Nearly 50 years of serving St. Francois County. We need to continue growing with you.
Here’s What You Need to Know
What We’re Asking For
The St. Francois County Ambulance Growth Proposition would increase the ambulance sales tax from half a cent to one full cent per dollar you spend.
That’s an extra 50 cents on every $100 purchase. An extra penny when you buy a $2 soda. A small investment in the emergency care that’s there for every one of us.
Why Now? The Math Has Caught Up With Us
We’ve been serving this county since 1977. Nearly 50 years. And for the last 20 of those years, we’ve operated on the same half-cent sales tax without asking for more.
Here’s what has changed in those 20 years:
- In 2004, we answered 8,586 calls with up to 5 ambulances on duty and 45 employees.
- In 2025, we answered 19,361 calls — more than double — with up to 9 ambulances on duty and over 100 employees.
Our call volume more than doubled. Our staff has more than doubled. Our ambulances on duty nearly doubled.
But our sales tax revenue only grew 54%, from $3.5 million to $5.4 million.
Meanwhile, operating costs nearly quadrupled, from $2.8 million to $13.8 million.
We stretched every dollar. We were patient and responsible. But we’ve reached our limit. Our community is growing and aging, and emergency calls keep rising. We can’t continue to keep pace on the same funding we had when we served far fewer people.
What Your Investment Would Make Possible
The St. Francois County Ambulance Growth Proposition would allow us to:
Equip our paramedics with advanced life-saving tools — including capabilities already standard in some of our neighboring counties, such as blood products for trauma patients and portable ultrasound imaging.
Add satellite stations in rural areas — so residents in the northern, southern, and western parts of the county aren’t waiting 20 minutes or more for help to arrive.
Put more ambulances on duty — reducing and working toward eliminating the times when every single ambulance is already on a call, and someone has to wait.
Shorter wait time for non-emergent transfers — When a patient needs specialty care unavailable locally, our crews have to transport them to hospitals in Festus, St. Louis, or Cape Girardeau. That can keep an ambulance out of our county for up to 3 hours at a time. With more crews and ambulances, we could maintain better coverage here at home, even as some make those critical runs. This would enable us to respond more quickly to non-emergency transfers, relieving the burden on local hospitals, nursing homes, and the families waiting on them.
We’ll Still Be Here Either Way
We want to be honest with you. We are not going anywhere regardless of what happens on April 7th. We will still answer every 911 call. We are your neighbors. Our families live here too.
But without additional funding, response times will continue rising as calls keep growing. There will be more moments when every ambulance is already on a call. We won’t be able to add satellite stations for rural residents who currently wait the longest. And we won’t be able to provide the advanced care capabilities that the community deserves.
We don’t want that for you. You deserve more — and we know we can provide it.
Your Questions, Answered
We believe you deserve clear, honest answers. Here’s what we hear most often, and the full story behind each one.
Question: How much will this actually cost me?
Answer: The increase is half a cent per dollar — the same amount you’ve already been paying for ambulance services, added on top.
Here’s what that looks like in everyday spending:
– A $2 soda: 1 penny more
– A $50 meal: 25 cents more
– $100 spent at a local store: 50 cents more
The current average sales tax in our area is about 9 cents per dollar, depending on the city. This proposal would bring the ambulance portion to 1 full cent, making the total tax on a purchase about 9.5 cents per dollar.
* This is an example only, as each city has a different total sales tax percentage. Refer to your city to determine your local tax rate.
Question: Why is this being asked now? Why didn’t you ask sooner?
Answer: We didn’t ask sooner because we committed to making the original half-cent tax work as long as we could, and we did. For 20 years.
In 2004, that tax brought in $3.5 million per year. It now brings in $5.4 million, a 54% increase. But in the same period, our operating costs grew from $2.8 million to nearly $13.8 million. Almost four times higher! That gap has been growing every year.
We’ve added staff, added ambulances, and managed every dollar carefully. But the demand for 911 services has now outpaced our ability to grow on current funding. We made it work for 20 years. We’re asking for help now because the math no longer works.
Question: Why have your costs gone up so much?
Answer: Several things have driven costs higher at the same time.
– Call volume more than doubled from 8,586 calls in 2004 to 19,361 in 2025. More calls mean more staff, more fuel, more supplies, and more wear on equipment.
– The cost of a fully equipped ambulance has more than quadrupled from about $125,000 in 2004 to $565,600 today. That’s not just inflation. Today’s ambulances carry far more advanced medical equipment than they did 20 years ago. Things like power stretchers to protect our paramedics’ backs, advanced ventilators, CPR compression machines, more advanced cardiac monitors, and electronic patient reporting systems. None of that was standard in 2004. It is now.
Lastly, inflation has affected everyone over the past 20 years, including ambulance services. The costs of equipment, supplies, insurance, utilities, and day-to-day operations have risen sharply, increasing the cost of delivering reliable emergency care.
Question: What does a fully-equipped ambulance actually cost, and why?
Answer: A fully equipped ambulance costs $565,600 today. In 2004, that same ambulance cost about $125,000.
The vehicle itself, before any medical equipment, costs $345,000. The remaining $220,600 covers the life-saving equipment inside, including:
– A heart monitor that sends data to the hospital before we arrive: $65,000
– A power-assisted patient loading system for patient and crew safety: $31,000
– A mechanical CPR compression machine: $32,100
– A ventilator to help patients breathe: $22,000
– A power cot to safely lift patients: $44,900
– Medications, IV supplies, airway equipment, and trauma supplies
– Laptops, radios, and communication systems
This equipment wasn’t standard 20 years ago. It is what’s required now to provide the level of care our community deserves.
Question: Why are there sometimes no ambulances available at all?
Answer: This is one of the most important things we want people to understand.
We serve 455 square miles and more than 67,000 residents with 9 ambulances on duty during our busiest times, and only 5 during non-peak hours. When multiple emergencies occur simultaneously, every ambulance can be on a call.
When that happens, there may be no ambulance immediately available in St. Francois County when you call 911. A crew from a neighboring county may need to respond, which means longer wait times.
This happens very frequently. It’s not a rare edge case. It’s a reality of serving a growing county with the resources we currently have. The St. Francois County Ambulance Growth Proposition would allow us to put more ambulances on duty, reducing and working toward eliminating these moments.
Question: Why do your ambulances sometimes go to St. Louis? Aren’t they needed here?
Answer: Our ambulances often go to St. Louis because patients in St. Francois County need care that isn’t available locally.
When a patient has a heart attack, they may need an emergency cardiac procedure that requires a specialized hospital, like Mercy Jefferson in Festus or a St. Louis hospital. When someone has a stroke or serious trauma, they need a specialty center. We have to get them there safely. There is no other option.
The problem is that a single transfer like that can keep one of our ambulances out of St. Francois County for up to 3 hours. When multiple transfers happen at the same time, it leaves fewer ambulances available for 911 calls right here at home. That’s when wait times get longer for everyone else.
This isn’t anyone’s fault. It’s the reality of providing complete emergency care in a county without those specialty services on-site. With more crews and ambulances, we could maintain better coverage here at home, even as some ambulances transport patients to the care they need.
Question: What about non-emergency transfers? Why do those sometimes take so long?
Answer: 911 emergencies and emergency transfers always come first. They have to.
During non-peak hours, we often have only a small number of ambulances covering all 455 square miles. When 911 calls come in, we have to prioritize those. That means non-emergency transfers sometimes get delayed or rescheduled to protect our emergency coverage.
Even with those limits in place, we still sometimes find ourselves with very few, if any, ambulances available as emergencies pile up. It’s a difficult situation, and we know it creates real problems for patients and families who are waiting.
More ambulances on duty would give us the flexibility to handle both emergency and non-emergency needs without constantly choosing between them.
Question: Why can’t you just bill insurance companies to cover the costs?
Answer: We do bill insurance when we transport a patient. But insurance rarely covers the full cost of our care, leaving a significant gap.
Medicare, for example, may pay $600 to $1,000 for a transport that costs us $2,000 or more. Unlike hospitals, we are not allowed to bill separately for each medication or treatment we provide. Whether we use 3 medications or 20, we get paid the same flat rate. But our actual costs vary dramatically depending on each patient’s needs.
Ambulances respond to fire scenes to ensure our firefighters receive immediate care if needed. We respond to assist law enforcement during operations suspected to pose an increased risk of officer injury. We have ambulances standing by at school sporting events to be there for the children of St. Francois County if they are injured. We are not reimbursed for this, but it is an essential part of being a partner in our community.
We also do not bill for calls where we respond and assess a patient but do not transport them. We still had a crew, a vehicle, and supplies deployed, but no reimbursement.
And many patients don’t have insurance at all. We respond to every 911 call regardless of a person’s ability to pay. The sales tax fills the gap between what insurance pays and what it actually costs to provide care for everyone.
Question: Don’t you already have money in reserves? Why ask for more?
Answer: Yes, we maintain reserves, and our auditors direct us to do so. Here’s why that matters.
Our operating expenses in 2025 were $13,787,031. Our auditors recommend that emergency services maintain 12 months of operating reserves. Right now, we have about 8 months. We’re actually below the recommended level.
Those reserves exist to protect our ability to serve the community in the event of unexpected disruptions to our funding. Events such as a tornado, an earthquake, another pandemic, or a prolonged government shutdown. These are not hypothetical scenarios for emergency services.
They are real risks we have to plan for.
Beyond that, we have major known expenses coming. Our cardiac monitors need to be replaced next year at a cost of $1.5 million. We have 8 ambulances that will need to be replaced in 2027 and 2028. Our board plans ahead for these costs because that’s how we’ve responsibly managed your investment for 20 years.
Spending down reserves to fund temporary service improvements would give the community a few years of better service, followed by a financial crisis and forced service cuts, leaving no cushion. Our community deserves a sustainable, long-term solution. That’s what the Ambulance Growth Proposition is designed to provide.
Question: Does this affect my property tax?
Answer: No. This is a sales tax, not a property tax. It has no effect on what you pay for your home or land. St. Francois County Ambulance District does not collect any income from property taxes.
Question: Are there items that are exempt from the sales tax?
Answer: Yes. Many everyday purchases are exempt from this sales tax. Those exemptions include utilities, fuel for your vehicle, prescriptions, and many hygiene products.
Question: What happens if this doesn’t pass?
Answer: We will still be here. We will still answer every 911 call. We are not going anywhere.
But here’s the honest reality: response times will continue rising as call volume grows. There will be more moments when every ambulance is already on a call, and someone has to wait longer. We won’t be able to add satellite stations for residents in rural areas who currently wait the longest. We won’t be able to provide advanced care capabilities, such as blood products for trauma patients and portable ultrasound, that neighboring counties already offer.
We don’t want that for our community. But we want you to have the full picture.
Question: Do neighboring counties already carry blood products and ultrasound machines?
Answer: Yes. Some of them do. There are EMS agencies in our region that already carry blood products for trauma patients and use portable ultrasound in the field. These are not experimental ideas. They are proven, life-saving tools that are becoming standard across modern EMS.
Yes, our paramedics can train and use these tools. What we lack is the funding to equip our ambulances with them. The St. Francois County Ambulance Growth Proposition would allow us to close that gap and provide our community with the same level of care that’s already available in other parts of Missouri.
Question: What is the Mobile Integrated Healthcare program, and is that part of this?
Answer: Our Mobile Integrated Healthcare (MIH) program is a program in which community paramedics visit patients at home to help manage ongoing health conditions such as diabetes, heart disease, and breathing problems. The goal is to help people stay healthy at home and avoid repeated hospital visits or 911 calls.
In 2025, our MIH team cared for over 700 patients and handled approximately 1,700 responses. It’s working!
The challenge is that MIH is currently 100% funded by grants we have to compete for every year. That’s not a stable foundation. Sustainable funding would allow us to maintain and potentially grow this program and serve more people who need help staying healthy at home.