Addressing Challenges in Emergency Medical Services: A Legislative Update
by Rep. Tim Walburg, Dist. 8
The 2025 Legislative Session has brought forth significant discussions on various concerns, particularly in the realm of Emergency Medical Services (EMS). In preparation for the EMS Summer Study, Rep. Kull and I embarked on a journey across different EMS agencies to grasp the challenges faced at a local level. Our visits consistently highlighted two predominant issues: funding and staffing. When we talk staffing, we can’t forget training.
Rural Emergency Services: Staffing and Training
In our initial meetings, we were tasked with addressing the unique needs of rural emergency services, specifically in obtaining, maintaining, and training staff. We explored ways to deliver trauma services in remote areas lacking immediate access to trauma centers and sought to identify the efficiencies and resources necessary for effective operations. Throughout the summer session meetings, we heard from numerous EMS agencies, local citizens, and state agencies, all voicing their concerns and suggestions.
Staffing and Compensation Concerns
A significant portion of the feedback we received from citizens revolved around staffing shortages and inadequate compensation for EMS personnel. Although insurance reimburses many calls, numerous others go uncompensated. The crux of the issue lies in the nature of the calls—insurance only pays if the patient is transported, and even then, the reimbursement often covers only 50% or less of the actual costs.
Regulatory Changes and Their Impact
Several testimonies detailed the impact of recent changes in EMS regulations. The South Dakota Osteopathic Board now oversees EMS providers in the state. This shift, while initially promising, has strained smaller volunteer services already struggling to meet operational demands. The board’s rules for ambulance operators have added another layer of complexity, particularly for smaller agencies.
Nursing in Emergency Services: Regulatory Challenges
Another vital concern brought to our attention involved the role of nurses in emergency services. Changes in the law in 2024 left many Licensed Practical Nurses (LPN) and Registered Nurses (RN) uncertain about their coverage while serving in rural areas. The dual oversight by the Board of Nursing and the Osteopathic Board led to confusion and, in some cases, a decision by nurses to withdraw from EMS roles—exacerbating staffing challenges in remote areas.
Defining the Role of “Ambulance Operator”
The term “Ambulance Operator” has become a focal point of debate. Previously managed by the South Dakota Department of Health, oversight now falls under the Osteopathic Board. This transition has sparked concerns among ambulance services, who feel the certification requirements add unnecessary bureaucratic hurdles. The requirement for drivers to complete a state-approved Emergency Vehicle Operations Course (EVOC) has been particularly contentious, as it overlaps with existing training received by law enforcement officers.
In response to these challenges, I introduced two bills for consideration by the EMS Summer Study:
Draft 142: Local Control for “Ambulance Operator” Certification
Draft 142 proposes transferring the authority over “Ambulance Operator” certification back to individual agencies. This change would empower agencies to determine their staff’s training requirements, including recognizing the training of law enforcement officers. The bill aims to reduce bureaucratic burdens and enhance operational flexibility for local EMS agencies.
Draft 135: Clarifying Nursing Roles in EMS
Draft 135 seeks to clearly define the roles of LPNs and RNs within emergency services. By integrating nursing terminology into EMS statutes, the bill ensures that nurses can continue to operate in ambulances and provide emergency care, alleviating confusion and anxiety among nursing professionals.
Looking Ahead: Continuing Efforts for EMS Support
I am grateful for the support of my colleagues as we present these bills to the executive board, who will ultimately decide their fate. While we have made strides in addressing staffing and operational challenges, the issue of funding remains unresolved. We have committed to continuing discussions on funding solutions in the next legislative session, with several promising ideas already on the table. Our goal is to support rural areas in delivering essential emergency services to their residents, ensuring that no community is left without the care it needs.
I was surprised that this wasn’t talked about during the Property Tax Task Force. I have an ambulance taxing district, a fire taxing district, and a county fire taxing district. These are 95% paid for services by property taxes. Over 1/2 the calls involve tourists or out of staters and are paid for by property taxes. It would be nice if we could get a little of the sales tax money they spend to take care of the emergency services that they require.
Great insight by Representative Walburg whose background as a licensed paramedic make him particularly well suited to analyze and develop solutions in this area.
in rural areas the first responders are usually family members, neighbors, bystanders.
It helps if they have had some training, because if they don’t know what they are doing they can cause more harm than good. It would make sense if basic EMT training were included in the high school physical education curriculum.