SD EMS Medical Director Hardship Exemption

During the 2024 legislative session, regulations affecting oversight of Emergency Medical Services were approved and became law. Effective July 1st, 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. 

Specifically, the language 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 from the department that authorizes the ambulance service to have a program director. 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 circuit court as provided by chapter 1-26. 

The department shall promulgate rules, pursuant to chapter 1-26, to establish: 
(1) The application form for a hardship exemption; and 
(2) The standards used to evaluate a request for a hardship exemption. 

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

Interim Approval Granted for Hardship Exemption

The Department of Health has promulgated Administrative Rules which are scheduled for the legislative Interim Rules Review Committee in August. Once the rules are adopted and effective in mid-September, the Department of Health will issue a full one-year hardship exemption to the requesting service. The Department has granted interim approval to these services listed below until that time.

  • Clark County Ambulance
  • Douglas County Armour
  • Douglas County Corsica
  • Plankinton
  • Stickney