On Tuesday, Governor Kristi Noem said South Dakota needs to spend money to recruit and support more volunteer emergency medical technicians:
Unfortunately, our emergency responders are getting fewer and fewer. Many have gotten older, and less people are stepping up to volunteer. We must reverse this trend. We need to recruit more volunteer firefighters and emergency responders. And we need to support them with modern tools – my budget does that. I look forward to working with all of you to get these wonderful folks the equipment and training that they need [Gov. Kristi Noem, State of the State Address, Pierre, SD, 2022.01.11].
Emergency medical technician Cully Williams, who has held his EMT license for nine years, says Noem’s focus on volunteer emergency services only perpetuates decades of neglect by the State of South Dakota.
Around 1966, the DOT discovered people were dying on highways, so they formed NHTSA and started using it to dump money into ambulances in rural areas. This is why most ambulances in SD (as well as the Office of EMS, and Board of Medicine) were formed +/- 1972.
For the next 30-40yrs, everything remained remarkably unchanged. In 1994, NHTSA came in for an Assessment for a nationwide report, and again in 2002. I’d like to take a quote from this 2002 report:
“On revisit, however, the absence of clear statutory authority for a lead agency consistently and predictably funded, and bureaucratically positioned to plan, implement and coordinate a comprehensive EMS system is evident…. Particularly disturbing is the continued lack of a State EMS Medical Director, the current absence of a State EMS Advisory Council, and distribution of authority over EMS issues and personnel among Department of Health offices and other state agencies.”
In reaction to this, nothing happened. Ambulance crews ticked along. Some crews couldn’t keep 2 EMT, so they would take a hardship exemption from the state and run with 1 EMT + 1 driver. By 2013, that was around 15% according to this Needs Assessment.
The 2013 report looked at the 2002 one and asked what got done. Out of 71 action items, only ten were done. Nine were the development of a statewide trauma system, and the other was a state DNR form. Come 2015, Safetech released their data.
In SD, 73% of services used volunteers, 94% said workforce recruitment was their greatest need, and 32% of services missed a call due to volunteer staffing. It became clear s[*] was about to hit the fan. I’d argue it hit sooner than expected, *then* COVID happened.
Safetech identified only 1 in 3 as sustainable in the coming 3-10 years. The next year, the leg[islature] lowered the minimum staffing reqs down to one EMT and one driver. Too many on hardship exemption. In 2018, townships were given authority to impose a tax levy for EMS.
Safetech returned 2019 saying: “In the past decade, this informal network of services has begun to show signs of strain. Volunteerism has declined, and the demand for services has risen. Pressure on the system now threatens the reliability and sustainability of EMS in rural SD.”
They also calculated how subsidized EMS is by volunteer labor, and returned a $36 Million/yr figure. Every year, volunteers contribute $36M to keep our ambulances afloat. That’s admirable, but very much not a smart/sustainable business model [Cully Williams, Twitter thread, 2022.01.11].
South Dakota’s model of praying for/preying on the kindness of its people’s hearts is running up against the reality of low wages, higher costs of living, and demographics. The Blue State Refugees the Governor claims are coming to South Dakota for Freedom™ aren’t volunteering to drive our ambulances. (They probably include a lot of older folks and risk takers who are going to need more ambulance calls.)
Williams thus proposes paid, full-time ambulance services facilitated by the state with an opt-in ambulance district plan and $37 million a year to cover operating expenses. According to an April 2021 South Dakota News Watch report, the state of South Dakota currently allocates enough each year to staff just one rural ambulance:
The EMS program within the South Dakota Department of Health Office of Rural Health received about $422,000 from the state general fund, EMS agency licensure fees and EMS professional licensing fees, according to a 2020 report from the National Association of EMS Officials. The state received about $115,000 in federal funding, according to the same report. The health department did not respond to follow-up questions about state funding for EMS and a spokesman said the director for EMS was not available for an interview.
The estimated cost of operating and staffing a single rural ambulance in South Dakota is about $484,000 each year, according to SafeTech Solutions survey. About $384,000 of that is estimated to be volunteer work [Danielle Ferguson, “Viability of Rural Ambulance Services in S.D. at Risk Due to Staffing and Funding Shortages,” South Dakota News Watch, 2021.04.29].
$37 million a year—is South Dakota willing to spend that money on ambulance services? Or will South Dakotans continue to cling to their low-wage/low-tax lifestyle and just hope someone volunteers to stop their bleeding and drive them to the hospital when they crash their electric ATVs?