RD Instruction 2000-EE PART 2000 - General Subpart EE - Memorandum of Understanding Among Rural Development and the Forest Service, U.S. Department of Agriculture, and the National Highway Traffic Safety Administration, U.S. Department of Transportation. §2000.1501 General Rural Development has entered into a Memorandum of Understanding with the Forest Service (FS) and the National Highway Traffic Safety Administration (NHTSA) regarding rural emergency medical services. The memorandum provides for cooperation, briefly describes programs, and includes a list of personnel relating to the development of emergency medical services in rural areas. The memorandum is attached as Exhibit A. §§2000.1502 - 2000.1550 [Reserved] Attachment: Exhibit A oOo __________________________________________________________________________ DISTRIBUTION: W, S, D, C Administration General 1 (6-13-84) PN 932 RD Instruction 2000-EE Exhibit A Memorandum of Understanding Among Rural Development and the Forest Service, U.S. Department of Agriculture and the National Highway Traffic Safety Administration, U.S. Department of Transportation regarding Rural Emergency Medical Services Purpose: The purpose of this memorandum is to provide for both the exchange and transmittal of information about Federal programs that are applicable to developing emergency medical services (EMS) programs and to provide points of contact for obtaining assistance to develop EMS program components and systems. Background: The U.S. Department of Transportation (USDOT) through the National Highway Traffic Safety Administration (NHTSA) and the U.S. Department of Agriculture (USDA) through Rural Development and the Forest Service (FS) have assistance programs which can provide support for the development and implementation of EMS programs in rural areas. These are the Highway Safety Program--NHTSA, the Community Facilities Loan Program—Rural Development and the Rural Community Fire Protection Program--FS. Limited technical assistance, loans, grants, and equipment for planning and implementing components of rural EMS systems may be available under one or more of these programs subject to the budgetary and priority constraints which exist in each agency. Policy: It is U.S. Government policy to encourage people at all levels to cooperate in developing rural EMS components and systems and to inform them about the variety of available Federal funds. To enhance this cooperation, there are attached lists of key personnel who can aid rural EMS system development. All personnel are encouraged to establish working relationships among the organizations involved to ensure that there is a clear understanding of how the programs are structured and that they interact in complementary and supplementary ways. The U.S. Department of Health and Human Services (DHHS) also makes funds available for EMS through its Preventive Health and Health Services Block Grant Program as provided in Public Law 97-35, Section 901. The State EMS Directors should be the focal point for the planning, coordination, and interaction among EMS activities funded through the DHHS Block Grant Program and those funded through other Federal funding sources. Details on the DHHS funds must be obtained from the State EMS Director. Programs: Under the provisions of the Highway Safety Act of 1966, States are implementing comprehensive (as amended) highway safety programs in accordance with various guidelines published by NHTSA. One of the most important and effective highway safety programs, "Emergency Medical Services," is concerned with ambulance service and the post emergency response. Its objective is to reduce mortality and disability by bringing the injured and definitive medical care together in the shortest possible time. (6-13-84) PN 932 RD Instruction 2000-EE Exhibit A Page 2 NHTSA has developed guidelines for ambulance design, training, communications, and suggested practices which are applicable to all prehospital medical emergencies. These and additional general guidelines for planning, implementation, and managing of EMS systems were published in Volume 11, "Emergency Medical Services," of the Highway Safety Program Manual of 1974. This manual also makes reference to other EMS related studies and manuals which are available for general guidance, so as to ensure that the best resources, including knowledge, techniques, and equipment would be focused on the victim of an emergency. In pursuing the development and implementation of this life-saving program, NHTSA has viewed the rural requirements as being of equal stature with the urban. The guidelines that have been published are considered minimal and appropriate for all who render emergency care. Highway death rates in rural areas have exceeded those of urban areas by 70 percent. Trauma centers and emergency departments are of no value to the victim who has expired due to lack of proper care at the onset of the emergency or in transit to the facility. Quality of service rather than speed in transit is being emphasized. Two USDA programs that support the upgrading of EMS in rural areas include community facility loans from Rural Development and grants for equipment and training from FS of USDA. Their programs are resources which the States should also consider in EMS planning and implementation. Rural Development is authorized under the Community Facilities Loan Program to make loans for constructing, enlarging, extending, or otherwise improving community facilities that provide essential services to residents in rural areas and towns of not more than 20,000 population. This may include a loan for one or more of the various physical components included in EMS systems such as fire fighting apparatus, rescue equipment, ambulances, and buildings to house the equipment or provide training facilities. Funds may also be used as the local share of cost for matching grant funds. The loans are available to public entities and nonprofit corporations. Loans for EMS secured under this program should be coordinated with the State EMS Director, State Comprehensive EMS Plan (implementing schedule), and NHTSA published criteria. The goal of FS's Rural Community Fire Protection Program is to provide fire protection in rural areas. It is intended to help maintain or improve the quality of life in rural America by preventing or reducing loss of life, protecting financial investments, and improving environmental conditions. Eligible applicants are official units of government, private and/or public nonprofit organizations, and other rural residents in communities under 10,000 population. Groups of small communities, however, may join together in a combined effort to serve more than 10,000 people. Priority is given to unprotected or inadequately protected rural communities. This determination will be used on the current Insurance Services Office rating of the community. State RD Instruction 2000-EE Exhibit A Page 3 foresters select communities to participate in the program on the basis of vulnerability to fire, adequacy of existing protection, and other factors. Participating communities can receive up to 50 percent of actual costs for approved projects. Specifically, the assistance under the Rural Community Fire Protection Program cannot be used for EMS. However, often EMS is a function of a rural fire department. Program support can be directed toward the fire--related activities to an integrated department, thus freeing other resources for application to EMS. Eligible candidates making application under either program should be encouraged by the responsible State officials to follow NHTSA guidelines where appropriate. In addition, a survey of the rural rescue/extrication capability should also be encouraged. Any deficiencies related to prompt and efficient access to, and extrication of, trapped victims in vehicle crashes should be corrected. Finally, it should be noted that NHTSA has developed EMS training courses including, the: (a) First Responder Course which is the appropriate level of training for any first responder to a traffic accident other than the personnel of ambulance services; and (b) Crash Victim Extrication Course which provides the essential training and identifies the necessary equipment to meet 85 percent of the extrication needs. Information on NHTSA materials and program may also be obtained from the EMS Division of NHTSA. Implementation: At the Federal level the agencies will meet annually to update relevant data, exchange program progress, and transmit pertinent information to those implementing programs in the field. Attachment /s/ 11/15/83 /s/ 8/15/83 ______________________________ _________________________________ Charles W. Shuman (Date) Diane K. Steed (Date) Administrator, FmHA Deputy Administrator, NHTSA /s/ 10/28/83 _____________________________ R. Max Peterson (Date) Chief, FS oOo (6-13-84) PN 932 Exhibits A-1 & A-2 not automated see manual