For National Rural Health Day, SAMHSA is celebrating the unique strengths of rural communities. SAMHSA strengthens rural resilience by providing behavioral health resources and tools. supporting the capacity of rural communities to mitigate, adapt and recover from stressors; promoting behavioral health equity; and building and sustaining a diverse, strong and resilient behavioral workforce.
SAMHSA recognizes the urgent need for emergency medical services (EMS) in rural areas and the critical role EMS personnel play across the country. While the need for a strong and diverse rural EMS workforce with the ability to address behavioral health is great, rural areas lack the training to build and maintain such a workforce. In rural areas, the absence of advanced-level EMS providers—who are more likely to administer overdose reversal drugs than less-trained EMS providers—has been shown to contribute to increased overdose death rates. Further, Lack of EMS Access in Rural Areas Linked to Increased Suicide Rates (PDF | 449 KB). Barriers to building a strong EMS workforce include tuition for certification, which individuals are responsible for. These out-of-pocket costs vary, depending on the institution and level of certification. Typically, education requirements (PDF | 194 KB) it is 40 hours for first responders, 120-150 hours for Emergency Medical Technicians (EMTs), and 1,000 hours for paramedics. In rural areas, where rely heavily on volunteer EMS professionals (PDF | 542 KB)these requirements are a particularly heavy burden.
The purpose of the SAMHSA-sponsored Rural EMS Training grant program is to recruit and train EMS personnel in rural areas, with a specific focus on addressing substance use disorders (SUDs) and co-occurring mental health and substance use disorders (CODs). Grant recipients are expected to train EMS personnel in SUD and COD, trauma-informed, rehabilitation-based care for individuals with such disorders in emergency situations and, as appropriate, obtain and maintain licenses and certifications required to serve in an EMS service. With this program, SAMHSA aims to provide support to rural EMS services to build and sustain behavioral health workforce programs, expand providers’ capacity to respond to health emergencies, and improve physical infrastructure through of acquiring the necessary equipment and supplies.
SAMHSA first funded the Rural EMS Training grant program in 2020. In 2024, the fifth cohort of this grant program was awarded to 62 EMS organizations across the country. Funding and commitment to this program is growing every year. Over the past five years, SAMHSA has invested over $38.7 million in training and support for rural EMS organizations across the country. From 2020 to 2024, SAMHSA presented a total of 197 awards to 116 unique rural EMS organizations. Most nominated organizations (63.8 percent) have been awarded only once, while 18 percent have received at least two awards.
In addition to providing an excellent opportunity to recruit and train over 20,000 EMS personnel across the country, this program has also provided opportunities for organizations to improve their practice:
- Jersey Community Hospital District (IL): The organization was able to host community business executives to educate them on cardiopulmonary resuscitation (CPR), automated external defibrillators (AEDs) and naloxone during lunch and staff learning events.
- Morgan County (WV) Rescue: One of the requirements of this grant is to train EMS personnel in administering overdose reversal medication, motivational interviewing and de-escalation techniques. As a result, the agency has seen the survival rate for patients with life-threatening emergencies increase by 5 percent and patient satisfaction with EMS services increase by 15 percent since the program began. The program also helped improve coordination of care between EMS and other health care providers.
- Rio Arriba County (MN): Due to the popularity and relevance of the SUD-related curriculum in the EMS First Responder courses provided through the grant, the University of New Mexico-Taos plans to incorporate similar content into all of its EMS courses in the future and offer related training SUD programs for volunteer fire departments across the county.
- Brooks Ambulance (ME): The grant program helped build community engagement across sites and build cross-departmental relationships to promote collaboration and strengthen partnerships and awareness of available community support resources to address behavioral health issues.
- Lester E. Cox Medical Centers (MO): After receiving the grant, Lester E. Cox Medical Centers has new full-time Community Paramedics and recently trained several on-site paramedics to help patients who have substance use needs and access health care.
- Golden Valley Memorial Hospital (MO) Ambulance: This organization works closely with other providers to implement protocols that connect people who have experienced an opioid overdose with SUD treatment.
- Washington Co Ambulance (MO): The grant allowed this organization to develop the Mobile Integrated Health and Community Paramedic project, which includes overdose and mental health emergency response. They have been able to leverage other programs to grow and have reported positive results in EMS practice.
- Pine Hill Indian Community Development Initiative (SC): In alignment with the grant program, this organization started a weekly First Responder (“Warrior Spirit”) mental wellness meeting every Thursday evening at Pine Hill Health Network.
- Lawrence County (TN) Court: Lawrence County EMS has made significant changes to treatment policies and is in the process of improving treatment programs to better serve community members with SUDs.
Recipients of the Rural EMS Training grants have provided feedback on the program’s impact, with comments such as, “…it’s literally the only thing that can keep rural EMS services alive” and “what needs to be emphasized and impressed. is that this grant has given this institute the tools to provide a successful learning environment for years to come.”
On September 26, 2024, the bipartisan EMS Rural Emergency Support and Enhancement (SIREN) for reauthorization signed into law reauthorizing funding for the Rural EMS Training program for five additional years through fiscal year 2028.
In determining which grantees to highlight for this blog, staff (including government project officers) identified grantees that represent the breadth of SAMHSA’s rural behavioral health portfolio by reflecting diversity in: 1) population served or focus population (eg; e.g. age, nationality, sexual origin, orientation, social context of the family or the individual). 2) geography (eg rural or regional); 3) implementation strategies (eg, number of EMS personnel recruited and trained, program implementation and impact); and 4) outcome of focus (eg, increasing the rural EMS workforce, preventing a downstream outcome such as overdose).
