' state licensure, and persons who are currently experiencing mental health and substance abuse issues. The "EMS Training enhancement through the use of technology with a patient centric focus" program will start with an initial investment into building technological infrastructure within CCFD3's stations that will allow for advanced remote and in-person training at all fire stations. Coinciding with this will be an investment into purchasing dedicated training equipment or replacement of existing training equipment that has reached end of life and is no longer functional. This phase will be completed within 60 days of the program being funded and allow for improved communication, standard of care equipment, enhanced training simulations, and collaboration between personnel for development of training curriculum. In addition to the technological build out collaboration with external agencies will begin with the intent to develop training curriculum with a focus on crisis response, alternative treatments, and post incident follow-up to improve patient outcomes, provide patient centric layers of care, and increase responder capabilities in de-escalation techniques. Curriculum development would be completed with 90 days of grant funding. A steering committee of internal and external behavior health specialists would be created to guide curriculum assessment and improvements with quarterly meetings. Outcomes would be assessed by the Clark County Medical Program Directors Office covering patient satisfaction and appropriateness hospital transports. Continuum of training for the remainder of project time period would have several components, Selection of internal candidates for receiving paramedic education with the goal of obtaining their state EMS license as a paramedic to increase ALS service coverage, providing Intravenous Therapy and Supraglottic Airway Courses for entry or advancement into EMS, and maintaining their existing EMS licensure through the Clark County Medical Program Directors Continuing Education Program and Advanced Cardiac or Basic Life Support courses, and facilitated or attending EMS conferences for advanced education in EMS. These will be monitored using electronic reporting systems for easy documentation and retention of training and credentials. The final component of this program is a development of a robust Quality Improvement and Quality Improvement program that will use LEAN and 6 Sigma methods for collecting grant related data in addition to patient centric data as it relates to Washington EMS Information system (WEMSIS) and the National EMS Information System (NEMSIS). This will be monitored for success based on grant reporting capabilities and monitoring of submission scores within the WEMSIS system.

Project Name: Ness Rural Emergency Medical Services (REMS) Training Program. Population(s) to be Served: Ness Healthcare NFP plans to implement training for EMS and other first responders across Louisiana with a priority focus of responders actively serving in the following rural parishes of Louisiana Public Health Region 9: Livingston, St. Helena, St. Tammany, Tangipahoa and Washington. Strategies/Interventions: Ness Healthcare NFP’s REMS Training Program has been providing education and training to EMS, Fire, and First Responders since grant inception September 2022 to present. During this time, the Ness training team has developed Evidenced-Based training courses on mental health; addiction; crisis resources, linkage and referral to treatment resources; crisis de-escalation and suicide risk assessment; motivational interviewing; training that qualify EMS to serve in an EMS agency; and Narcan Training and distribution. Ness’s courses bolster the competencies and effectiveness of EMS and other first responders and meet the requirements for licensing and certifications. This training will also increase the number of individuals qualified to work in mobile crisis teams across the catchment area. Partners include All Deserve Advocacy, Prevention & Treatment (ADAPT, Inc.), City of Hammond Police Department AND Training Center, Louisiana Association of Nationally Registered EMT’S (LANREMT), Louisiana Rural Ambulance Alliance (LRAA), Louisiana Bureau of EMS, New Orleans River Region (NORR), and St. Tammany Fire Protection District NO 1, AND Training Center. The training has been approved by the LDH Bureau of EMS and qualified for Continuing Education for certification. The Ness training team developed a “Crisis Resources” training, approved for CEU’s by the LDH EMS Bureau which provides 1.5 hours of resources training to Responders, and community members on the new State of Louisiana Crisis Response System, SAMHSA’s Transfer Technology Centers and the 988 Suicide Prevention Crisis Line. This training specifically educates responders on how to describe the new system and 4 levels of care, how to connect with crisis providers per catchment areas of the state, link and refer individuals and families encountered at the first intercept point of contact which is oftentimes by EMS and Fire. The training goals are measured by pre- and post-test demonstrating an increase in knowledge of crisis resources and how to access, link and refer. Training Participant surveys demonstrate an increase in knowledge about mental health awareness, identifying substance misuse, resources and the role empathy plays in getting people the help they so desperately need. Follow-up surveys will track metrics related to securing licensure and certifications. Project Goals and Measurable Objectives: Ness Healthcare NFP aims to recruit and train EMS/first responders in 1) identification of MH/SUD crisis in the field; 2) de-escalation and stabilization techniques; ; 3) Naloxone Training, distribution and protocol development, 4) Develop Processes for data sharing information across multiple agencies and regions; 3) linking with mobile crisis teams; 4) increasing competencies of a small cohort of individuals who could serve as leads on MH/SUD encounters with an overall goal of reducing the intensity of interactions and getting the individuals the most appropriate level of treatment. The Unduplicated Number of People to be Served Annually and Throughout the Lifetime of the Project: 500 annually and 1,000 throughout the grant period.

CoxHealth requests funding from SAMHSA for HERO-IIII: Helping train EMS in the Rural Ozarks IIII. The purpose of HERO-IIII is to continue recruitment and training to rural residents in Southwest Missouri. We will be adding Barry County to HERO-IIII, The goal is for recruits and trainees to become vital health care providers in Emergency Medical Services (EMS) through certification, and for HERO-IIII to continue to provide continuing education units (CEUs), for existing, active EMS personnel who reside in this medically underserved region. CoxHealth will continue partnering with Ozark Technical Community College (OTC), an accredited institution offering a Certificate of Specialization in Emergency Medical Technician (EMT) training. HERO-IIII will add advanced training for rural-based staff through a new Paramedic Apprenticeship program and an existing Community Paramedics training program. CoxHealth is requesting $400,000 over 2 years from SAMHSA to strengthen and expand the HERO program. HERO-IIII will expand on the current SAMHSA Rural EMS HERO-III grant (Award No. 1H79TI086729-01) that is currently training EMS recruits in Douglas, Stone, Taney and Barton counties to graduate in May of 2024. The current class is vital in addressing the CoxHealth EMS staffing shortages in these counties and retaining EMS services in the rural community. Additional funding with HERO-IIII will expand existing and new advanced paramedic courses offered to existing EMS personnel in the rural communities served. CoxHealth, with its partner Ozarks Technical Community College (OTC), will reach the goal through the following Objectives: Objective 1: By August 31 of each project year, HERO-IIII will recruit and train a cohort of 24 residents from HERO-IIII counties to become new, certified EMT personnel. Objective 2: By August 31 of each project year, HERO-IIII will provide over 800 CEUs hours of trauma-informed care education to 100 CoxHealth and partnering EMS agency personnel. Objective 3: By August 31 of each project year, HERO-IIII recruit and train 24 experienced EMS staff to become Paramedics or Advanced Paramedics. The HERO-IIII geographic service area includes Douglas, Stone, Taney, Barton, and Barry counties, which are all rural counties located in Southwest Missouri. The target population includes high school seniors, CoxHealth employees seeking job advancement, residents in industries experiencing layoffs and closures, and residents seeking career opportunities beyond the service-based industry. The target population faces higher than average unemployment and poverty rates, lower levels of education and lower median household incomes. They are living in rural and HPSA low income, primary care, and mental health shortage areas.

The Rural EMS Training in Northwest Georgia Project will serve Dade County and Walker County in rural Georgia. CHI Memorial will undertake a multi-faceted project with the goal of significantly expanding the capacity of EMS personnel to administer care for mental health and substance use disorder emergencies occurring in rural portions of Dade and Walker Counties. This will include enhancing EMS training on trauma-informed, recovery-based care for individuals experiencing mental health and substance use related crises; administering Advanced EMT training, Geriatric Education for EMS, Advanced Medical Life Support training, and Emergency Pediatric Care training EMS personnel; facilitating the enrollment of four (4) EMTs in an EMT-to-Paramedic Bridge Program through the Faithful Guardian Training Center, and; procuring Automated CPR Devices and Naloxone Kits to outfit ambulances responding to rural areas of Dade and Walker Counties.

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 53 rural counties with a population of over 1.9 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, partnered with MiREMS, has received four previous SAMHSA-funded EMS Training Grant awards in 2020, 2021, 2022, and 2023. Since 2020 Michigan's rural 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. The Michigan Supporting and Improving Rural EMS Needs (MiSIREN) project will provide training for first responders in rural designated counties of Michigan's northern region of the lower peninsula, the eastern region commonly referred to as the "Thumb", and the Upper Peninsula. In 2022 the Michigan Rural EMS Network (MiREMS), with the Northern Michigan Fire Chiefs Association, completed a First Responder Needs Assessment (FRNA). The FRNA was funded by grants from FEMA and the Office of Rural Health Policy for the project region. Our proposed project covers 53 rural counties with a total population of over 19.1 million people (US. Census). All counties to be served by the project are nonmetropolitan statistical areas. There are significant EMS service gaps and barriers in the catchment area. These project will address the following challenges: Workforce Shortages: Using EMS personnel data from the state of Michigan to identify agencies at risk of having to downgrade their level of service from ALS to BLS or closing their agency entirely, we will concentrate our efforts to offer initial MFR and EMT education in regions with the most need for new recruits. We will also identify and prioritize communities with greatest economic need. These communities may not have the resources to support recruitment programs and may encounter greater challenges in attracting new recruits due to the need for individuals to have at least one existing full-time job to make ends meet. This creates difficulty in having the time available to serve in a volunteer department. In our experience, offering MFR (Medical First Responder) courses develops an effective pipeline from which to recruit students for EMT classes. Training Gaps: Access to initial education, such as MFR and EMT courses, and continuing education opportunities results in difficulties attracting new recruits to EMS and maintaining licensure. We will recruit 182 participants for MFR and EMT training, and 330 EMS personnel through continuing education which includes education to increase competencies regarding mental health and substance use disorders.

The purpose of Washington County Ambulance District’s EMS Training Program is to recruit and train emergency medical services (EMS) personnel in rural Missouri. The goal, in partnership with the Missouri Emergency Medical Services Association, Mineral Area College, Washington County Health Department and Washington Community Partnership is to increase capacity of Missouri EMS agencies to provide life saving services through certification and continuing education. The funding request will fund Year 1 of a two-year project. WCAD and its partners will provide training on life-saving skill and provide life saving devices to first responders including EMS, fire, highway patrol, law enforcement and park rangers, across three counties. More than 500 individuals will receive training annually and continuing education will be provided to another 250. Funds will be leveraged to further support education and training to meeting EMS certifications and licensure for an additional 150 individuals (e.g., EMTs, paramedics, etc.). The goal of the project is to provide EMS personnel and first responders in Dent, Reynolds and Washington Counties in Missouri with lifesaving training, including training in the use of lifesaving devices, with an emphasis on addressing substance use disorder (SUD) and co-occurring SUD and mental disorders (COD). WCAD will leverage its existing training programs through Mineral Area College to ensure EMS personnel receive ongoing training and education on mental and SUD trauma-informed, recovery-based care in emergency situations. Objectives to be undertaken during the two year period to meet this goal include conducting courses that qualify up to 150 graduates to serve in an EMS agency, leveraging existing programs and resources; providing initial training on lifesaving devices for a minimum of 1,000 first responders, to include EMS, fire fighters, law enforcement, highway patrol, and park rangers, implementing an inventory and tracking system for placement and monitoring of life-saving devices throughout the three-county service area to aid dispatch and first responders in accessing devices; conducting continuing education on lifesaving skills and devices for a minimum of 500 first responders, to include EMS, fire fighters, law enforcement, highway patrol and park rangers; and placing 200 life-saving AEDs in accessible locations in each county, including first response vehicles.

Project Summary: Coffey County Emergency Medical Services (EMS), a Coffey County Hospital (aka Coffey Health System) service will increase the capacity of EMS personnel to respond to mental health and SUD emergency calls by hiring additional staff, implementing a robust training plan, and enhancing procedures, care coordination, and patient support systems. Population to Be Served: CHS-EMS provides Type 1 medical services on a 24-hour basis to residents of Coffey County, KS, and as requested in the four surrounding counties of Anderson, Lyon, Osage, and Woodson, all in rural southeast Kansas. The rural residents of the service area live in an area that faces shortages of mental health professionals, lower percentages of individuals with health insurance, fragmented care, and societal stigma around substance use and mental health. These challenges contribute to high rates of illicit drug use, overdoses, and death due to drug poisoning. Strategies/Interventions: CHS is proposing to increase the capacity and training of its EMS personnel with a particular focus on addressing substance use disorders and co-occurring mental health conditions. This project will support CHS in improving the EMS workforce capacity, enhancing staff training, and connecting individuals to mental health and SUD services. CHS is proposing a robust set of strategies and activities to enhance current efforts and improve its capacity to implement the required activities. Goals and Objectives: CHS can achieve its goal of increasing the capacity of EMS personnel to respond to mental health and SUD emergency calls by hiring additional EMT staff, implementing a robust training plan, and enhancing procedures, care coordination, and patient support systems. CHS will hire, onboard, and train three EMTs and provide financial support for five EMTs to become paramedics. In addition, CHS will implement a robust training program and provide training for 25 EMS each year for a total of 50 (duplicated) staff on substance use, mental health, trauma-informed care, harm reduction, and motivational interviewing during the two-year performance project. The training plan will also include continuing education and training needed for certifications. To support EMS staff in responding to emergencies in the service area CHS will purchase needed equipment and PPE. CHS will partner with Crosswinds Counseling and Wellness to increase care coordination and connect individuals with substance use services.

Project Abstract Project Title: EMS Training Grant Clarinda Regional Health Center, 220 Essie Davison Dr, Clarinda, IA 51632 Project Director: Tyril Green Contact Phone Number: 712-542-8208 Email Address: tgreen@clarindahealth.com clarindahealth.com The purpose of this project is to recruit and train Emergency Medical Services staff to care for residents of Southwest Iowa in emergency situations with a special focus on treating patients that may be experiencing issues with mental health or substance abuse. The project will allow approximately 860 individuals to be trained to properly respond to medical emergencies including those related to mental health and substance abuse calls by providing a curriculum of on-line and in-person training designed to enhance skills. The performance period is from September 30, 2024, through September 29, 2026. The goals of the project are: 1. Recruit 35 additional EMS staff in Southwest Iowa by September 2026. 2. Establish a training program by EOY 2024 for EMS staff to earn licenses and certifications. 3. Increase knowledge of EMS providers in topics related to substance abuse and mental health issues in all three focus area counties at year one and two. 4. Collaborate with area business to increase knowledge of AED usage and install AED devices in interested businesses by September 2026. The objectives include: --The Project Director attending job fairs, EMS conferences, and visiting high schools and colleges to recruit EMS candidates. As well as actively advertising positions available on online platforms. --Train EMS staff on skills tests utilizing new training equipment and provide an in-person conference locally that will count towards certifications. Classes will be offered that have a focus on mental health and substance abuse. Community members and organizations in the focus area will take part in training focused on AED usage, stop the bleed, CPR, and Naloxone training. The target population that will benefit from the implementation of this project is 31,206 residents of Page, Taylor, and Montgomery Counties in Southwest Iowa. These are underserved, primarily white rural residents of all ages with higher-than-average numbers of people living in poverty, elderly, uninsured, and veterans. These circumstances put the population of Southwest Iowa at a greater risk for mental health and substance abuse issues as evidenced by the documented higher-than-state-average percentage of Medicare beneficiaries with depression and adults with frequent mental distress. A target population needs assessment was completed in 2019 and identified concerns of poverty, lack of mental health treatment, lack of affordable housing, abuse of opioids, lack of awareness of health resources, and smoking/vaping. The number one and number two health priorities identified in the Community Health Needs Assessment were Mental Health (Diagnosis/Treatment/Aftercare) and Drug Abuse (Opioid/Meth) respectively.

Population Served: Upper Pine River Fire Protection District appreciates having been the recipient of SAMHSA Rural EMS Training grants for the past three years. The continuation of funding has supported UPRFPD in offering high-quality training for EMS providers and advanced training for responding to instances of individuals in behavioral health or substance use crises, including opioid overdose. In FY24, an estimated 50 providers will continue to receive training, certification, and recertification for new and current EMS providers providing services in rural Colorado. Project Goals and Objectives: The program aims to train and maintain EMS personnel by offering EMS training and certification for EMS providers and community partners on EMS skills, Motivational Interviewing, Trauma-Informed Care, skills for treating an individual in behavioral health or substance use crisis, and linking these patients with the most appropriate intervention, and available therapy opportunities in the catchment area. Project Strategies and Interventions: EMS Providers at the EMT, Paramedic, and Community Paramedic levels will be trained across UPRFPD's primary response area to maintain and advance their skills and maintain current state and national licensing and certificate levels. This education will be augmented with specialized training on behavioral health and substance use disorders, utilizing opioid reversal agents in the case of opioid overdose, and engaging with patients in behavioral health or substance use crises utilizing Motivational Interviewing, Trauma-Informed Care, and other advanced topics, and develop further collaboration with the behavioral health workforce. In addition, the district will continue a project to provide EMS-specific Motivational Interviewing online training, ensuring that the training is available in various language options to make it as accessible as possible. The Rural EMS Training grant will implement a structured data collection process across both tracks to drive project management and strengthen outcomes. In addition, demographic data will be collected to identify trends in EMS providers in Colorado. The project director will oversee the quality management of the programs to identify adjustments to improve them.

The purpose of the CCH FY 2024 Rural EMS Training Project is to address ongoing barriers to the sustainability of CCH EMS services and improve mental health (MH) and substance use disorder (SUD) services for people in the service area. Through the project, CCH EMS will increase the number of qualified EMS providers in the region by providing scholarships for EMT Basic courses. They will increase MH and SUD training and provide continuing education for both CCH and external EMS providers to assist them in meeting their licensure and certification requirements. They will facilitate collaboration between CCH EMS staff and community partners in caring for individuals who have undergone opioid overdose reversals or who are experiencing an MH or SUD crisis. In addition, CCH will use grant funds to purchase and implement emergency rescue equipment to help ensure high-quality EMS services are available for the care of the population of focus throughout the service area. The geographic area for the CCH EMS Training Project includes Campbell, Sheridan, and Weston Counties in NE Wyoming, and 200 square miles of Custer County in SW South Dakota. The population of focus for the project is individuals across the lifespan in the service area, from all the demographics outlined below, who need emergency medical services care. The combined total population of the counties included in the service area is 95,020 people. The demographics of the combined population are outlined below: Male 51.8% Female 48.2% White, not Hispanic 93.6% Hispanic Latino 6.2% American Indian and Alaska Native 2.2% Asian 1.0% Black 0.8% Pacific Islander 0.1% Multiracial 2.3% Persons in Poverty 9.7% Per Capita Income $40,062.25 Veterans 7.6% Disabled persons under 65 years of age 8.8% No Health Insurance 15.0% Persons under 18 years of age 19.8% Persons 65 and over 23.2% 3.3% of the people living in Wyoming (at large) and 3% of the people living in South Dakota (at large) identify as lesbian, gay, bisexual, or transgender (LGBT). 0.48% of the people living in Wyoming (at large) and 0.44% of the people living in South Dakota (at large) specifically identify as transgender. Like rural populations across the nation, residents in the service area experience health disparities such as lack of access to healthcare, lack of access to mental healthcare, distance from resources, lack of access to substance abuse treatment and prevention, stigma about MH and SUD, and limited transportation options. EMS service acts as a healthcare safety net for people in the US, and even more so for people in rural areas. With funding from the FY 20242 Rural EMS Training Grant, CCH EMS intends to train 220 EMS providers in the region through their EMSU educational conference; continuing education offerings for their EMS staff; increased MH and SUD-specific training for both internal and external EMS providers; and their EMT Basic course. In addition, they will purchase technologically advanced training tools and resources to improve the training they can provide to EMS providers and a Quick Response Vehicle (QRV) to enhance 911 emergency response in the service area.

The Old Forge Volunteer Ambulance Corps is an EMS provider in rural Herkimer and Oneida counties. These areas have a low year-round population that surges during the summer and winter tourist season; often adding more individuals who require emergency care. These areas are also experiencing a rising incidence of substance abuse and mental health issues, an increase in 911 call volume and a decrease in the number of responding EMTs. Additional trained EMTs are critical to support the health needs of these rural communities. Old Forge is seeking funds to offer comprehensive EMS training programs across rural communities in Herkimer, Oneida, and neighboring Madison counties. Training will also be available online and through virtual/augmented reality programming with specific focus on substance abuse and mental health issues. The goal is to address the service gaps and enhance the delivery of emergency medical services; thus improving health outcomes for all residents.

According to the CDC, death rates for unintentional injuries like drug overdoses are about 50 percent higher in rural areas than in urban areas. Unfortunately, Louisiana has the 7th highest opioid pain reliever-prescribing rate in the U.S. Louisiana also has the 5th highest rate of past year nonmedical prescription opioid pain reliever use and has the 24th highest drug overdose death rate. The Louisiana Commission on Preventing Opioid Abuse reported in its findings, “Rural areas have pronounced opioid dependent persons, and these areas have few resources to provide to them.” The training and technical assistance made available through this grant is necessary to address the substance abuse epidemic occurring in rural Louisiana. Simply put, access to quality and culturally appropriate Emergency Medical Services Opioid Prevention Education must be delivered in the communities in which the practitioners live and work.

Parker County Hospital District Emergency Medical Services (PCHD EMS) program, designed for 2024-2026, addresses the unique challenges faced by EMS providers in rural areas, by enhancing skills and knowledge in mental health and substance abuse emergencies, expanding the EMS workforce, and ensuring comprehensive EMS coverage for the entire population of Parker County. This initiative emerges from a comprehensive needs assessment revealing substantial training challenges faced by Fire Rescue Organizations (FRO) within Parker County, including Parker County Emergency Service Districts (ESD) and Weatherford Fire Department (WFD) due to staffing constraints and limited financial resources. This proposal seeks to unify and refine the standard of care across all agencies by fostering partnerships focused on mental health disorders, substance use disorders (SUD), co-occurring disorders (COD), and establishing de-escalation practices. Moreover, this proposal will extend mental health and substance use disorder training to local rural EMS clinic staff, of which are serving the general public for health concerns including prevention and treatment services for patients with co-occurring disorders. This comprehensive approach addresses training deficits, service gaps and other barriers across rural areas of Parker County throughout two award years. The program includes several key goals and objectives: (1) Enhance the number of highly trained critical care paramedics in Parker County by expanding Critical Care Paramedic (CCP) course offerings to Parker County FROs and PCHD EMS for 20 EMS personnel, focusing on managing critical patients in extended rural transports; (2) Increase the total number of EMS providers in the county through scholarship programs for 30 EMT-B high school seniors, 60 for EMT-B for adults, as well as 7 EMT- paramedic students; (3) Increase the number of trained EMS in Critical Incident Stress Management (CISM) training by 30 students to improve their capabilities in managing stress and mental health crises; (4) Providing specialized mental health and stress management training to all telecommunicator agencies, targeting 18 leads and 37 dispatchers, across Parker County; (5) Implementing comprehensive, evidence-based mental health training for 35 patient-facing staff at PCHD rural clinics, to enhance the overall quality of patient care in rural settings. Additionally, our LMSW will provide follow-ups with individuals having undergone overdose reversal to link individuals to dedicated community partners providing recovery support. This proposal is invested in increasing the number of specialty trained individuals across various initiatives for a total of 237 unduplicated individuals. The program's comprehensive evaluation strategy is designed to confirm the achievement of its goals and to significantly enhance mental health and substance abuse services in rural areas. Through this training, we aim to promote healthy behaviors, and strengthen partnerships, through enhancing the coordination of rural EMS services and therefore improving overall community resilience.

The purpose of this project is to recruit and train rural EMS personnel to provide holistic evidence and recovery based, as well as trauma informed care for mental health and substance use disorder patients. This will provide resources that should lead to decreased substance use disorders and seeking treatment for under recognized/treated mental health conditions for both patients and field personnel. Courses funded will be offered to all Hampshire County EMS personnel, both paid and volunteer. It is estimated that 100, or more, health providers annually will be educated in substance use disorders, co-occurring mental health conditions and physical wellness directed specifically for first responders and their patients. Hampshire County Emergency Service Agency is a county government entity that provides EMS coverage for the residents within Hampshire County and surrounding communities. Home to approximately 24,000 residents spread across 644 square miles of rural community, HCESA is responsible for the coverage of nearly 3100, 911 EMS calls annually. Our area is surrounded by high-volume drug trafficking highways and locales, including: Winchester, VA; Cumberland, MD; Martinsburg, WV; and Baltimore, MD. Being surrounded by these areas makes it easy for large amounts of drugs to come into our area, especially fentanyl and heroin. This drastically increases, and exacerbates, other related societal symptoms of social poverty. In 2023, according to Hampshire County 911 Center and HCESA data, 90% of those patients were administered naloxone on scene, and later refused EMS transport for ED evaluation. Between 2020 and 2023 Hampshire County averaged 16.3 overdose deaths per year. The first objective is to purchase FDA-approved medication, devices for emergency reversal of known or suspected opioid overdose, education, and follow up referral to be distributed to all overdose patients who refuse EMS transport during the project year. The current EMS model does not provide crisis intervention training in standard EMS initial or continuing education pertaining to motivational interviewing and de-escalation. According to report data for HCESA, crews responded to 39 adult psychiatric or suicidal patients and an additional 16 pediatric totaling 18.7 percent of total pediatric encounters. For this objective in the project period, 100% of current HCESA EMS providers will participate in training on mental health and substance disorders in emergency situations. This will also address mental health disparities in the personal mental health care for rural EMS providers by providing local access to training and equipment proven to reduce stress, "burn out", PTSD and substance use disorders in first responders themselves. The EMS personnel deficit grows to be an increasing challenge with initiatives to increase both recruitment and retention of providers. An aging and dwindling population amongst the active volunteers within the local EMS companies often leaves a shortage of available providers responding to high volumes of calls for service. According to WV EMS coalition document, overall turnover among paramedics and EMTs ranges from 20-30% annually. The third objective is to provide educational reimbursement to obtain and/or maintain personal NREMT and WV EMS certification. Funds will also be used towards making access to courses more attainable. Training first responders in the techniques related to mental health and substance use disorders not only assists in treating the providers themselves but increases their ability to be effective clinicians in these areas for their patients in the community.

Rural western and central South Dakota has a critical shortage of emergency medical technicians (EMTs). The purposed program will address this shortage by training 294 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 680 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 strength the emergency medical services workforce in rural South Dakota. Estimated number of people to be served as a result of this grant: 827

Increase the number of Paramedics through development of an on-site Certification program to serve candidates locally as well as throughout the rural region. Increase the capacity to reduce Opioid overdose, with training on administration of naloxone, safety protocol with fentanyl and other drugs, adequate supplies and equipment. Increase the proficiency and abilities of the EMS force by providing the support training and experience with regards to substance use disorders, trauma informed care, interface with peer support specialists to facilitate a “warm handoff” and transition to services.

Project Abstract Name: The SAMHSA EMT Training Project for APEC & CBY Alaska Pre-Hospital Education Consortium (APEC) is partnering with the City and Borough of Yakutat (CBY) to enhance Emergency Medical Services (EMS) in the region. APEC provides EMS training across the entire state of Alaska, mostly in rural areas. They train individuals according to the Alaskan and National standards for Basic EMT, Advanced EMT, and paramedic certification. They have developed a curriculum method that has proved to be very successful. They provide face-to-face and virtual instructor led training, with in-person skills labs held across the state. APEC comes to those who need it most. APEC is women led, rural focused, equity driven, and evidence based. Their mission is to improve the health of all Alaskans by providing high-quality, accessible, and consistent EMS education. The SAMHSA EMT training project, spearheaded by this partnership organization, aims to address substance use disorders (SUD) and co-occurring disorders (COD), including substance use and mental disorders. The primary objective is to enhance the training certification process for EMS personnel. This project will target service gaps, such as the shortage of trained EMS staff available to respond to emergency calls and overcome barriers like internet connectivity issues and scheduling conflicts. The overarching goals of this project: 1) Train and certify EMS personnel in trauma-informed care and emergency response. The project emphasizes addressing substance use disorders (SUD) and co-occurring disorders (COD), including substance use and mental disorders, as key priorities. 2) Ensure that all curriculum includes modules on substance use disorders and trauma-informed care. 3) Improve student performance on assessments related to substance use disorder and trauma-informed care. 4) Ensure that 100% of students receive cultural competency training in substance use disorder and trauma-informed care. 5) Develop a formal agreement with CBY’s behavioral health providers to facilitate collaboration and referral pathways. 6) Conduct quarterly assessments and make continuous improvements to the integration of substance use disorder and trauma-informed care education. 7) Increase community awareness and reduce stigma of substance use disorders and mental health issues. 8) Increase the pool of EMS responders, ensuring that at least two trained personnel are available for each emergency call. 9) Reduce response times for emergency calls. 10) Increase community overall satisfaction with EMS services. This SAMHSA EMT training project would provide crucial EMS training for providers who serve 662 residents, along with over 16,000 visitors who converge on the rural community of Yakutat annually due to tourism and fishing during the summer months, and approximately 250 Cruise Ships who visit the Hubbard Glacier near Yakutat. When they need medical care, they often call the Yakutat EMTs to assist.

Executive Summary: Title: Enhancing Rhode Island's Rural Healthcare Access through Behavioral Health Training and Support Introduction: In response to the pressing need for improved behavioral health services in Rhode Island's rural communities, the Rhode Island Disaster Medical Assistance Team/Medical Reserve Corps (RIDMAT/MRC), a distinguished 501(c)(3) non-profit organization, is spearheading a comprehensive grant initiative. With its unique statewide reach and the distinction of holding an EMS agency license, RIDMAT/MRC is poised to lead the charge in addressing this critical issue. Building on over two decades of experience in providing top-tier medical education to clinical volunteers, community health partners, first responders, and the general public, RIDMAT/MRC is well-positioned to execute this initiative effectively. Objectives: 1. Provide Comprehensive Behavioral Health Training: RIDMAT/MRC will deliver thorough behavioral health training programs tailored specifically for rural EMS personnel. Leveraging its wealth of experience and expertise in medical education, RIDMAT/MRC aims to enhance the capacity of rural EMS responders in recognizing, assessing, and responding to substance use disorders (SUD) and co-occurring mental health conditions. 2. Increase Access to Naloxone: As part of the initiative, RIDMAT/MRC will work to bolster access to naloxone within rural EMS agencies. By facilitating the availability of naloxone, the organization seeks to empower EMS responders to effectively combat opioid overdose emergencies, potentially saving countless lives. 3. Establish Partnerships with Local Peer-Support Specialists: Recognizing the importance of ongoing support for individuals grappling with substance use disorders, RIDMAT/MRC will forge partnerships with local peer-support specialists. These alliances will serve to provide continuous assistance and resources to individuals in need within rural communities. 4. Implement Innovative Technologies: RIDMAT/MRC's Training, Innovation & Leadership Institute, boasting a 10,000 square-foot state-of-the-art training facility, will serve as the hub for implementing innovative technologies. From immersive training and simulation capabilities to mobile training units, RIDMAT/MRC will ensure the seamless delivery of evidence-based and trauma-informed behavioral health training to EMS providers across Rhode Island's rural landscapes. Expected Outcomes: 1. Enhanced Recognition and Response: Through comprehensive training, rural EMS personnel will demonstrate improved abilities to recognize and respond to behavioral health emergencies, leading to more effective patient care. 2. Increased Availability of Naloxone: By expanding access to naloxone, RIDMAT/MRC aims to save lives by mitigating the devastating impacts of opioid overdose emergencies in rural communities. 3. Enhanced Support for Individuals: The establishment of partnerships with local peer-support specialists will ensure individuals grappling with substance use disorders receive ongoing support, fostering their journey towards recovery and well-being. 4. Improved EMS Education: Through the integration of innovative technologies, RIDMAT/MRC will enhance EMS education, ensuring providers are equipped with the latest tools and knowledge to deliver exceptional care. Conclusion: RIDMAT/MRC's commitment to enhancing Rhode Island's rural healthcare access through behavioral health training and support is unwavering. By leveraging its extensive experience, statewide reach, and cutting-edge training facilities, RIDMAT/MRC is poised to make a substantial impact on rural healthcare delivery. Through this grant initiative, the organization seeks to empower EMS providers with the necessary skills, resources, and support to drive positive change and foster healthier communities across the state.

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 EMS personnel to our community ambulance service. We currently have five EMT’s, two active Advanced EMT’s (AEMT) and two Paramedics. We have two EMT’s that are available on weekdays. One of our AEMT’s works out of the area weekdays and is only available on nights and weekends. Both of our Paramedics are career firefighters and are only available when their schedules permit. With this funding for the next two years, we would like to train 20 EMT’s, six additional AEMT’s and two Paramedics. This would allow us to have additional EMT’s for daytime coverage and 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 375 calls per year in our community of 3,520 with 11 active EMS personnel. All these members of our service have “regular” jobs or are students 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 $439,949.00 by 3520 residents the cost per resident is $125.00 annually. If we amortize that over 20 years, the cost per resident drops to $6.25 per year. The Brooks Ambulance will establish a training program for EMT’s, AEMT’s and Paramedics in our area. This will be an opportunity for 20 community members to be trained and licensed as EMT’s. We will also train 6 current 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 over a two-year period. This training will be provided with a combination of distance learning, classroom and hands on skill training as needed. We will prepare these students to test and certify to a national standard for EMT’s, 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 the over three hundred Waldo County firefighters EMS providers to recognize the signs of overdose and administer Naloxone during an overdose. We will also train these same three hundred firefighters and local EMS providers on how to recognize and deal with substance use disorder (SUD) and mental health problems in themselves, their fellow firefighters and EMS personnel.

In response to the critical need for enhanced emergency medical services (EMS) for individuals experiencing mental health and substance use crises in rural areas, our project, titled "Rural EMS Resilience and Response Initiative," aims to strengthen the capacity of EMS personnel to provide trauma-informed care and facilitate connections to treatment and support services. Serving the rural population of Edgar County, Illinois, characterized by diverse demographics and prevalent socioeconomic challenges, our project will implement comprehensive training programs and establish innovative protocols to address the unique needs of this underserved community. Our strategies include training EMS personnel on mental health and substance use disorders, naloxone administration, motivational interviewing, and warm handoffs to peer support specialists. Additionally, we will acquire essential emergency medical services equipment, develop reporting procedures for overdose incidents, and ensure ongoing professional development for EMS staff. Through partnerships with local organizations such as ROSC, CARE and the HRC Living Room Program, and collaboration with regional training resources, we aim to maximize the reach and effectiveness of our interventions. The goals of our project are to improve the quality of emergency response for individuals with mental health and substance use concerns, reduce stigma surrounding these issues within the EMS community, and increase access to timely and appropriate care for rural residents. Measurable objectives include training all EMS personnel to facilitate warm handoffs for 100% of all patients with mental health and substance use concerns, and reporting overdose incidents to public health authorities within 72 hours. Over the project's duration, we anticipate providing EMS training to over 100 individuals annually and over 200 individuals throughout the entirety of this project fostering long-term improvements in emergency response and community well-being.