RAPID CITY, SD – The future of ambulance services in rural Pennington County isn’t clear despite county commissioners acknowledging the service is a priority.

On Tuesday, commissioners discussed the loss of ambulance services at the end of the year to much of rural Pennington County. Currently, ambulance service is provided by Rapid City Fire.

In December 2025, Rapid City Fire Chief Jason Culberson notified the Pennington County Commissioner of necessary changes to the ambulance service. Culberson noted that Rapid City had provided ambulance services to some county residents since 2003 with no subsidy and there has been no contract since 2007.

Culberson said if a contract wasn’t reached by December 31, 2026, ambulance services to the unincorporated areas of Pennington County would no longer be provided.

According to county commissioner Jerry Derr, about 2,700 calls for service in rural Pennington County and neighboring areas cost nearly $3 million to respond to. After reimbursement, the subsidy need was about $1.5 million.

“I look at EMS service as an essential service,” Derr said. “And then I look at it and say what are the functions of government? …I see it no different than law enforcement, roads and infrastructure.”

Derr said to address the shortfall, commissioners had three options: direct county levy ranging between $73 and $140 a year and contract with Rapid City Fire, create ambulance districts, or paying Rapid City Fire from existing funds.

To address the impending December 31 deadline and maintain county ambulance services, commissioners approved sending a request to Rapid City Fire asking for a short-term contract or other concession as the county funding process took place.

“Would the City be willing to consider a short-term contract or interim agreement that would maintain ambulance service into 2027 if Pennington County and other affected partners are able to identify an appropriate funding source before the end of 2026?” the letter asks.

In Rapid City Fire’s 2025 notice to the commissioners, fire chief Culberson said the increasing Pennington County population increased demands on ambulance services, increasing costs that were not reimbursable.

“We are taking steps to ensure that the communities we respond to have quality emergency medical care,” Culberson informed the commissioners in 2025. “This means we are seeking a contract with the communities and counties in which we provide public service. A contract will ensure that our service stays viable and that the county will have quality medical care.”

Rural Emergency Medical Services are largely volunteer-based in South Dakota, and volunteer levels are expected to decline over the next five to 10 years. Adding to the strain on the system, ambulance demand has increased more than 50 percent from 2018 to 2022 and often reimbursement rates don’t cover the costs of the services.