42672 Federal Register / Vol. 74, No. 162 / Monday, August 24, 2009 / Notices 

Docket No. File date Presenter or requester 

3. P–405–087 ................................................................................................................................. 08–03–09 Benjamin L. Cardin. 

4. P–12569–001 ............................................................................................................................. 08–06–09 Gregory Griffith. 

5. P–12569–001 ............................................................................................................................. 08–04–09 Dan Boettger. 

6. P–12737–002 ............................................................................................................................. 08–06–09 Brenda Winn. 

Kimberly D. Bose, 

Secretary. 

[FR Doc. E9–20213 Filed 8–21–09; 8:45 am] 

BILLING CODE 6717–01–P 

ENVIRONMENTAL PROTECTION 

AGENCY 

[FRL–8948–4] 

North Carolina Waters Along the Entire 

Length of New Hanover County No 

Discharge Zone Determination 

The Environmental Protection Agency 

(EPA), Region 4, concurs with the 

determination of the North Carolina 

Department of Environment and Natural 

Resources (DENR), Division of Water 

Quality (DWQ) that adequate and 

reasonably available pumpout facilities 

exist for the designation of New 

Hanover County North Carolina Coastal 

Waters as a No Discharge Zone (NDZ). 

Specifically these waters extend three 

nautical miles (nm) into the Atlantic 

Ocean along the entire length of New 

Hanover County, including Futch Creek, 

Pages Creek, Bradley Creek, Hewlett’s 

Creek, Howe Creek, Whiskey Creek, 

Snow’s Cut, as well as unnamed 

tributaries and all unnamed tidal creeks 

to those waters. 

The geographic description including 

latitudes and longitudes are as follows: 

Northern border of New Hanover 

County with southern border of Pender 

County (34°17′53.5′′ N 77°42′32.2′′ W), 

to a point 3 nm off the coast at the 

intersection of New Hanover and Pender 

Counties (34°16′01.9′′ N 77°40′20.5′′ W). 

Intersection of the southern tip of 

New Hanover County with Brunswick 

County at the Cape Fear River 

(33°55′43.0′′ N 77°56′13.6′′ W), 

southeastward along the extended 

intersection of the two counties, 3 nm 

into the Atlantic Ocean (33°53′07.5′′ N 

77°55′34.5′′ W). 

This petition was filed pursuant to the 

Clean Water Act, Section 312(f)(3), 

Public Law 92–500 as amended by 

Public Law 95–217 and Public Law 

100–4. A NDZ is defined as a body of 

water in which the discharge of vessel 

sewage, both treated and untreated, is 

prohibited. 

Section 312(f)(3) states: 

After the effective date of the initial 

standards and regulations promulgated under 

this section, if any State determines that the 

protection and enhancement of the quality of 

some or all of the waters within such States 

require greater environmental protection, 

such State may completely prohibit the 

discharge from all vessels of any sewage, 

whether treated or not, into such waters, 

except that no such prohibition shall apply 

until the Administrator determines that 

adequate facilities for the safe and sanitary 

removal and treatment of sewage from all 

vessels are reasonably available for such 

water to which such prohibition would 

apply. 

According to DENR DWQ the 

following facilities are located in New 

Hanover County for pumping out vessel 

holding tanks: 

(1) Carolina Beach Municipal Marina, 

Carolina Beach, 910–458–2540, open 

24/7, 6′ draft at mean low tide 

(2) Carolina Beach State Park Marina, 

Carolina Beach State Park, Carolina 

Beach, 910–458–7770, 8 a.m.–5:45 p.m., 

7 days/week, 6′ draft at mean low tide 

(3) Federal Point Yacht Club, 910 

Basin Road, Carolina Beach, 910–458– 

4511, only available to club members, 5′ 

draft at mean low tide 

(4) Mona Black Marina, Carolina 

Beach, 910–458–0575, open 24/7, 20′ 

draft at mean low tide 

(5) Joyner Marina, Carolina Beach, 

910–458–5053, open 7 a.m.–6 p.m., 7 

days per week, 6′ draft at mean low tide 

(6) Bridge Tender Marina, City of 

Wilmington, 910–256–6550, 7 a.m.–8 

p.m., 7 days/week, 10′ draft at mean low 

tide 

(7) Creekside Yacht Club, City of 

Wilmington, 910–350–0023, 

Operational December 2009, 4′ draft at 

mean low tide 

(8) Sea Path Yacht Club, Town of 

Wrightsville Beach, 910–256–3747, 7 

a.m.–7 p.m., 7 days/week, 10′ draft at 

mean low tide 

(9) Wrightsville, Beach Marina & 

Transient Dock, Town of Wrightsville 

Beach, 910–256–6666, 7 a.m.–7 p.m., 7 

days/week, 12′ draft at mean low tide 

Two Marinas that are located within 

7 nautical miles of the proposed NDZ 

are: 

(A) Wilmington Marine Center, 910– 

395–5055, 8 a.m.–5 p.m. 7 days/week, 7′ 

draft at mean low tide 

(B) Bald Head Island Marina, 910– 

457–7380, 8:30 a.m.–5:30 p.m. 7 days/ 

week, 8′ draft at mean low tide 

The total vessel population for New 

Hanover County as of August 5, 2008 

was 13,940. This number reflects active 

vessel registrations and was obtained 

from the North Carolina Wildlife 

Resources Commission. During the 

period of 2006 to 2008, the total number 

of active registered vessels increased 

nearly 15%. The result is that there are 

nearly 1,800 more pleasure boats in the 

area waters today than just two years 

ago, with the largest increase occurring 

in boats between 16′ and 25′ in length. 

It is recognized that only a percentage 

of the vessels in the coastal waters of 

New Hanover County are equipped with 

a Marine Sanitation Device (MSD). To 

estimate the number of MSDs in use, 

percentages obtained from EPA (Region 

2) were applied, and are listed below: 

Boat Length Percent with 

MSDs 

<16′ ........................................... 8.3 

16′–25′ ...................................... 10.6 

26′–40′ ...................................... 78.5 

>40′ ........................................... 82.6 

This yields an estimated 2,046 MSDs 

in use by registered boats within New 

Hanover County. 

Through the use of a marina survey, 

the number of transient boats serviced 

by marinas in New Hanover County was 

calculated to be approximately 180 per 

month. This figure was arrived at by 

using the peak season transient boat 

figures from each marina. Using the 

figures for both county and transient 

boats, the total number of MSDs in the 

New Hanover County waters is 

estimated to be 2,194. There are 9 

marinas within New Hanover County 

and this yields a ratio of about 244 boats 

per pumpout facility. This figure does 

not include the two marinas that are 

located within 7 nautical miles of this 

proposed NDZ area. 

All vessel pumpout facilities that are 

described either discharge into State 

approved and regulated septic tanks or 

State approved on site waste treatment 

plant, or the waste is collected into a 

large holding tank for transport to a 

sewage treatment plant. Thus all vessel 

sewage will be treated to meet existing 

standards for secondary treatment. 

Comments regarding this proposed 

action should be addressed to David 

Parker, Chief, Coastal Section, EPA 

Region 4, Water Protection Division, 61 

Forsyth Street, Atlanta, Georgia 30303– 


erowe on DSK5CLS3C1PROD with NOTICES
Federal Register / Vol. 74, No. 162 / Monday, August 24, 2009 / Notices 42673 

3104. Comments regarding this 

proposed action will be accepted until 

September 23, 2009. 

A. Stanley Meiburg, 

Acting Regional Administrator, Region 4. 

[FR Doc. E9–20288 Filed 8–21–09; 8:45 am] 

BILLING CODE 6560–50–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Request for Information Relevant to 

the Regionalization of Emergency 

Medical Care Delivery Systems and 

Demonstration Model Development 

AGENCY: Department of Health and 

Human Services, Office of the Secretary. 

ACTION: Notice. 

SUMMARY: This is a time-sensitive 

Request for Information (RFI) issued by 

the Emergency Care Coordination 

Center in the Office of the Assistant 

Secretary for Preparedness and 

Response on behalf of the Council on 

Emergency Medical Care (CEMC) and 

the Federal Interagency Committee on 

Emergency Medical Services 

(FICEMS)—collectively known as the 

Emergency Care Enterprise (ECE). The 

information requested is meant to 

ascertain key concepts, best practices, 

and operational approaches to support 

regionalized, comprehensive and 

accountable emergency care and trauma 

systems. The information will be 

analyzed by the ECCC to help guide the 

development of demonstration programs 

that design and evaluate innovative 

models of regionalized, coordinated and 

accountable emergency care and trauma 

systems. 

ADDRESSES: Responses to this RFI may 

be submitted electronically to 

eccc@hhs.gov by COB September 30th 

2009. 

FOR FURTHER INFORMATION CONTACT: For 

further information on this RFI or the 

Emergency Care Coordination Center 

(ECCC), please contact Melicia Seay, 

Program Analyst, by e-mail at 

melicia.seay@hhs.gov or by phone at 

202–260–1383. 

SUPPLEMENTARY INFORMATION: The 

Emergency Care Coordination Center 

(ECCC) was created in order to: (1) Lead 

an enterprise to promote and fund 

research in emergency medicine and 

trauma health care, (2) promote regional 

partnerships and more effective 

emergency medical systems in order to 

enhance appropriate triage, distribution, 

and care of routine community patients, 

and (3) promote local, regional, and 

State emergency medical systems’ 

preparedness for and response to public 

health events. The office addresses the 

full spectrum of issues that have impact 

on care in hospital emergency 

departments, encompassing the 

complete continuum of patient care 

from the pre-hospital environment to 

disposition from emergency or trauma 

care. The Office coordinates with 

existing executive departments and 

agencies that perform functions relating 

to emergency medical systems in order 

to ensure unified strategy, policy, and 

implementation. 

The issue of regionalization is one of 

great interest across academic and 

clinical communities and is frequently 

touted as a potential solution to 

healthcare reform. The Future of 

Emergency Care reports published by 

the Institute of Medicine in 2006 

recommended the establishment of a 

demonstration program to promote 

coordinated, regionalized, and 

accountable emergency care delivery 

systems. As demonstrated by existing 

systems for trauma, cardiac arrest, and 

stroke patients, regionalized emergency 

care systems help get the right patients 

to the right hospitals in the right amount 

of time, improve patient outcomes, and 

reduce costs. These systems typically 

require careful coordination amongst 9– 

1–1 dispatch, pre-hospital emergency 

medical services, EMS system medical 

direction, categorization/designation of 

medical facilities, interfacility transfer 

protocols, data collection/analysis, and 

ongoing system-wide quality 

improvement. 

Yet regionalization of emergency care 

remains poorly defined and often 

misunderstood, with competing 

definitions, a variety of organizational 

and financial structures, and a lack of 

understanding regarding the 

implementation, evaluation, feasibility, 

and long term consequences of regional 

emergency care. Even amongst the State 

Trauma Systems, for instance, there is 

wide-scale variability in terms of 

resourcing mechanisms, support levels, 

functionality, and systems-wide 

interoperability. While some states have 

data mechanisms in place to monitor 

emergency care system status including 

medical facility bed availability and 

patient tracking, these systems vary in 

terms of management, sophistication 

and purpose, often collecting and 

reporting different data without uniform 

data definitions or agreement on which 

data should be collected. 

The ECCC, in coordination with the 

CEMC and FICEMS, aims to 

demonstrate model systems for 

Emergency Care through the 

development of regionalization 

demonstration projects that will provide 

information and lessons learned while 

generating guidance for the nationwide 

deployment of regionalized and 

accountable emergency care delivery 

systems. 

Issues on Which Information Is 

Requested 

The ECCC seeks input regarding 

regionalization of emergency care, with 

a focus on identification of the 

challenges and opportunities that could 

be addressed through federally funded 

national demonstration projects. The 

scope of emergency care being 

considered is defined as beginning with 

an event, disease, or condition that 

causes an individual to seek care 

through EMS or in an ED setting and 

ending with departure from the ED 

(either by admission to another hospital 

department, through discharge from the 

ED, or via transfer to another hospital). 

We welcome your comments, research 

findings, and/or practical experience on 

the following topics that can be used 

both to enhance our knowledge of 

regional emergency care networks and 

to help formulate guidance and 

strategies for potential Federal programs 

to develop regional emergency care 

systems. Please provide concise 

responses in the context of 

regionalization to any or all of the 

following topics. 

A. Existing Models. Please describe 

existing trauma or EMS regions in terms 

of characteristics such as: overall 

structure and organization, boundaries 

and geography, governance or oversight 

mechanisms and authorities, triagetransfer protocols, sustained financial 

support and provider reimbursement, 

data collection procedures, resource 

tracking, and communication/ 

coordination of relationships amongst 

State leadership, 9–1–1 services and/or 

EMS system medical direction, 

individual regions, etc. If desired, 

include opinions regarding the overall 

functioning and effectiveness of existing 

systems. 

B. Analysis of Current Practices in 

Regionalized Clinical Care. Whether at 

the local, State, or inter-State level, 

please provide suggestions and 

justifications as to which existing 

systems or specific elements of 

regionalized care models specifically 

merit further investigation, 

development, or targeted alteration and 

which clinical conditions are most 

suitable to regionalized care delivery. 

Please provide specific evidence where 

available and applicable. 

C. Communications Infrastructure. 

Please provide information on 

appropriate data elements that should 

be incorporated within regionalization 

systems to provide for situational 


erowe on DSK5CLS3C1PROD with NOTICES