EMS as an Essential Service: A Lifeline for South Dakota Ambulances on the Brink by State Rep. Eric Emery
When South Dakotans call 911, they expect help to arrive quickly and without hesitation.
However, in many communities, particularly in rural and tribal areas, that promise is not assured. Emergency Medical Services (EMS), which are crucial for public safety, are struggling due to outdated funding models, declining volunteer numbers, and increasing bureaucracy. If we don’t take action now, lives will be lost because no one is available to respond to the call.
Not an “Essential Service”
Unlike other public services, EMS is not considered essential under South Dakota law. This means it doesn’t have to be available in every community, and there is no reliable funding to keep ambulances running. Rural towns and communities, where fewer people live and access to hospitals is already tough, feel the impact the most. Some areas have just one ambulance station to serve hundreds of square miles. In emergencies where every minute counts, residents often wait 30 minutes or longer for assistance, if an ambulance is available
at all.
Cities Feeling the Strain
With South Dakota law categorizing EMS as nonessential, there is no legal requirement for it to be available in every community, and there is no reliable funding to keep ambulances running. Rural towns are hit the hardest, where population density is low and access to hospitals is limited. Some areas have only one ambulance station to cover hundreds of square miles. In emergencies where every minute counts, residents often wait 30 minutes or more for help, if an ambulance is even available. Urban EMS systems like those in Brookings, Mitchell, Rapid City, and Sioux Falls are also under pressure. They increasingly respond to calls outside their city limits in rural areas where local services have failed. Call volumes are rising, stretching crews thin and increasing response times. Cities end up subsidizing neighboring counties, but even the best-equipped departments can do only so much before patient care starts to decline.
The Volunteer Model Has Collapsed
At the core of the crisis is a failing volunteer system. Many small-town ambulances relied on community members who were ready to serve at all hours, often for minimal pay. However, these volunteers are getting older, and it’s hard to find new ones. People can’t afford to volunteer anymore, especially as training requirements keep increasing. A recent rule from the South Dakota Board of Medical and Osteopathic Examiners that requires an “ambulance operator” certification has made things worse. It discourages willing drivers who don’t have time for extra classes and red tape.
A Summer Study Isn’t Enough
This summer, lawmakers held an EMS summer study. It was a good idea, and the intention was positive, but three meetings wouldn’t solve decades of neglect. The study showed just how big the problem is: the funding gaps, the worker shortage, and the uneven system we’ve relied on for too long. However, without resources or true authority, the committee could only touch on the surface.
The Funding Wall
Meanwhile, EMS providers are being asked to do more with less. Medicare and Medicaid often pay only a small portion of the actual cost of a 911 call. Property tax caps restrict how much local governments can collect. In the current environment, where lawmakers prioritize tax cuts, there is little interest in raising taxes to support EMS. A recent eWort to classify EMS as an essential service and secure stable funding failed in the Legislature. Critics pointed to cost issues and uncertainty about how the service would be funded.
That mindset must change. EMS is not optional. It is a lifeline that should be universally available, just as all other public services are. South Dakota needs to formally declare EMS an essential service and provide the funding to back it up. That may include a mix of state support, revised Medicaid reimbursement rules, and creative revenue solutions, but the commitment must be there.
The days of relying on pancake breakfasts and pig roasts to fund life-saving care are over. The system is broken, and it’s hurting people. If we truly value our communities, families, and the first responders who answer the call, we must act now. Let’s give EMS the recognition, resources, and respect it deserves. Lives depend on it.
Time to Act
We need to stop pretending this is optional. EMS is not a luxury; it is just as essential as the snowplow that clears your roads each winter. Every South Dakotan, whether they live indowntown Sioux Falls or on a ranch in Meade County, deserves to know that when they call 911, trained professionals will show up. Volunteer goodwill cannot carry us anymore. The summer study showed the depth of the problem. Now is the time for the legislature to act with courage, secure funding, and pass the laws that make EMS essential.
Here’s the blunt truth: if lawmakers keep prioritizing property tax politics over public safety, South Dakotans will pay with their lives. Every ambulance that shuts down means longerwaits and worse outcomes. Every delay puts families at risk. We must fund EMS now, or we will stand by as South Dakotans die waiting for an ambulance that never arrives. There is no middle ground. Lives are on the line.
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Eric Emery represents District 26A in the South Dakota House of Representatives and serves as Program Director of the Rosebud Sioux Tribe Ambulance Service. A career paramedic, he brings front-line experience in rural and tribal healthcare to the legislature, advocating for stronger EMS, public safety, and access to care
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