In the latest episode of Dakota Town Hall, Sens. Tim Reed and Ernie Otten joined guest co-host Ryan Budmeyer and Jake Schoenbeck to discuss South Dakota’s struggling emergency medical services system and efforts to develop a more sustainable model before the 2027 legislative session.

The Legislature’s EMS task force is examining how ambulance services are funded and operated, particularly in rural communities where volunteer numbers have declined and the cost of maintaining emergency coverage continues to rise.

Reed said the state currently has a “patchwork” of EMS providers, ranging from hospital-operated systems to independent ambulance services. While rural communities may have fewer calls, he said they still need equipment and personnel ready when someone calls 911.

“You dial 911, you know it’s gonna be there,” Reed said, describing the reliability lawmakers hope to establish statewide.

Otten said years of funding concerns previously led him to oppose proposals involving EMS, but the deterioration of services has changed his position. He pointed to communities limiting ambulance coverage outside city boundaries as evidence that the current system is becoming unsustainable.

“We cannot fail this time,” Otten said. “We have to get something across the finish line.”

One potential solution is regionalization. Rather than maintaining completely separate systems in each county, neighboring areas could coordinate services, billing, equipment and transportation while keeping ambulances positioned to meet response-time needs. Otten said the state could establish a multiyear transition rather than attempting to overhaul the system immediately.

The discussion expanded into whether regional EMS could eventually encourage counties to share other government services. Otten said directly consolidating South Dakota’s 66 counties would likely face significant political resistance, but regionalized services could provide a starting point for greater cooperation.

The task force has meetings planned for September and October, with recommendations and proposed legislation expected to move to the Legislature’s Executive Board in November.

The episode also covered child care affordability, construction of South Dakota’s new prison and issues lawmakers expect to consider during the 2027 legislative session.