Rules for Missouri Ambulance Districts

II. AD Powers and Duties

List of powers

By becoming a political subdivision, an AD receives many specific powers. (The statutes that outline these powers and duties are generally in RSMo. 190.060.) As authorized by the state, these powers are:

  1. To establish and maintain perpetually an ambulance service within its corporate limits, and to acquire for, develop, expand, extend and improve such service.
  2. To adopt a corporate seal and bylaws by ordinance. (190.055.1).
  3. To acquire land in fee simple, rights in land and easements upon, over or across land and leasehold interests in land and tangible and intangible personal property used or useful for the location, establishment, maintenance, development, expansion, extension or improvement of an ambulance service. The acquisition may be by dedication, purchase, gift, agreement, lease, use or adverse possession.
  4. To operate, maintain and manage the ambulance service, and to make and enter into contracts for the use, operation or management of and to provide rules and regulations for the operation, management or use of the ambulance service.
  5. To fix, charge and collect reasonable fees and compensation for the use of the ambulance service according to the rules and regulations prescribed by the board from time to time.
  6. To borrow money and to issue bonds, notes, certificates or other evidences of indebtedness for the purpose of accomplishing any of its corporate purposes, subject to compliance with any condition or limitation set forth in sections 190.001 to 190.090 or otherwise provided by the Constitution of the state of Missouri. This would presumably include the authority to refund and refinance authorized bonded indebtedness.
  7. To employ or enter into contracts for the employment of any person, firm or corporation, and for professional services, necessary or desirable for the accomplishment of the objects of the district or the proper administration, management, protection or control of its property.
  8. To maintain the ambulance service for the benefit of the inhabitants of the area comprising the district regardless of race, creed or color, and to adopt such reasonable rules and regulations as may be necessary to render the highest quality of emergency medical care; to exclude from the use of the ambulance service all persons who willfully disregard any of the rules and regulations so established; to extend the privileges and use of the ambulance service to persons residing outside the area of the district upon such terms and conditions as the board of directors prescribes by its rules and regulations. Care should be taken, however, to suspend service only in compliance with applicable federal and state statutes, especially the Americans With Disabilities Act.
  9. To provide for health, accident, disability and pension benefits for the salaried members of its organized ambulance district and such other benefits for the members’ spouses and minor children, through either, or both, a contributory or noncontributory plan. The type and amount of such benefits shall be determined by the board of directors of the ambulance district within the level of available revenue of the pension program and other available revenue of the district. If an employee contributory plan is adopted, then at least one voting member of the board of trustees shall be a member of the ambulance district elected by the contributing members. The board of trustees shall not be the same as the board of directors.
  10. To purchase insurance indemnifying the district and its employees, officers, volunteers and directors against liability in rendering services incidental to the furnishing of ambulance services. Purchase of insurance pursuant to this section is not intended to waive sovereign immunity, official immunity or the Missouri public duty doctrine defenses.
  11. To provide for life insurance, accident, sickness, health, disability, annuity, length of service, pension, retirement and other employee-type fringe benefits, subject to the provisions of section 70.615, for the volunteer members of any organized ambulance district and such other benefits for their spouses and eligible unemancipated children, either through a contributory or noncontributory plan, or both.
  12. To sue and be sued (190.010.2).
  13. To receive gifts of land, rights in land, easements, leasehold improvements, and intangible personal property to the AD (190.080).
  14. To pay court costs and election costs (115.63; 115.65; 115.77).
  15. To have governmental powers, and all other powers, incidental, necessary, convenient or desirable to carry out and effectuate the express powers (190.060.1).

Short-Term Debt

Board-approved notes payable

Long-Term Debt

Voter-approved bonds

ADs also can collect taxes within limitations (190.010.2) and by law can fix, charge and collect reasonable fees according to prescribed rules and regulations (See Service Fees in Chapter VIII. Property and Sales Taxes and Fees for more details.)

Joint powers

Like all political subdivisions, ADs also have power to cooperate or contract with other governmental units for joint powers such as authorization to buy surplus property of United States government (70.100); payment by the United States in lieu of taxes (70.170); centralized emergency dispatching system (70.225); LAGERS — the Missouri Local Government Employees’ Retirement System (70.605); contracts for mutual aid (MA) services (190.107); and required memorandums of understanding (MOUs) between an emergency response agency (EMRA) and an ambulance service (190.133.1[4]) and between a dispatch agency and an ambulance service (190.134).


Uses paramedics and/or Emergency Medical Technicians (EMTs) but does not transport patients


Although an AD does not prosecute violations of its ordinances, the county prosecutor, the attorney general or the AD’s legal officer or attorney (as an appointed special assistant prosecutor) has jurisdiction to prosecute anyone in violation of the ambulance statutes (190.001-190.245), including injunctive proceedings against violators, as a class B misdemeanor, which carries a maximum punishment up to a $500 fine and/or six months in jail (190.180).

  • Adopted following Sunshine Law procedures
  • In writing and identified as an ordinance
  • Without words such as “should” or “may”
  • Limited to adoption of the AD’s fiscal year, corporate seal and bylaws
  • Show in the minutes how each member voted
  • Signed by the Chair if passed by a board majority


Bylaws are adopted only once by an AD (190.055.1). A majority vote is required to adopt the AD’s original bylaws. Once adopted, changes or amendments to AD bylaws are usually subject to a two-thirds vote with notice at a previous meeting. Bylaws can never be suspended, so avoid including specifics such as meeting times, locations, etc., in the bylaws.

While the concepts of bylaws may be familiar to many people, to develop bylaws, an AD should consult with a Professional Registered Parliamentarian or with an attorney with experience in parliamentary or corporate law. Bylaws that are appropriate for a business corporation or social organization may be redundant for an AD due to the state constitution or statutes. Redundancy can be particularly confusing if the constitution and/or a statute, or their interpretation, is changed and the bylaws become in conflict with a constitutional or statutory change or interpretation.

An AD may want to consider using special rules of order or standing rules to minimize the content of its bylaws.