A woman went into sudden cardiac arrest in early July near the Black Hills Playhouse. After someone called 911, nearby deputies arrived within minutes and applied an AED to restore her pulse. Soon after, the Custer Ambulance Service arrived on the scene. Paramedics and EMTs worked quickly to stabilize her condition.
While continuing to care for her inside the ambulance, they drove her to a Life Flight landing zone, where a helicopter flew her to the Rapid City hospital. The Custer Ambulance Service has since learned that she is recovering and doing well.
High-pressure situations like these are routine for Custer Ambulance Service, a nonprofit that responded to 1,200 medical emergencies last year in western Custer County—a number that’s up 20% from the year prior. Few people would deny that the ambulance is a critical service, many South Dakotans don’t realize it’s a nonprofit instead of a government service.
“The first thing that everyone doesn’t understand is that emergency medical services are not considered an essential service like the Fire Department [under South Dakota state law].
If we couldn’t fund ourselves tomorrow, and we had to close our doors, that would be that, because there’s no mandate that says there has to be an ambulance service.”
Mike bielmaier, custer ambulance service director
When a service isn’t classified as essential, that means the South Dakota state government is not obligated to pay for or provide it. Instead, local governments determine their involvement in emergency medical services on a case-by-case basis.
“There are so many different models, and it’s difficult to describe, because it depends on how, when, and why the ambulance got started in the first place,” Bielmaier said.
Nonprofit ambulance services often provide the backbone of emergency medical responses in rural communities with a smaller tax base.
The Custer Ambulance Service is a 501(c)(3) that relies heavily on ambulance fees, small grants, and a county mill tax collected from west Custer County residents.
The county tax covers about 33% of their staff salaries, leaving the ambulance fees, of which they receive about 50%, to cover the their other capital costs. Small grants and donations help fill in gaps like minor equipment needs and staff training and certificates.
Funding models for emergency services vary across the state. In several other Black Hills communities, a nonprofit provides the primary emergency medical services.
The nonprofit tax status helps Custer Ambulance “save a few dollars here and there,” Bielmaier said. It also aligns with their mission. “We’re not trying to make money on the people here; it’s just important that we’re able to provide the service and break even,” he said.
The Custer Ambulance Service partners with the Sheriff’s Office for cardiac emergencies, the Fire Department for fires, and Search and Rescue for wilderness calls. The emergencies they respond to range from horse and motorcycle accidents to sudden health issues like strokes.
“When you’re talking about a call for medical help, the ambulance is the primary response. Depending on the situation, it might be the only thing that responds,” Bielmaier said.
A Grant from BHACF Fills a Small Operational Gap
The Custer Ambulance Service received a $5,000 Capacity Building Grant from Black Hills Area Community Foundation this spring for staff retention and grant research efforts. The grant helped them hire Innovative Nonprofit, a consulting agency, to conduct a process of integrating staff feedback into the nonprofit’s strategic planning.
“We’re trying to create a cohesive group so that we don’t have employee turnover, and the employees we have feel happy and fulfilled, and we can develop a good communication line between each other, so that we have a stable group to run the ambulances.”
Mike bielmaier, custer ambulance service director
Innovative Nonprofit is also working with Bielmaier to identify small grants that could help fund his nonprofit’s expansion into east Custer County, an area reliant on slower emergency services that come from farther away.
Custer Ambulance Service’s coverage area.
While talking with Bielmaier, he was interrupted by an incoming 911 call. The caller described an elderly resident showing signs of disorientation and having a difficult time getting around. He paused the interview to answer the call, and he made sure an ambulance was on its way.
Would You Like to See More Articles Like This?
This article is part of a new effort to illuminate the little-known gaps that nonprofits fill in the Black Hills region. We found this story by asking grantees: “What is one thing you wish the community knew about your services?”
If you’ve enjoyed this article, please let us know! Your feedback helps strengthen the stories we share with our community. Feel free to send your feedback to our Communications Manger, Nicole Schlabach, at nicole@bhacf.org.
