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Viability of rural ambulance services in S.D. at risk due to staffing and funding shortages

by: Danielle Ferguson, South Dakota News Watch

Rural ambulance services in South Dakota are having an increasingly hard time recruiting volunteers and generating revenues, putting the stability of the services at risk and making it more likely that rural residents will endure longer response times in emergencies or possibly lose ambulance service altogether.

While most larger cities in South Dakota have professional ambulance services or fire departments with paid staff members, rural services rely mostly on volunteers. In recent years, those rural providers have seen fewer people willing to volunteer and those who do volunteer are older residents who are aging out of the workforce.

About a third of rural ambulance directors in South Dakota said they couldn’t respond to a call because of staffing shortages, according to a 2016 survey. Roughly a third more said response times were delayed due to lack of staffing.

Paying the bills is also a growing challenge for ambulance services, which see limited patient billings and high levels of non-payment write-offs. Patient billing is the main funding source, and it usually does not cover the costs of responding to an emergency or transporting a patient, let alone covering overhead for the service.

Rural ambulance services sometimes do not see the call volume needed to cover costs such as equipment, insurance, training or staff. Budgets are often supplemented by millions of dollars a year in volunteer labor.

Ninety-five of South Dakota’s 126 ambulance services are staffed with at least some volunteer labor, according to a state-funded survey from SafeTech Solutions. The majority of rural ambulance directors said they think they can function financially for the next five to 10 years, but just one-third were confident they would be able to fully staff a 24/7 service in the future, according to the survey.

To run a 24/7 ambulance service in South Dakota, a provider needs at least 14 workers, yet almost half of the state’s volunteer ambulance services reported having fewer than 10 people on the roster, according to the survey.

The COVID-19 pandemic reduced the dwindling volunteer pool even further. The active EMS workforce decreased by almost 30% in the last year because volunteers worried about contracting the virus, according to the South Dakota Department of Health.

Ambulance volunteers and directors said the decline in volunteerism has been a concern for years. Younger people are moving into more urban areas or don’t want to volunteer for a medical job they think should be a paid position.

“The major concern is that an ambulance will be needed and no one is available, and we will see an increase in morbidity and mortality,” said John Becknell, an analyst for SafeTech Solutions, a consulting firm that studies and provides guidance to emergency medical services. “I’m really concerned because fewer and fewer South Dakotans are bearing the brunt of carrying this load.”

Staffing shortages caused a volunteer ambulance service in rural Meade County to shut down last year, suddenly putting residents of the area an hour of travel time from any ambulance coverage.

The Rural Meade County Ambulance Service in Enning, about 50 miles east of Sturgis, closed in April 2020. The service responded to about 30 calls each year, and volunteers from Enning also assisted other agencies and transported patients in major emergencies.

After the closure, ambulances services in Faith and Newell agreed to cover most of the more than 1,200 square miles previously serviced by the Rural Meade County Ambulance Service. In extreme emergencies, air ambulances can respond to calls in the small swath still considered uncovered by the other ground ambulances.

In a subsequent election, Meade County voters approved a new ambulance tax district last year. Households in the county outside of Sturgis will contribute about $75 a year for the service, and county commissioners agreed to give the Rural Meade County Ambulance $5,000 to re-open. About 10 people are taking the 180-hour class required to become emergency medical technicians. County leaders hope these efforts bring back the service.

The uncertainty in Enning is a possible harbinger of future problems for other rural ambulance services, said Jerry Derr, assistant for the Meade County Commission office.

“What’s happened in central Meade County is going to be replicated statewide,” said Derr, who has had conversations with the South Dakota DOH about the issue. “You’ve got people doing this for decades but want to get out of it, having that responsibility and trying to get younger people in the community and pick up that mantle, you’re just not getting in the rural areas.”

Ambulance services critical to rural areas

Long response times for ambulance services are commonplace in rural South Dakota, and could get worse if rural service providers are unable to stay in operation.

Kathy Chesney and her crew in Philip recently drove 47 miles north of their station to help a patient too weak to get out of his house. While the ambulance team was there, that patient went into cardiac arrest and was saved by the responding EMTs.

The Philip Ambulance Service, located in sparsely populated Haakon County, was the closest to the rancher’s home.