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South Dakota Department of Health
South Dakota Department of Health
Emerging Issues:
Measles Cases in South Dakota

EMS & Trauma Program

Ambulance Services

South Dakota's Ambulance Service: Comprehensive support for emergency medical services in rural areas by the Department of Health.

Ambulance Service Licensure/Re-Licensure/Updates

SD EMS Medical Director Hardship Exemption

During the 2024 legislative session, regulations affecting oversight of Emergency Medical Services were approved and became law. Effective 2024, Codified Law governing medical direction require all licensed ambulance services to have medical direction oversight, unless an ambulance service is granted a hardship exemption. Although SDCL requires a medical director for all ambulance services, the hardship exemption criteria are in Administrative Rule.

Specifically, the Administrative Rules states:

If no physician licensed pursuant to chapter 36-4 is available and willing to serve as the medical director, the ambulance service may request a hardship exemption, following the requirements of Administrative Rule: 44:05:07:02, from the department that authorizes the ambulance service to have a program director.

Administrative Rule 44:05:07:02. Approval of hardship exemption application states:

The department shall approve a hardship exemption if an ambulance service:

  1. Demonstrates by clear and convincing evidence that no physician who is within a fifty-mile radius of the ambulance service coverage area and credentialed to work at the primary receiving facility for the ambulance service is available and willing to serve as the medical director of the ambulance service for a fee that is less than five percent of the ambulance service’s annual budget; and
  2. Provides documentation that the program director selected has:
    1. A minimum of two years of clinical experience as a physician assistant or nurse practitioner;
    2. Agreed, in writing, to be responsible for the supervision and healthcare direction of the ambulance service; and
    3.  Attested to having reviewed and to understanding the Introduction to Rural EMS Healthcare Direction in South Dakota document on the department website.

To request a hardship exemption, an ambulance service must file an application with the department that documents the efforts made to obtain a medical director.

The department shall grant the hardship exemption if the ambulance service demonstrates, to the satisfaction of the department, that no physician is available and willing to serve as the medical director.

A hardship exemption is valid for one year from the date of issuance. An ambulance service may renew a hardship exemption upon application to the department. 
The granting or denial of a hardship exemption may be appealed to the circuit court as provided by chapters 1-26. 

The department shall post on its website a list of ambulance services granted a hardship exemption under this section. 

The ambulance services below have applied for and have received a hardship exemption by the Department of Health. 

SD EMS Medical Director Hardship Exemption Form 

Please submit this form to Julie.Smithson@state.sd.us.

Approval Granted for Hardship Exemption

The Department of Health has issued a full one-year hardship exemption to the services listed below.

Content last updated: June 5, 2025. For questions, contact:

  • Marty Link
    Healthcare Access Deputy Division Director and Rural Health Administrator
    4101 West 38th Street, Suite 102
    Sioux Falls, SD 57106

    email: Marty.Link@state.sd.us
    local: 605-367-5372