For National Rural Health Day, SAMHSA celebrates the unique strengths of rural communities. SAMHSA empowers rural resilience by providing resources and tools that address behavioral health; supporting rural communities' ability to mitigate, adapt, and recover from stressors; promoting behavioral health equity; and building and retaining a diverse, robust, and resilient behavioral health workforce.

SAMHSA recognizes the urgent need for emergency medical services (EMS) in rural areas and the critical role EMS personnel serve across the country. While the need for a strong and diverse rural EMS workforce with capacity to address behavioral health is great, rural areas lack training to build and maintain such a workforce. In rural areas, an absence of advanced-level EMS providers—who are more likely to administer overdose reversal medication than are lesser-trained EMS providers—has been shown to contribute to increased rates of overdose deaths. Further, lack of EMS access in rural areas is linked to increased rates of suicide (PDF | 449 KB). Barriers to building a strong EMS workforce include tuition for certification, for which individuals are responsible. These out-of-pocket expenses vary, depending on the institution and the level of certification. Typically, the training requirements (PDF | 194 KB) are 40 hours for first responders, 120-150 hours for Emergency Medical Technicians (EMTs), and 1,000 hours for paramedics. In rural areas, which rely heavily on volunteer EMS professionals (PDF | 542 KB), these requirements are an especially high burden.

The purpose of the SAMHSA-funded Rural EMS Training grant program is to recruit and train EMS personnel in rural areas, with a particular focus on addressing substance use disorders (SUD) and co-occurring mental health and substance use disorders (COD). Grant recipients are expected to train EMS personnel on SUD and COD, trauma-informed, recovery-based care for people with such disorders in emergency situations and, as appropriate, to gain and maintain licenses and certifications required to serve in an EMS agency. With this program, SAMHSA aims to provide support for rural EMS agencies to build and maintain their behavioral health workforce programs, expand provider capacity to respond to behavioral health emergencies, and improve physical infrastructure through acquisition of needed 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 throughout the country. The funding of and commitment to this program have grown every year. During 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 issued a total of 197 awards to 116 unique rural EMS organizations. Most applicant organizations (63.8 percent) were awarded only once, while 18 percent have received at least two awards.

Aside from providing a great opportunity for recruitment and training of over 20,000 EMS personnel throughout the country, this program has also provided opportunities for organizations to improve their practice:

• Jersey Community Hospital District (IL): The organization has been able to host community business leaders to train them on cardiopulmonary resuscitation (CPR), automated external defibrillators (AED), and naloxone during staff Lunch and Learn events.
• Morgan County Rescue Service (WV): One of the requirements of this grant is to train EMS staff in the administration of overdose reversal medication, motivation interviewing and de-escalation techniques. As a result, the organization has observed that the - survival rate for patients with life-threatening emergencies has increased by five percent, and patient satisfaction with EMS services has increased by 15 percent since the program began. The program has also helped to improve the coordination of care between EMS and other healthcare providers.
• County Of Rio Arriba (MN): Because of the popularity and relevance of the SUD-related curriculum in the EMS First Responder courses provided through the grant, University of New Mexico-Taos plans to incorporate similar content into all of its EMS courses in the future, and to offer related SUD training programs for its volunteer fire departments throughout the county.
• Brooks Ambulance (ME): The grant program helped to build community engagement across localities and build interdepartmental relationships to foster collaboration and strengthen partnerships and awareness of resources available to support the community to address behavioral health issues.
• Lester E. Cox Medical Centers (MO): After receiving the grant, the Lester E. Cox Medical Centers have new full time Community Paramedics and recently trained several field Paramedics to assist patients who have needs related to substance use and access to health care.
• Golden Valley Memorial Hospital Ambulance (MO): This organization has been working 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 Mobile Integrated Health and Community Paramedic work, which involves the response to overdose and mental health emergencies. They have been able to leverage other programs to grow and have reported positive outcomes in EMS practice.
• Pine Hill Indian Community Development Initiative (SC): In alignment with the grant program, this organization started a weekly First Responder mental wellness meeting (“Warrior Spirit”) every Thursday evening at Pine Hill Health Network.
• Lawrence County Courthouse (TN): Lawrence County EMS has made significant changes in treatment policies and is in the process of improving treatment programs to better serve community members with SUD.

Rural EMS Training grant recipients have provided feedback on the impact of the program, with comments such as, “...it is literally the one thing that can keep the rural EMS services to survive” and “what needs to be stressed and impressed upon 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 Supporting and Improving Rural EMS Needs (SIREN) Reauthorization Act was signed into law, which reauthorizes 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 scope of SAMHSA’s rural behavioral health portfolio by reflecting diversity in: 1) population served or population of focus (e.g., age, ethnicity, sexual orientation, social context of family or individual); 2) geography (e.g., rural or regions); 3) implementation strategies (e.g., number of EMS staff recruited and trained, program implementation and impact); and 4) outcome of focus (e.g., increasing rural EMS workforce, preventing a downstream outcome such as overdose).