83_FR_18731 83 FR 18649 - Request for Information: Improving Prehospital Trauma Care

83 FR 18649 - Request for Information: Improving Prehospital Trauma Care

DEPARTMENT OF TRANSPORTATION
National Highway Traffic Safety Administration

Federal Register Volume 83, Issue 82 (April 27, 2018)

Page Range18649-18651
FR Document2018-08504

NHTSA, on behalf of the Federal Interagency Committee on Emergency Medical Services (FICEMS), is seeking comments from all sources (public, private, governmental, academic, professional, public interest groups, and other interested parties) on improving prehospital trauma care. The purpose of this notice is to solicit comments on improving prehospital trauma care, and to request responses to specific questions provided below. This is neither a request for proposals nor an invitation for bids.

Federal Register, Volume 83 Issue 82 (Friday, April 27, 2018) 
[Federal Register Volume 83, Number 82 (Friday, April 27, 2018)]
[Notices]
[Pages 18649-18651]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2018-08504]


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DEPARTMENT OF TRANSPORTATION

National Highway Traffic Safety Administration

[Docket No. NHTSA-2018-0056]


Request for Information: Improving Prehospital Trauma Care

AGENCY: National Highway Traffic Safety Administration (NHTSA), 
Department of Transportation (DOT).

[[Page 18650]]


ACTION: Notice.

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SUMMARY: NHTSA, on behalf of the Federal Interagency Committee on 
Emergency Medical Services (FICEMS), is seeking comments from all 
sources (public, private, governmental, academic, professional, public 
interest groups, and other interested parties) on improving prehospital 
trauma care.
    The purpose of this notice is to solicit comments on improving 
prehospital trauma care, and to request responses to specific questions 
provided below. This is neither a request for proposals nor an 
invitation for bids.

DATES: It is requested that comments on this announcement be submitted 
by July 26, 2018.

ADDRESSES: You may submit comments [identified by Docket No. NHTSA-
2018-0056] through one of the following methods:
     Federal eRulemaking Portal: http://www.regulations.gov. 
Follow the online instructions for submitting comments.
     Mail or Hand Delivery: Docket Management Facility, U.S. 
Department of Transportation, 1200 New Jersey Avenue SE, West Building, 
Room W12-140, Washington, DC 20590, between 9 a.m. and 5 p.m., Monday 
through Friday, except on Federal holidays.

FOR FURTHER INFORMATION CONTACT: Gamunu Wijetunge, Office of Emergency 
Medical Services, (202) 493-2793, [email protected], located at 
the United States Department of Transportation; 1200 New Jersey Avenue 
SE, NPD-400, Room W44-232, Washington, DC 20590. Office hours are from 
9 a.m. to 5 p.m., Monday through Friday, except Federal holidays.

SUPPLEMENTARY INFORMATION: 

Background

    FICEMS was created (42 U.S.C. 300d-4) by the Secretaries of 
Transportation, Health and Human Services and Homeland Security to, in 
part, ensure coordination among the Federal agencies involved with 
State, local, tribal or regional emergency medical services and 9-1-1 
systems. FICEMS has statutory authority to identify State and local 
Emergency Medical Services (EMS) and 9-1-1 needs, to recommend new or 
expanded programs and to identify the ways in which Federal agencies 
can streamline their processes for support of EMS. FICEMS includes 
representatives from the Department of Defense (DoD) Office of the 
Assistant Secretary of Defense Health Affairs, the Department of Health 
and Human Services (HHS) Office of the Assistant Secretary for 
Preparedness and Response (ASPR), HHS Indian Health Service (IHS), HHS 
Centers for Disease Control and Prevention (CDC), HHS Health Resources 
and Services Administration (HRSA), HHS Centers for Medicare and 
Medicaid Services (CMS), the Department of Homeland Security (DHS) 
Office of Health Affairs (OHA), DHS U.S. Fire Administration (USFA), 
NHTSA, the Federal Communications Commission (FCC) and a State EMS 
Director appointed by the Secretary of Transportation.
    In 2016 the National Academies of Sciences, Engineering, and 
Medicine (NASEM) published a report, A National Trauma Care System: 
Integrating Military and Civilian Trauma Systems to Achieve Zero 
Preventable Deaths After Injury (2016 NASEM Trauma Report), that 
estimated as many as 20 percent of the nearly of 200,000 annual trauma 
deaths in the United States could be prevented.
    On December 2, 2016 the National Emergency Medical Services 
Advisory Council (NEMSAC) issued recommendations to FICEMS in response 
to the NASEM report (https://www.ems.gov/pdf/nemsac/NEMSAC_Advisory_MTSPE_Alignment_Trauma_Care_Report.pdf). NEMSAC 
recommended that FICEMS develop an integrated Federal strategy to 
address both the recommendations of the NASEM report and the need to 
update the Model Trauma Systems Planning and Evaluation (MTPSE) 
document which includes a Benchmarks, Indicators and Scoring (BIS) 
tool.
    On December 6, 2017, FICEMS and the Council on Emergency Medical 
Care (CEMC) co-hosted a listening session to hear from stakeholders 
about the challenges facing prehospital trauma care, especially in 
rural settings, and how to better integrate military and civilian EMS 
systems. An integrated national trauma care system would allow lessons 
learned from the battlefield to be translated to civilian EMS and 
provide opportunities for improved patient care.
    A national trauma care system, that integrates military and 
civilian capabilities, is a crucial part of our Nation's infrastructure 
and is vital to preserve the health and productivity of the American 
people.
    The 2016 NASEM report estimates that as many as 20% of the nearly 
200,000 annual trauma deaths in the United States could be prevented. 
In its report, the NASEM defined preventable deaths after injury as 
those casualties whose lives could have been saved by appropriate and 
timely medical care, irrespective of tactical, logistical, or 
environmental issues.

Questions on Improving Prehospital Trauma Care

    Responses to the following questions are requested. Please provide 
references as appropriate.
    1. What are the current impediments, and possible solutions, to 
achieving zero preventable deaths in the following settings:
    a. Wilderness;
    b. Rural;
    c. Suburban; and
    d. Urban.
    2. What should be the national aim for preventable prehospital 
trauma deaths?
    3. What should be the interim national goals to achieve zero 
preventable deaths in the prehospital setting?
    4. What are the most promising or innovative opportunities to 
improve prehospital trauma care in the following settings:
    a. Military;
    b. Wilderness;
    c. Rural;
    d. Suburban; and
    e. Urban.
    5. How could the Learning Health System model (as described in the 
2016 NASEM Trauma Report) be applied to civilian EMS?
    6. Are there actions that could be taken today in the prehospital 
setting (such as promising clinical interventions) that could 
dramatically improve outcomes for patients who are:
    a. Suffering from traumatic pain;
    b. Severely injured in a rural roadway crash;
    c. Suffering from penetrating trauma;
    d. Subjected to a compromised airway;
    e. Suffering from a major hemorrhage;
    f. Suffering from a pneumothorax;
    g. Suffering from blunt force trauma;
    h. Suffering from traumatic brain injury;
    i. Other clinical conditions (please explain).
    7. What EMS evidence based guidelines could be developed to improve 
trauma patient outcomes?
    8. As an EMS stakeholder what do you see is the potential role of 
the National EMS Information System (NEMSIS) and the EMS Compass 
performance measures in improving prehospital trauma care?
    9. How might active duty, National Guard, and reserve component 
military resources be used to improve civilian trauma care outcomes in 
the following settings:
    a. Use of military rotary wing assets to support civilian EMS;
    b. Placement of military medics in the field to support and cross 
train with civilian EMS.

[[Page 18651]]

    10. What actions can be taken to improve public awareness of 
traumatic injury as a public health issue?
    11. What actions could be taken to improve the rapid extrication of 
motor vehicle crash patients?
    12. What actions could be taken to improve the rapid transport of 
trauma patients?
    13. What actions could be taken to improve prehospital care for 
pediatric trauma patients?
    14. What actions could be taken to improve tribal prehospital 
trauma care?
    15. What research is needed to improve prehospital trauma care 
during a mass casualty incident?
    16. What is the potential role of 9-1-1 in improving prehospital 
trauma care outcomes?
    17. What is the potential role of bystander care, such as Stop the 
Bleed, in improving prehospital trauma care outcomes?
    18. What is the potential role of vehicle telematics in improving 
prehospital trauma care outcomes?
    19. What is the potential role of telemedicine in improving 
prehospital trauma care outcomes?
    20. What is the potential role of community paramedicine, mobile 
integrated healthcare, and other emerging EMS subspecialties in 
improving prehospital trauma care outcomes?
    21. How could data-driven and evidence-based improvements in EMS 
systems improve prehospital trauma care?
    22. How could enhanced collaboration among EMS systems, health care 
providers, hospitals, public safety answering points, public health, 
insurers, and others improve prehospital trauma care?
    23. What are some opportunities to improve exchange of evidence 
based prehospital trauma care practices between military and civilian 
medicine?
    24. Do you have any additional comments regarding prehospital 
trauma care?

    Authority: 44 U.S.C. Section 3506(c)(2)(A).

    Issued in Washington, DC, on April 19, 2018.
Jeff Michael,
Associate Administrator, Research and Program Development.
[FR Doc. 2018-08504 Filed 4-26-18; 8:45 am]
 BILLING CODE 4910-59-P

Federal Register / Vol. 83, No. 82 / Friday, April 27, 2018 / Notices 18649 exemption to be evaluated by an their vision disqualified them from have a copy of the exemption when optometrist or ophthalmologist. Both driving in interstate commerce. We driving, for presentation to a duly optometrists and ophthalmologists are believe that the applicants’ intrastate authorized Federal, State, or local medically qualified to evaluate the driving experience and history provide enforcement official. applicant’s eye conditions when an adequate basis for predicting their VI. Preemption applying to the vision exemption ability to drive safely in interstate program. The examination includes commerce. Intrastate driving, like During the period the exemption is in identifying and defining the nature of interstate operations, involves effect, no State shall enforce any law or the vision deficiency, how long the substantial driving on highways on the regulation that conflicts with this deficiency has been present, stability, interstate system and on other roads exemption with respect to a person visual acuity, field of vision, and color built to interstate standards. Moreover, operating under the exemption. vision. driving in congested urban areas VII. Conclusion exposes the driver to more pedestrian IV. Basis for Exemption Determination Based upon its evaluation of the 18 and vehicular traffic than exists on Under 49 U.S.C. 31136(e) and 31315, interstate highways. Faster reaction to exemption applications, FMCSA FMCSA may grant an exemption from traffic and traffic signals is generally exempts the following drivers from the the vision standard in 49 CFR required because distances between vision requirement, 49 CFR 391.41(b)(10) if the exemption is likely them are more compact. These 391.41(b)(10), subject to the to achieve an equivalent or greater level conditions tax visual capacity and requirements cited above: of safety than would be achieved driver response just as intensely as Michael H. Eheler, II (WI) without the exemption. The exemption interstate driving conditions. Roberto Espinosa (FL) allows applicants to operate CMVs in The applicants in this notice have Lee J. Gaffney (OH) interstate commerce. driven CMVs with their limited vision Mark S. Hale (AL) The Agency’s decision regarding these in careers ranging for 3 to 70 years. In Raymundo Maldonado (TX) exemption applications is based on Mickey D. McCoy (TN) the past three years, one driver was Colin D. McGregor (WI) medical reports about the applicants’ involved in a crash, and two drivers Thomas B. Miller (VA) vision as well as their driving records were convicted of moving violations in Ryan J. Plank (PA) and experience driving with the vision CMVs. All the applicants achieved a Donald J. Poague (GA) deficiency. The qualifications, record of safety while driving with their Jose R. Ponce (TX) experience, and medical condition of vision impairment, demonstrating the Ronald F. Prezzia (IL) each applicant were stated and likelihood that they have adapted their Jorge A. Rodriguez (CA) discussed in detail in the January 16, driving skills to accommodate their Jimmy W. Rowland (FL) 2018, Federal Register notice (83 FR condition. As the applicants’ ample Aaron R. Rupe (IL) 2311) and will not be repeated in this driving histories with their vision Charles L. Sauls (FL) notice. deficiencies are good predictors of Gery M. Shoultz (IN) FMCSA recognizes that some drivers future performance, FMCSA concludes Juan D. Zertuche, Jr. (TX) do not meet the vision requirement but their ability to drive safely can be In accordance with 49 U.S.C. 31136(e) have adapted their driving to projected into the future. and 31315, each exemption will be valid accommodate their limitation and Consequently, FMCSA finds that in for two years from the effective date demonstrated their ability to drive each case exempting these applicants unless revoked earlier by FMCSA. The safely. The 18 exemption applicants from the vision requirement in 49 CFR exemption will be revoked if the listed in this notice are in this category. 391.41(b)(10) is likely to achieve a level following occurs: (1) The person fails to They are unable to meet the vision of safety equal to that existing without comply with the terms and conditions requirement in one eye for various the exemption. of the exemption; (2) the exemption has reasons, including amblyopia, aphakia, resulted in a lower level of safety than cataracts, central scarring, complete loss V. Conditions and Requirements was maintained prior to being granted; of vision, glaucoma, macular scarring, The terms and conditions of the or (3) continuation of the exemption retinal detachment, retinal scarring. In exemption are provided to the would not be consistent with the goals most cases, their eye conditions were applicants in the exemption document and objectives of 49 U.S.C. 31136 and not recently developed. Nine of the and includes the following: (1) Each 31315. applicants were either born with their driver must be physically examined Issued on: April 23, 2018. vision impairments or have had them every year (a) by an ophthalmologist or Larry W. Minor, since childhood. The nine individuals optometrist who attests that the vision Associate Administrator for Policy. that sustained their vision conditions as in the better eye continues to meet the [FR Doc. 2018–08913 Filed 4–26–18; 8:45 am] adults have had it for a range of 4 to 26 standard in 49 CFR 391.41(b)(10) and (b) BILLING CODE 4910–EX–P years. Although each applicant has one by a certified Medical Examiner who eye which does not meet the vision attests that the individual is otherwise requirement in 49 CFR 391.41(b)(10), physically qualified under 49 CFR DEPARTMENT OF TRANSPORTATION each has at least 20/40 corrected vision 391.41; (2) each driver must provide a in the other eye, and in a doctor’s copy of the ophthalmologist’s or National Highway Traffic Safety opinion, has sufficient vision to perform optometrist’s report to the Medical Administration all the tasks necessary to operate a CMV. Examiner at the time of the annual daltland on DSKBBV9HB2PROD with NOTICES Doctors’ opinions are supported by medical examination; and (3) each [Docket No. NHTSA–2018–0056] the applicants’ possession of a valid driver must provide a copy of the Request for Information: Improving license to operate a CMV. By meeting annual medical certification to the Prehospital Trauma Care State licensing requirements, the employer for retention in the driver’s applicants demonstrated their ability to qualification file, or keep a copy in his/ AGENCY: National Highway Traffic operate a CMV, with their limited vision her driver’s qualification file if he/she is Safety Administration (NHTSA), in intrastate commerce, even though self-employed. The driver must also Department of Transportation (DOT). VerDate Sep<11>2014 18:18 Apr 26, 2018 Jkt 244001 PO 00000 Frm 00149 Fmt 4703 Sfmt 4703 E:\FR\FM\27APN1.SGM 27APN1

18650 Federal Register / Vol. 83, No. 82 / Friday, April 27, 2018 / Notices ACTION: Notice. Service (IHS), HHS Centers for Disease Questions on Improving Prehospital Control and Prevention (CDC), HHS Trauma Care SUMMARY: NHTSA, on behalf of the Health Resources and Services Federal Interagency Committee on Responses to the following questions Administration (HRSA), HHS Centers are requested. Please provide references Emergency Medical Services (FICEMS), for Medicare and Medicaid Services is seeking comments from all sources as appropriate. (CMS), the Department of Homeland 1. What are the current impediments, (public, private, governmental, Security (DHS) Office of Health Affairs academic, professional, public interest and possible solutions, to achieving zero (OHA), DHS U.S. Fire Administration preventable deaths in the following groups, and other interested parties) on (USFA), NHTSA, the Federal improving prehospital trauma care. settings: Communications Commission (FCC) a. Wilderness; The purpose of this notice is to solicit and a State EMS Director appointed by comments on improving prehospital b. Rural; the Secretary of Transportation. c. Suburban; and trauma care, and to request responses to In 2016 the National Academies of d. Urban. specific questions provided below. This Sciences, Engineering, and Medicine 2. What should be the national aim for is neither a request for proposals nor an (NASEM) published a report, A preventable prehospital trauma deaths? invitation for bids. National Trauma Care System: 3. What should be the interim DATES: It is requested that comments on Integrating Military and Civilian national goals to achieve zero this announcement be submitted by July Trauma Systems to Achieve Zero preventable deaths in the prehospital 26, 2018. Preventable Deaths After Injury (2016 setting? ADDRESSES: You may submit comments NASEM Trauma Report), that estimated 4. What are the most promising or [identified by Docket No. NHTSA– as many as 20 percent of the nearly of innovative opportunities to improve 2018–0056] through one of the 200,000 annual trauma deaths in the prehospital trauma care in the following following methods: United States could be prevented. settings: • Federal eRulemaking Portal: http:// On December 2, 2016 the National a. Military; www.regulations.gov. Follow the online Emergency Medical Services Advisory b. Wilderness; instructions for submitting comments. Council (NEMSAC) issued c. Rural; • Mail or Hand Delivery: Docket recommendations to FICEMS in d. Suburban; and Management Facility, U.S. Department response to the NASEM report (https:// e. Urban. of Transportation, 1200 New Jersey www.ems.gov/pdf/nemsac/NEMSAC_ 5. How could the Learning Health Avenue SE, West Building, Room W12– Advisory_MTSPE_Alignment_Trauma_ System model (as described in the 2016 140, Washington, DC 20590, between 9 Care_Report.pdf). NEMSAC NASEM Trauma Report) be applied to a.m. and 5 p.m., Monday through recommended that FICEMS develop an civilian EMS? Friday, except on Federal holidays. integrated Federal strategy to address 6. Are there actions that could be FOR FURTHER INFORMATION CONTACT: both the recommendations of the taken today in the prehospital setting Gamunu Wijetunge, Office of NASEM report and the need to update (such as promising clinical Emergency Medical Services, (202) 493– the Model Trauma Systems Planning interventions) that could dramatically 2793, gamunu.wijetunge@dot.gov, and Evaluation (MTPSE) document improve outcomes for patients who are: located at the United States Department which includes a Benchmarks, a. Suffering from traumatic pain; Indicators and Scoring (BIS) tool. b. Severely injured in a rural roadway of Transportation; 1200 New Jersey On December 6, 2017, FICEMS and crash; Avenue SE, NPD–400, Room W44–232, c. Suffering from penetrating trauma; Washington, DC 20590. Office hours are the Council on Emergency Medical Care d. Subjected to a compromised from 9 a.m. to 5 p.m., Monday through (CEMC) co-hosted a listening session to airway; Friday, except Federal holidays. hear from stakeholders about the e. Suffering from a major hemorrhage; SUPPLEMENTARY INFORMATION: challenges facing prehospital trauma f. Suffering from a pneumothorax; care, especially in rural settings, and g. Suffering from blunt force trauma; Background how to better integrate military and h. Suffering from traumatic brain FICEMS was created (42 U.S.C. 300d– civilian EMS systems. An integrated injury; 4) by the Secretaries of Transportation, national trauma care system would i. Other clinical conditions (please Health and Human Services and allow lessons learned from the explain). Homeland Security to, in part, ensure battlefield to be translated to civilian 7. What EMS evidence based coordination among the Federal EMS and provide opportunities for guidelines could be developed to agencies involved with State, local, improved patient care. improve trauma patient outcomes? tribal or regional emergency medical A national trauma care system, that 8. As an EMS stakeholder what do services and 9–1–1 systems. FICEMS integrates military and civilian you see is the potential role of the has statutory authority to identify State capabilities, is a crucial part of our National EMS Information System and local Emergency Medical Services Nation’s infrastructure and is vital to (NEMSIS) and the EMS Compass (EMS) and 9–1–1 needs, to recommend preserve the health and productivity of performance measures in improving new or expanded programs and to the American people. prehospital trauma care? identify the ways in which Federal The 2016 NASEM report estimates 9. How might active duty, National agencies can streamline their processes that as many as 20% of the nearly Guard, and reserve component military for support of EMS. FICEMS includes 200,000 annual trauma deaths in the resources be used to improve civilian daltland on DSKBBV9HB2PROD with NOTICES representatives from the Department of United States could be prevented. In its trauma care outcomes in the following Defense (DoD) Office of the Assistant report, the NASEM defined preventable settings: Secretary of Defense Health Affairs, the deaths after injury as those casualties a. Use of military rotary wing assets Department of Health and Human whose lives could have been saved by to support civilian EMS; Services (HHS) Office of the Assistant appropriate and timely medical care, b. Placement of military medics in the Secretary for Preparedness and irrespective of tactical, logistical, or field to support and cross train with Response (ASPR), HHS Indian Health environmental issues. civilian EMS. VerDate Sep<11>2014 18:18 Apr 26, 2018 Jkt 244001 PO 00000 Frm 00150 Fmt 4703 Sfmt 4703 E:\FR\FM\27APN1.SGM 27APN1

Federal Register / Vol. 83, No. 82 / Friday, April 27, 2018 / Notices 18651 10. What actions can be taken to DEPARTMENT OF TRANSPORTATION make a positive impact throughout the improve public awareness of traumatic country. The FY 2018 BUILD injury as a public health issue? Office of the Secretary of Transportation program will continue to Transportation give special consideration to projects 11. What actions could be taken to located in rural areas. For this round of improve the rapid extrication of motor Notice of Funding Opportunity for the BUILD Transportation Discretionary vehicle crash patients? Department of Transportation’s Grants, the maximum grant award is $25 12. What actions could be taken to National Infrastructure Investments million, and no more than $150 million improve the rapid transport of trauma Under the Consolidated can be awarded to a single State, as patients? Appropriations Act, 2018 specified in the FY 2018 Appropriations 13. What actions could be taken to AGENCY: Office of the Secretary of Act. Each section of this notice contains improve prehospital care for pediatric Transportation, DOT. information and instructions relevant to trauma patients? the application process for these BUILD ACTION: Notice of funding opportunity. Transportation Discretionary Grants, 14. What actions could be taken to and all applicants should read this improve tribal prehospital trauma care? SUMMARY: The Consolidated Appropriations Act, 2018 (Pub. L. 115– notice in its entirety so that they have 15. What research is needed to 141, March 23, 2018) (‘‘FY 2018 the information they need to submit improve prehospital trauma care during Appropriations Act’’ or the ‘‘Act’’) eligible and competitive applications. a mass casualty incident? appropriated $1.5 billion to be awarded Table of Contents 16. What is the potential role of 9–1– by the Department of Transportation A. Program Description 1 in improving prehospital trauma care (‘‘DOT’’ or the ‘‘Department’’) for B. Federal Award Information outcomes? National Infrastructure Investments. C. Eligibility Information This appropriation stems from the D. Application and Submission Information 17. What is the potential role of program funded and implemented E. Application Review Information bystander care, such as Stop the Bleed, pursuant to the American Recovery and F. Federal Award Administration in improving prehospital trauma care Reinvestment Act of 2009 (the Information outcomes? ‘‘Recovery Act’’). This program was G. Federal Awarding Agency Contacts H. Other Information 18. What is the potential role of previously known as the Transportation vehicle telematics in improving Investment Generating Economic A. Program Description prehospital trauma care outcomes? Recovery, or ‘‘TIGER Discretionary The Consolidated Appropriations Act, 19. What is the potential role of Grants,’’ program and is now known as 2018 (Pub. L. 115–141, March 23, 2018) the Better Utilizing Investments to (‘‘FY 2018 Appropriations Act’’ or the telemedicine in improving prehospital Leverage Development, or ‘‘BUILD ‘‘Act’’) appropriated $1.5 billion to be trauma care outcomes? Transportation Discretionary Grants,’’ awarded by the Department of 20. What is the potential role of program. Funds for the FY 2018 BUILD Transportation (‘‘DOT’’ or the community paramedicine, mobile Transportation program are to be ‘‘Department’’) for National integrated healthcare, and other awarded on a competitive basis for Infrastructure Investments. Since this emerging EMS subspecialties in projects that will have a significant local program was first created, $5.6 billion improving prehospital trauma care or regional impact. The purpose of this has been awarded for capital outcomes? Final Notice is to solicit applications for investments in surface transportation 21. How could data-driven and BUILD Transportation Discretionary infrastructure over nine rounds of evidence-based improvements in EMS Grants. competitive grants. Throughout the systems improve prehospital trauma DATES: Applications must be submitted program, these discretionary grant care? by 8:00 p.m. E.D.T. on July 18, 2018. awards have supported projects that ADDRESSES: Applications must be have a significant local or regional 22. How could enhanced impact. collaboration among EMS systems, submitted through Grants.gov. The Department is committed to health care providers, hospitals, public FOR FURTHER INFORMATION CONTACT: For addressing the unmet transportation safety answering points, public health, further information concerning this infrastructure needs of rural areas. Rural insurers, and others improve notice, please contact the BUILD America is home to many of the nation’s prehospital trauma care? Transportation program staff via email most critical transportation 23. What are some opportunities to at BUILDgrants@dot.gov, or call Howard infrastructure assets, including 444,000 Hill at 202–366–0301. A TDD is bridges, 2.98 million miles of roadways, improve exchange of evidence based available for individuals who are deaf or and 30,500 miles of Interstate highways. prehospital trauma care practices hard of hearing at 202–366–3993. In More than 55 percent of all public road between military and civilian medicine? addition, DOT will regularly post miles are locally-owned rural roads. 24. Do you have any additional answers to questions and requests for While only 19 percent of the nation’s comments regarding prehospital trauma clarifications as well as information population lives in rural areas, 49 care? about webinars for further guidance on percent of all traffic fatalities occur on Authority: 44 U.S.C. Section 3506(c)(2)(A). DOT’s website at rural roads (2015). In addition, www.transportation.gov/BUILDgrants. Americans living in rural areas and on daltland on DSKBBV9HB2PROD with NOTICES Issued in Washington, DC, on April 19, SUPPLEMENTARY INFORMATION: Many of Tribal lands continue to 2018. the selection criteria of BUILD disproportionately lack access to basic Jeff Michael, Transportation grants overlap with broadband service. The Department Associate Administrator, Research and previous rounds of National believes that underinvestment in rural Program Development. Infrastructure Investments discretionary transportation systems has allowed a [FR Doc. 2018–08504 Filed 4–26–18; 8:45 am] grants, though the program is refocused slow and steady decline in the BILLING CODE 4910–59–P on infrastructure investment that will transportation routes that connect rural VerDate Sep<11>2014 18:18 Apr 26, 2018 Jkt 244001 PO 00000 Frm 00151 Fmt 4703 Sfmt 4703 E:\FR\FM\27APN1.SGM 27APN1


Document Created: 2018-04-27 01:44:55
Document Modified: 2018-04-27 01:44:55
CategoryRegulatory Information
CollectionFederal Register
sudoc ClassAE 2.7:
GS 4.107:
AE 2.106:
PublisherOffice of the Federal Register, National Archives and Records Administration
SectionNotices
ActionNotice.
DatesIt is requested that comments on this announcement be submitted by July 26, 2018.
ContactGamunu Wijetunge, Office of Emergency Medical Services, (202) 493-2793, [email protected], located at the United States Department of Transportation; 1200 New Jersey Avenue SE, NPD-400, Room W44-232, Washington, DC 20590. Office hours are from 9 a.m. to 5 p.m., Monday through Friday, except Federal holidays.
FR Citation83 FR 18649 
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