- This is a production of SDPB.

- Most ambulance services in South Dakota struggle with rising costs, increasing call volumes and limited staff.

But those aren't the only challenges.

Emergency responders need competent new members and sustainable support systems, both on call and after.

That's tonight's South Dakota Focus.

Sherry Hocking is director of the Newell Ambulance Service.

She's been an EMT for 27 years.

It's meaningful work, but it's not easy.

- The pay is poor for the things that we do.

Getting called out in the middle of the night, seeing things that you can't unsee and people are aging out of it.

Young people don't wanna be doing this work.

It's not what they wanna do.

And so as we age out of it and you lose your staffing, you get down to just a couple of people or three people covering a huge area.

And burnout is, it's a, it's big and it's real.

I, I think the biggest challenge with staffing and keeping staff is it takes a lot of education.

It takes a lot of hours to get to be like, to be an EMT.

It's a minimum of 160 hours of classroom study.

And then you have to do your continuing education.

You have to keep your education up every two years.

- The Newell Ambulance Service partners with the City of Belle Fourche ambulance service about 25 miles west.

Donnie Walding is a paramedic and Belle Fourche ambulance director.

He says the city service alone answers up to a thousand calls a year with the help of 15 staff members.

- It's a specialized area, so not everybody off the street, you know, and that makes it hard for us, is we can't just say, Hey, we need, you know, we need more staff come on in.

We have to look for people, you know, with the correct training and up to date training.

A lot of times we have to put on EMT classes and, train those people just to get 'em on the ambulance.

So it takes a few months, four or five months sometimes to increase our, our roster sizes.

- Roughly a hundred miles south.

The Custer Ambulance Service holds EMT trainings on a regular rotation.

- So we're at the Custer Ambulance Station having our basic EMT class.

We're about a third of the way into it tonight.

We're working on scene size up and working on getting vitals, blood pressure, pulse respirations, things like that.

- 124 over 86.

Can I see this real quick?

Can you see this?

Sure.

- Okay.

What were her base lane vitals?

- 122 over 78.

- The reason behind me taking this course at this particular time, I crashed a dirt bike, which put me on administrative leave for quite a while.

So this course falls in that timeframe where I know I'm not gonna get called out at night, not gonna be kept late during the day because I'm only doing administrative work rather than being out on patrol.

I've wanted to be in EMT get involved in that for quite a while and this is my opportunity to be able to do that.

Being an EMT compliments being a firefighter, because we often show up either first or as first responders on a call and if there's a medical, it's good to have medical knowledge that we can treat patients.

It's not always a fire that we're going to.

- Offering he course is part community service, part recruitment strategy.

Sharon Bielmaier is the Custer Ambulance training coordinator with more than 40 years experience in EMS.

- The courses, even when they were volunteer service, they were dedicated to doing EMT in advanced every year.

That was also to hope to get some volunteers out of that, but it's also a community service because the people that get trained, even if they're not with us, if they get trained here and they go fill a spot somewhere else, we're still adding to the overall system.

And, but obviously we're always looking when we're teaching to recruit out of those because we get to know them, we spend so much time with them, they become part of our family.

- Some students receive financial backing from their employer to take the EMT class.

Others pay out of pocket.

Kisha Meyer is a paramedic and an EMT instructor for Custer Ambulance.

- A lot of places in South Dakota are not paid services.

So I think that can sometimes hurt people's interests.

They want to have a career, a paid job, whereas a volunteer service, that's kind of like something that you do because you love it and you're invested in the community that you're in.

So I think it can be very difficult to get new people.

And you know, we are seeing less of that than in previous years.

- But there are exceptions to every trend.

Like Owen Pollard of Pringle, who's now an advanced EMT with Custer Ambulance, - I got into it because of the aging population with first responders down in Pringle.

As soon as I turned 18, they were all over me about join the fire department.

We need young blood coming in here to help out.

And then once I started doing it, I was just hooked.

I think teaching is probably one of the best ways to learn.

And being new in this career, I got, I have the opportunity here where they've allowed me to teach and I think it's extremely helpful to me.

It's helpful to the students.

Of course you need somebody.

I think seeing a younger face up there teaching too helps out trying to draw some younger people into it.

So here in Custer, our pass rate for my advanced DMT class was about 90%.

We still are waiting on one to finish testing, so it might get up there to a hundred here.

But I think the quality of our instructors here in Custer is just amazing.

Mike and Sharon taught most of the advanced EMT class and the knowledge that they could pass on to us was just huge.

- Passing the EMT certification is yet another challenge for ambulance crews.

Last year, the first attempt pass rate for South Dakotan's, taking the National Registry EMT certification test was 62%.

So far this year that rate is up to 72%.

Some are frustrated that rural services are held to national standards from more densely populated regions, but ensuring ambulances are staffed is just part of the battle.

EMTs have to be competent.

- I think, you know, it's a rural service, so certainly the day-to-day looks maybe a little different than it might in a big city EMS, but some of the same stuff still applies.

You're still going in, you're checking out your truck, your equipment, make sure you have everything that you need.

You do respond to calls as needed.

Some of the skills that we do in Custer are not some that we do as often as you might in a higher volume service.

And so we do place a lot more emphasis on training those high acuity skills so that when we do need to use them we're prepared.

- But even the most competent EMTs can benefit from an extra set of eyes, especially when a small crew is faced with a dire situation and a long transport.

South Dakota led the nation with a potential partial solution.

The Telemedicine in Motion program through Avel eCare.

- We talk about a pictures worth a thousand words.

Imagine in the back of that ambulance where you have two-way audio video connectivity and that provider in Avel can look and see the acuity level.

They can hear the patient, they can hear the EMS providers that are taking care of the patients.

It allows for that information to flow very, very quickly.

- Marty Link is the statewide EMS director for the South Dakota Department of Health.

He's also Deputy Division Director for the Division of Healthcare Access.

- Under that umbrella is our office, which is the Office of Rural Health and Emergency Services.

So that encompasses not only the Office of Rural Health, but emergency Medical Services in our trauma system and then soon to be our stroke system.

- Telemedicine in Motion's public private partnership was jump started with Federal Pandemic Relief dollars.

It was part of a broader initiative to address challenges in emergency medical services.

- The regional service designation came about with funding from Governor Noem and supported by the South Dakota Legislature back in fiscal year 22.

And what this really did is showed the EMS industry that there is administrative support and that we really wanted to tackle some of the tough issues that we're having in South Dakota.

So that funding totaled about $20 million and it was divided up into three different projects.

One of 'em were three different initiatives.

One of them was a regional service designation, one of 'em was telemedicine in motion, which is equipping ambulance services with audio video connectivity so that those providers never have to be alone in the back of an ambulance anymore.

And then we offered up to 308 Lifepak monitor defibrillators to participating ambulance services.

Now these are in the tune of $33,000, so it's definitely something that those, especially our rural ambulance services needed.

We have our ambulance personnel and we have some of the best of the best in the state of South Dakota, but sometimes they're alone in the back of that truck for minutes to hours at a time, depending on whether, depending on trans, you know, the distance to transfer to a a hospital.

- The program connects the ambulance crew to board certified physicians and paramedics in Sioux Falls.

John Gruber is a paramedic and the EMS operations manager for Avel eCare.

- So maybe it's just a quick phone call.

They maybe have a question just about some medication that they're giving a patient or a medication that a patient has and they just wanna clarify like, yeah, is this something I need to be concerned about?

So could take 30 seconds to a minute all the way up to, you know, some of the ambulances that are in the more rural parts of the state could be transporting that patient for, you know, upwards of 60 to 90 minutes.

And so then we can stay on through that whole duration of care.

We've been on calls with a brand new EMT that said, okay, I, I've done this in school so I know what I'm doing, but can you just help me?

What things should I take into the house that I need to go in to help this patient?

And then we're able to walk them through, you know, just making sure that they were doing the right steps that they learned how to do and just support them in that way.

Especially, you know, with the lower volume calls.

But those higher acuity patients, those are the times where they're like, okay, yeah, I may have done this a few months ago, but I just wanna make sure that I'm doing the right thing for the patient.

I think a big thing with rural EMS is it might be a coworker that you have picked up in the back of the ambulance.

It might be a family member, it might be your neighbor that you work on.

And that can really change the emotions that you're working with on a call.

And so be able to have someone that's removed from that to say, yeah, you are doing exact absolutely everything that you can for that patient the right way.

You're taking care of 'em best way possible.

I think that really helps.

That - 105 communities in South Dakota use telemedicine in motion.

The Newell Ambulance Service is one of them.

- So if things are really bad in the back and it's all hands on deck and we don't have time to make that call to the hospital, they'll do that for us.

They do that call, they do all of our documentation, they document our vitals, those types of things.

Then they fax that to us.

So we can include all of that in our patient care report.

So it's like having another person in the back with you that is doing things that we may not have time to do if we have a bad trauma back there or we have CPR going on or something like that.

We don't have extra hands and you really don't wanna show up to the hospital without calling report.

They, they don't ever smile at us when we come in and haven't called report and gave them a heads up that we're coming in with a patient.

- When you look at the demographics of South Dakota.

Critical Access Hospital might have a couple people working around the ER at seven o'clock at night.

The doctors might be home.

Radiology x-ray might be doing their own thing, or they might be done for, for the night.

By allowing that time for EMS crew to say we're coming in and we've got a 45 minute ETA that allows that hospital to get their staff ready and prep for that patient.

It also allows them through telemedicine in motion and the communication channels back and forth for flight services to be able to get to that critical access hospital and then ultimately get that patient safely to tertiary care.

- The first few years of the program have demonstrated another benefit, improved EMT retention.

Becky VandeKieft is the VP of emergency and EMS services for Avel.

- Our interest survey, we repeated it and really looked at workforce and retention.

And in that we had over 80% say that yes, this indeed is helping with recruitment and retention of our EMTs and our medics along with the training and education piece.

We also just got approval from the South Dakota Board of Osteopathic that we can provide continuing education credit.

So an EMT or a medic that has just ran a patient call and activates telemedicine in motion can receive continuing education credit or hours towards their licensure.

It's kind of, it's a win-win for them to only, not only being active and responding to a 9 1 1 call, but then getting the credit and the education that I'm doing while I'm working on that call is, is pretty cool.

And really one of the first in the nation, I would say.

- Telemedicine in motion, it is a game changer.

And we, we should be very proud of the State of South Dakota.

We are first in the nation.

We have other states that are surrounding us that are trying to dabble into it.

Some have been very successful, but I'm particularly proud 'cause when we look at recruitment and retention, when you look at the impact that Telemedicine in Motion has had already, we already see positive strides towards maintaining the workforce that we have because it shows that there's support.

- Telemedicine in Motion has fielded more than 2000 calls to date, but keeping the program sustainable will take ongoing investment.

- We owe it to the people, we owe it to the administration, we owe it to the legislators to say, this is a product of what you support and these are the people that are being impacted by it.

And this is the cost.

And, and looking at future funding that, you know, that's a conversation that we have each and every day, right?

We look at budgets, we look at how lean things are gonna get.

We look at, there's gonna be a surplus.

But the the biggest component that we can offer right now is making sure that we're telling the story of the goodness the Telemedicine in Motion is bringing and getting that to the right people so they can make those decisions ultimately moving forward.

- Sustainable support systems during an emergency call is one thing.

Supporting first responders after a call is another.

- When I was going to school, the average career length of a medic was only seven years.

You know, the, the mental health side of EMS is is a pretty big challenge.

You know, there's, you're constantly seeing people on their, on their worst days and things don't always go the way that we would like them to.

You can be the best trained EMS personnel and you can do everything right.

And that doesn't mean that it's still gonna end, you know, the way you want it to and at what point, you know, how many Ls do you gotta take before it really starts to, to affect, you know, your mental health.

- Humans were not meant and not hardwired to see this kind of trauma on a daily basis.

We all have trauma at sometimes in our lives, we do.

But they're exposed to a lot out there.

And that's a hard job.

That's a hard job.

- Karen Griffith is a mental health responder with the Spearfish Ambulance Service.

She was trained to provide mental health support to first responders more than 30 years ago.

She was part of a team that responded to the aftermath of the September 11th terrorist attacks in New York.

- Came back here and I was talking to Brian Hambek, who's the director of the Spearfish Ambulance Service and talking about my experience in New York.

And I said, you know, we, we need to do something here with mental health.

And yeah, we come in after a, a traumatic event and we talk to the responders for an hour or two, but I'd like to see something bigger.

- She used to come to the scene of an, an accident or to a house where somebody has died and she would take the family aside and work with them as far as their mental health goes while we take care of the patient, which takes that focus off of us, we don't need that.

- It does lift the burden off the first responders.

They don't have to worry about the kids that are in the house.

They don't have to worry about the, the partner that just lost their spouse or significant other.

They don't have to do that.

That's why mental health is there to try to help with that.

- After a real bad call, Karen will come up here to the office after the trucks restocked and ready to go again.

And we'll sit down as a whole group and say, all right, this is a normal response to an abnormal situation.

Tell me how you're feeling.

That's one service that Spearfish Ambulance has provided to our membership for the last 20 years.

And it's invaluable.

I wish more agencies would do that.

- That's the one thing that we can do for one another.

And I would like to see mental health response teams across the state along with the ambulance or the police department.

And I know that they're doing more of that now.

I, I would encourage more of it.

- EMS workers are at higher risk for mental health issues across the nation.

For example, a 2023 article in the Journal of Emergency Medical Services found more than 41% of EMS workers report, some kind of mental health issue.

Nearly 90% of respondents screened positive for burnout.

- If you talk to them about why they're burned out, yes, it can be long hours.

Yes, it can be a lot of calls, but what they're not processing and what they don't know how to handle is what's on the inside.

If we're not dealing with what we're holding in, it's gonna come out.

And if you can at least start talking about it, then they can start processing it and then they probably won't leave the field.

- If you don't shed some of that stuff, you're gonna end up in real trouble.

And we have suicidal behaviors, we also have domestic violence is another symptom.

And that, yeah, there are other reasons for all of those things.

For drug and alcohol abuse and domestic violence and suicidal behavior.

But when you're a first responder, if you don't take care of yourself, those things are right there.

And you don't wanna lose yourself in this job.

You wanna do the best job you can do.

And I know everybody that goes into it feels that way.

They want to do the best work they can do for their community and for families out there.

But if you're not taking care of yourself, you're not really doing your best job.

And the culture used to be that if you asked for help that was held against you.

- That was a huge thing when I first started too, that you didn't shed a tear and you didn't show one emotion 'cause then you were weak.

And since then it has been shifted and we now have peer support groups, but we're still fighting that where if you're having problems, you've gotta speak up.

- And that, and that's on leadership.

That's leadership being in, in the trenches.

That's leadership being, you know, where their people are.

Not just sitting in the office but checking on their people.

- The options for EMS workers to access mental health services can vary by their organization.

Karen Griffith doesn't respond in the field anymore, but she still takes calls and makes referrals in the Spearfish area and advocates for EMS workers.

- The thing that I was disappointed by was when it was the ambulance services were not made mandatory because it was an unfunded mandate.

Well, okay then fund it.

Use money from DUIs, from child abuse cases, from divorce cases, from some of the other things that we have going on that may contribute to the ambulance service having to run.

I can't imagine, I've got health issues, I can't imagine not having the ambulance show up.

And I've, I've had to use it.

So at that point in time I was so sick I couldn't have even gotten out to my own car so my husband could take me to the hospital.

The ambulance came and I don't know what I'd do if I didn't have that service.

So I think we owe it to the citizens to do that.

But more than that, we owe it to the first responders to have their backs on this.

- She's referencing House Bill 1043 from the 2025 legislative session.

Representative Eric Emery, a paramedic with the Rosebud Ambulance Service, brought the bill to make EMS an essential service with a reliable funding source.

The bill itself failed, but it resulted in the EMS interim committee.

Their scope was broad and included research into ways to make EMS more sustainable in rural areas.

The group of lawmakers met for a third and final time in late October.

They agreed on two drafted bills to bring to the 2026 legislative session.

Both are aimed at making it easier for certain people to assist emergency medical workers.

Senator Tim Reed co-chaired the committee.

- So in the first and second meeting we had, we had heard about nurses not quite understanding if they could participate or be in the ambulance to help because there is a volunteer shortage.

And I received calls from nurses who just didn't feel it was clear, so did other committee members.

And then we also heard it in testimony.

So one of the bills just really clarifies that, whether it be an LPN or an RN, you know, can participate as one of the members of the EMS team that would respond to an emergency.

The second bill, what it does is it, it relieves some of the pressures on volunteers that actually drive the ambulances.

And those could be a police officer, a volunteer firefighter.

And so what this bill does is it makes it a little bit easier to use those resources instead of actually having to have somebody go through the large licensing process there is and, and it's still gonna make sure that the correct person is driving that vehicle and everybody will be safe.

- The committee also agreed to continue the conversation on making EMS an essential, tax-funded service, but that will take much more than an interim committee can accomplish on its own.

- We talked about that having to discuss EMS as an essential service, which the committee agreed to.

It's just that we were overshadowed quite a bit with some of the financial challenges we have that we'll be having plus we'll be talking about reduction in property taxes and there's always that discussion, you makeit essential, how's it gonna be paid for?

And so what we did at the end of the, of the committee is we said, listen, we gotta continue this conversation.

Everybody believes it should be an essential service.

And so I think it's gonna take the legislature in the next year to say, we agree it should be an essential service.

And then we're gonna have to probably set up a little bit different of a type of a committee, but their charge will be figure out how to make it an essential service, how will it be funded, how will it be organized?

- As more policymakers learn about the challenges facing emergency medical services, momentum is increasing to address some of these complex issues.

But the work is just beginning.

Representative Emery is glad to see the process his bill started is moving forward, - Going into the session, the 25 session, when this was originally placed out there, you know, it was a lot of unknowns that were placed in front of me.

I knew that going into the session, the bill went exactly where I thought it was going to go.

It was gonna go to the 41st day.

But it sparked a debate and sparked a discussion for that.

And I, that's exactly what I wanted.

And we've, we've gotten to that point.

There's still a lot of work to be done to make EMS an essential service here in South Dakota, but I think we're going in the right direction.