INDEPENDENT ANALYSIS — NOT OFFICIAL.  This document is not produced by, sponsored by, endorsed by, or affiliated with the City of St. Louis, the St. Louis Fire Department, IAFF Local 73, the STLFD Division of EMS, or any city agency or labor organization.  All figures are derived from publicly available city budget documents, annual reports, and cited published sources.  Revenue estimates are planning figures, not audited results.  Tax yield projections are policy proxies only — not official revenue forecasts.
2023
Independent analysis — not official. Not produced by, sponsored by, or affiliated with the City of St. Louis, STLFD, IAFF Local 73, the Division of EMS, or any city agency or labor organization. Figures derived from publicly available city budget documents, annual reports, and cited sources. Revenue estimates are planning figures, not audited results.

EMS · Fire · Police · Pay disparity report

Same
emergency.
Different
paycheck.

City paramedics handle tens of thousands of life-critical calls each year — yet they earn up to $20,000 less than entry-level police officers and are dramatically undercut by every regional competitor.

Call volume — calendar year 2023

97,752

Total department responses

80,000

EMS calls for service citywide

41,000

City medic unit responses

28%

Diverted to private EMS

City EMS absorbs 41,000 medic calls/year across just 8–12 units (depending on staffing). Nearly 1 in 3 EMS calls is already being handed off to private providers — a symptom of under-resourcing the primary service.

Entry-level compensation — city roles

Police Fire EMS / Dispatch
Police officer entry-level$60,000
Firefighter entry-level$53,000
Paramedic crew chief supervisory$56,000
Paramedic entry-level$52,000
Dispatcher$48,000
EMT entry-level$40,000

Sources: City pay schedule (entry-level roles) · Calendar Year 2023 Company Run Totals. Private EMS diversion rate estimated at 28% of ~80,000 total EMS calls for service.

Slide 1 of 9  ·  Topic 1: The Pay Disparity
2023
Independent analysis — not official. Not produced by, sponsored by, or affiliated with the City of St. Louis, STLFD, IAFF Local 73, the Division of EMS, or any city agency or labor organization. Figures derived from publicly available city budget documents, annual reports, and cited sources. Revenue estimates are planning figures, not audited results.

EMS · Fire · Police · Pay disparity report

Same
emergency.
Different
paycheck.

City paramedics handle tens of thousands of life-critical calls each year — yet they earn up to $20,000 less than entry-level police officers and are dramatically undercut by every regional competitor.

What the regional market pays paramedics

Mehlville FPD

$69–99k

Critical care paramedic, entry → 4 yr. +$7k with CCP-C/FP-C cert.

+$17k–$47k vs city

Christian EMS

$60–80k

Paramedic, based on shift and unit assignment.

+$8k–$28k vs city

SCCAD — St. Charles Co.

$84,756

Surge Division paramedic, year one. 4-year step program above this.

+$32k vs city entry
A city paramedic starts at $52,000. St. Charles County pays the same credential $84,756 on day one — a 63% premium, before benefits or overtime. These agencies recruit from the same labor pool. The talent will follow the money.

Sources: City pay schedule · Mehlville FPD posted compensation · Christian EMS recruitment data · St. Charles County Ambulance District (SCCAD) Surge Division announcement.

Slide 2 of 9  ·  Topic 1: The Pay Disparity
FY24
Independent analysis — not official. Not produced by, sponsored by, or affiliated with the City of St. Louis, STLFD, IAFF Local 73, the Division of EMS, or any city agency or labor organization. Figures derived from publicly available city budget documents, annual reports, and cited sources. Revenue estimates are planning figures, not audited results.

Workload · Training · Equipment · Staffing crisis

Running
on
empty.

City EMS carries the heaviest clinical burden in the region — with the least training support, the least equipment authority, and a staffing model that buckles the moment a truck breaks down.

FY24 EMS call volume — where 80,633 dispatches go

80,633

220.9/day total dispatches

Total EMS calls for service citywide

22,718

28.2% of all dispatches

Initially assigned to private EMS — STLFD unavailable

41,393

113.4/day · 51.3% of dispatches

STLFD patient encounters — assessment, treatment, care

29,719

81.4/day · 71.8% of encounters

Transported by STLFD — 60+ min committed per transport

Of 80,633 total dispatches, 22,718 went to private EMS — leaving 57,915 calls STLFD actually ran (158.7/day). Of those, 41,393 were patient encounters and 29,719 required transport, each averaging 60+ minutes of committed crew time. At full staffing (12 units) that's 13.2 STLFD calls/unit/day. Short-staffed at 7 units: 22.7/unit/day — every one a patient contact with no mutual aid to call.

Daily call-load — STLFD medic unit responses vs. fire company responses

Busy Medic Unit Day short-staffed · 7 units · 57,915 ÷ 365 ÷ 722.7
Avg Medic Unit Day normal ops · 10–11 units · 57,915 ÷ 365 ÷ 10–11 · 29,719 of those transport14–16
Full staffing · 12 units · 57,915 ÷ 365 ÷ 12 · best case13.2
Busy Fire Company E-02 · 5,075 total responses/yr · fires, auto-aid, alarms, assists, medical13.9
Avg Fire Company 40-company avg · 2,486 responses/yr · all types combined6.8
Less-Busy Fire Company T-22 · 1,258 total responses/yr · all types combined3.5
Base: 80,633 total dispatches − 22,718 to private = 57,915 calls STLFD actually ran (158.7/day). At full staffing (12 units) that's 13.2 calls/unit/day. At typical staffing (10–11 units), 14–16/day. Short-staffed at 7 units: 22.7/day — every one a patient contact. The busiest fire company in the system runs 13.9 responses/day of all types combined, including false alarms, auto-aid standbys, and service calls. Not all fire responses are patient contacts. Every EMS call is.

Fire company total response load — CY2023 (all call types)

Less-Busy Fire Companies

3.5–5.5

total responses/day · T-22 (1,258/yr) through E-31 (1,779/yr)

Lowest-volume companies in the system. Responses include all types — fires, auto-aid, medical assists, service calls, false alarms. Not all are patient contacts.

Avg Fire Company

6.81

total responses/day · 99,424 ÷ 40 companies ÷ 365

System average across all 40 companies — engines, trucks, hook & ladders, rescue, and battalion units. 2,486 responses/company/year across all call types combined.

Busy Fire Companies

11–14

total responses/day · E-29 (11.0), T-27 (11.6), E-28 (11.7), E-02 (13.9)

Highest-volume companies. E-02 leads at 5,075/yr = 13.9/day — still mixed types. Not all calls require patient contact or transport.

Sources: STLFD FY24 Annual Report · FY24 AOP · CY2023 Company Run Totals.

Slide 3 of 9  ·  Topic 2: The Workload
FY24
Independent analysis — not official. Not produced by, sponsored by, or affiliated with the City of St. Louis, STLFD, IAFF Local 73, the Division of EMS, or any city agency or labor organization. Figures derived from publicly available city budget documents, annual reports, and cited sources. Revenue estimates are planning figures, not audited results.

Workload · Training · Equipment · Staffing crisis

Running
on
empty.

City EMS carries the heaviest clinical burden in the region — with the least training support, the least equipment authority, and a staffing model that buckles the moment a truck breaks down.

Revenue lost to private EMS — FY24 estimates

$2.79M

direct EMS billing lost annually

~11,272 foregone transports × $247/transport avg realized rate (FY24 AOP)

$2.11M

GEMT reimbursement at risk

Proportional share of $7.5M FY24 GEMT budget exposed by 28.2% private diversion rate

$4.90M

combined annual revenue exposure

Direct billing + GEMT — conservative planning estimate, not audited cash loss

6 yrs

since billing rates last updated

Fee schedule is stale — volume leakage compounded by pricing lag on retained calls

EMS generates approximately $17.39 million in identifiable EMS-linked revenue (direct billing + GEMT). Only $12.06 million is appropriated directly to EMS operations and billing programs. The $5.32 million difference is currently paying for shared departmental obligations — radios, breathing apparatus debt, department-wide salary support. EMS is not necessarily being robbed of $5.3M. But EMS-generated revenue is being used to support broader departmental obligations while EMS itself remains under-resourced, underpaid relative to the regional market, and reliant on private providers to absorb more than one-quarter of city EMS demand. That is a question the city's own budget documents cannot answer away.

The math that breaks the system

8,640

12 units × 720 min shift

Total crew-minutes available per shift at full staffing

4,884

81.4 transports × 60 min avg

Minutes committed to transport alone — before hospital offload wait

94%

transport + offload at max wait

Shift capacity consumed when hospital offload averages 40 min

67%

paramedic positions vacant — FY24

24 hires, 24 departures in 2023. Net staffing gain: zero.

At 12 fully staffed units, transport and hospital wait time can consume up to 94% of all available crew-minutes per shift. Any breakdown, any call-out, and the system crosses into NUA territory — not occasionally, but routinely. When EMS goes NUA, fire engines are dispatched to medical calls and held on scene. That engine is now unavailable for a simultaneous structure fire. EMS understaffing degrades fire coverage system-wide.

Sources: STLFD FY24 Annual Report · FY24 AOP (EMS Billing, GEMT programs). Revenue estimates are planning figures; not audited cash-loss figures.

Slide 4 of 9  ·  Topic 2: The Workload
FY24
Independent analysis — not official. Not produced by, sponsored by, or affiliated with the City of St. Louis, STLFD, IAFF Local 73, the Division of EMS, or any city agency or labor organization. Figures derived from publicly available city budget documents, annual reports, and cited sources. Revenue estimates are planning figures, not audited results.

Workload · Training · Equipment · Staffing crisis

Running
on
empty.

City EMS carries the heaviest clinical burden in the region — with the least training support, the least equipment authority, and a staffing model that buckles the moment a truck breaks down.

What it takes to get the job — training investment

EMT Certification

3–6 mo

Self-funded. No tuition reimbursement at hire.

Covers anatomy, airway, hemorrhage control, splinting, basic pharmacology. Must pass NREMT written + skills exam. CE hours required for recertification every 2 years — also on employee's dime.

Paramedic Certification

12+ mo

Self-funded. 500+ hours unpaid clinicals.

Full-year didactic + hospital and field clinicals before licensure. Advanced airway, cardiac, pharmacology, 12-lead, OB, pediatrics, toxicology. Must pass NREMT-P. No pay during clinicals.

Firefighter — Combined Track

18–24 wk

Fully employer-funded. Paid on city salary throughout.

EMT + Fire Suppression + HazMat bundled into one paid academy. No out-of-pocket cost. EMS component = BLS only — no IV, no meds beyond Narcan, no advanced airway.

A paramedic candidate spends 12+ months and thousands of dollars out of pocket before their first city paycheck — then earns 15.5% less per hour than a firefighter who completed a fully paid, employer-funded academy. EMS has no dedicated public-safety pay schedule. Fire and Police do. The clinical burden is inverted. The investment is inverted. The pay structure is inverted.

Sources: STLFD FY24 Annual Report · FY24 AOP · City Ordinance 71963 (pay schedules) · NREMT certification standards · Missouri DHSS EMS licensure requirements. Paramedic vacancy rate per FY24 annual report (67.27%).

Slide 5 of 9  ·  Topic 2: The Workload
03
Independent analysis — not official. Not produced by, sponsored by, or affiliated with the City of St. Louis, STLFD, IAFF Local 73, the Division of EMS, or any city agency or labor organization. Figures derived from publicly available city budget documents, annual reports, and cited sources. Revenue estimates are planning figures, not audited results.

System capacity · Deployment · The path forward

Not a
staffing
problem.

The system was already operating beyond capacity before any vacancy existed. Independent consultants identified it. Annual reports confirmed it. The city kept 12 trucks anyway. This is not a staffing problem. It is a deployment decision — and it has consequences.

Independent findings — ICMA consultant study

12

ambulances at time of study

Units in service when ICMA concluded resources were insufficient for demand

18

ICMA minimum recommendation

Consultant-recommended floor to address frequent NUA events and meet demand

+50%

increase recommended · never implemented

The recommendation was made before current call volumes and staffing crises

↑

demand has grown since study

80,633 EMS calls/yr today. The gap between capacity and demand has widened.

The ICMA study found the system was already at capacity — before today's call volumes, before today's hospital offload delays. The problem predates every current employee. It was identified, documented, and recommended against. The recommendation was not implemented. Every year since, demand has increased and the authorized fleet has not. This is a policy outcome, not a personnel outcome.

Unit Hour Utilization — industry benchmarks vs. STLFD peak-hour reality

Outer bar = total STLFD responses (57,915 · excl. private)  ·  Inner bar = transport-only committed time  ·  Peak-hour model: 65% of calls in 12-hr shift window

Healthy — reserve capacity  30–50% · units available for next call50%
Busy but manageable  50–60% · high-demand urban system60%
Significant strain / NUA frequent  70–80%80%
Unsustainable  80%+ · industry consensus threshold · NUA inevitable80%+
12 units — full staffing  annual avg · 57,915 total responses · 29,719 transports39.4% total  /  28.3% transport

Annual avg. Hospital offload (+30 min avg) raises total UHU to ~53.6%.

12 units — peak hours  65% of calls in 12-hr window · with avg hospital offload delay69.7% total  /  36.8% transport

At this utilization NUA begins occurring.

10 units — typical real-world staffing  peak hours · with hospital offload83.6% total  /  44.1% transport

Exceeds the 80% unsustainable threshold. NUA events are frequent and predictable.

7 units — short-staffed day  peak hours · with hospital offload>100% total  /  63% transport

119% UHU. Demand exceeds available time. NUA is a certainty. Engines dispatched to EMS calls. Fire coverage degrades simultaneously.

Annual averages understate the problem. Calls concentrate in peak hours — the system regularly operates at 70–84% UHU during normal shifts and exceeds 100% on short-staffed days. At >80% UHU, reserve capacity is gone. NUA is not a malfunction. It is arithmetic. And the math is happening every day.

Sources: STLFD FY24 Annual Report · ICMA independent EMS consultant study · UHU benchmarks per NAEMSP and ACEP position statements.

Slide 6 of 9  ·  Topic 3: System Capacity
03
Independent analysis — not official. Not produced by, sponsored by, or affiliated with the City of St. Louis, STLFD, IAFF Local 73, the Division of EMS, or any city agency or labor organization. Figures derived from publicly available city budget documents, annual reports, and cited sources. Revenue estimates are planning figures, not audited results.

System capacity · Deployment · The path forward

Not a
staffing
problem.

The system was already operating beyond capacity before any vacancy existed. Independent consultants identified it. Annual reports confirmed it. The city kept 12 trucks anyway.

Deployment targets — what the workload actually requires

Current / baseline

12

The authorized ceiling — not a floor. The city set 12 as the deployment model and kept it there through a decade of rising call volume, an independent consultant recommendation against it, and documented NUA events.

Insufficient · pre-identified

ICMA minimum · immediate target

18

Consultant-recommended minimum. Would reduce NUA frequency, provide limited surge capacity, and begin recapturing private diversion volume.

+6 units · minimum fix

Recommended operational goal

24

Aligns with accepted UHU benchmarks. Provides reserve capacity during peak hours. Positions city to absorb private diversion workload and stabilize response times.

+12 units · operationally sound
A 24-ambulance system requires roughly 192 field personnel at minimum. The city's authorized deployment model constrains the fleet well below that — not because qualified personnel don't exist, but because the number of trucks has been held artificially at 12. You cannot staff your way to adequacy if the deployment model won't authorize the units.

What turnover actually costs — institutional knowledge, not headcount

3.1

implied avg years before a paramedic leaves

At 31.8% annual turnover. The national all-paid EMS baseline implies 9.8 years. STLFD runs at less than a third of that.

~7

paramedic seats turning over per year

One paramedic position cycles roughly every 7 weeks. Each departure resets that seat's field experience to zero.

6.9

years — local government median tenure (BLS 2022)

What a stable public-sector workforce looks like. STLFD paramedic tenure runs less than half that benchmark.

0

net paramedic gain · FY23 · 24 in, 24 out

The city is running to stand still. Every hire offsets a departure — none of it adds capacity.

A paramedic with 3 years of field experience carries pattern recognition built from thousands of patient contacts. When that paramedic leaves at year three — predictably, because the math says they will — that knowledge does not transfer. It resets. The replacement starts at zero. The workload does not.

An under-resourced system that runs paramedics into the ground will always have high turnover. High turnover guarantees a perpetually junior workforce. It is the direct, predictable consequence of choosing to field 12 trucks for a city that needs 24.

The financial case · The question that has already been answered

$2.79M

direct EMS billing lost annually

~11,272 foregone transports at $247/transport avg realized rate (FY24 AOP)

$2.4M

overtime cost of maintaining 12 trucks

FY24 AOP overtime increase — the cost of forcing an understaffed system to hold a floor that was already inadequate

$5.32M

EMS revenue above EMS-specific appropriations

$17.39M generated vs. $12.06M appropriated to EMS. Difference funds shared dept. obligations — not a clean surplus, but a hard question.

$4.9M

combined billing + GEMT exposure

The city is losing more in revenue than it costs in overtime to maintain the inadequate model.

Reducing NUA events, improving response times, recapturing $4.9M in annual revenue, reducing private EMS dependence, and reducing per-crew workload are not separate problems. They are all downstream consequences of one decision: authorizing 12 ambulances for a city generating 80,000+ EMS calls per year. The consultants gave the city a number more than a decade ago. The workload has grown since then. The fleet has not. That is a policy choice — and policy choices can be changed.

Sources: STLFD FY24 Annual Report · FY24 AOP · ICMA study · AAA 2022 Workforce Report · Patterson et al. (2010) · BLS median tenure data. Revenue figures are planning estimates; not audited cash-loss figures.

Slide 7 of 9  ·  Topic 3: System Capacity
04
Independent analysis — not official. Not produced by, sponsored by, or affiliated with the City of St. Louis, STLFD, IAFF Local 73, the Division of EMS, or any city agency or labor organization. Figures derived from publicly available city budget documents, annual reports, and cited sources. Revenue estimates are planning figures, not audited results.

Funding · Policy · Call to action

The money
is already
there.

St. Louis does not need to find new money from scratch. It needs to stop losing EMS revenue, stop treating EMS pay as a generic city-pay problem, and authorize a deployment model that reflects the workload the city already carries.

The cost of fixing this — base line pay only, four-platoon model

Current baseline

12 trucks

48 EMTs + 48 paramedics at current city rates. $4.32M direct line pay. Does not meet ICMA minimum. Documented as inadequate.

$40k EMT · $52k paramedic

Stabilization — stop the bleeding

16 trucks

64 EMTs + 64 paramedics. Base pay at fair-pay floor: $7.87M. Increase over baseline: $3.46M. Attacks turnover. Does not fully solve NUA.

$53k EMT · $70k paramedic floor

Control your core — own the city

20 trucks

80 EMTs + 80 paramedics. Base pay at fair-pay floor: $9.84M. Increase over baseline: $5.42M. Near-term "own more of your city" model.

$53k EMT · $70k paramedic floor

24

operationally sound target

96 EMTs + 96 paramedics. Aligns with UHU benchmarks. Reserve capacity during peak demand.

$11.8M

base line pay at fair-pay floor · 24 trucks

$53k EMT / $70k paramedic. Base pay only — does not include benefits, pension, fleet, or overhead.

$7.4M

increase over 12-truck / current-pay baseline

The gap between where the city is and where it needs to be.

$4.9M

EMS revenue currently lost to private diversion

Revenue recapture alone nearly closes the gap to a 20-truck fair-pay system.

A 20-truck system at fair-pay rates requires about $5.4 million more in direct line pay than the 12-truck/current-pay model. The city's own analysis shows $4.9 million in EMS revenue currently leaving the system through private diversion and GEMT exposure. The revenue to fund most of the fix is already being generated — it is just not being kept.

Four layers of funding — in order of priority

1

Recapture EMS revenue already leaving the system ~$4.9M annual exposure

Ring-fence EMS billing and GEMT for EMS-first uses: staffing, fleet readiness, training, deployment. Stop the leak before adding new sources.

2

EMS-only pay matrix structural fix, not a one-time raise

City employees got 3% in FY26. Uniformed police and fire got 7%. EMS stays on the general schedule — every public-safety-specific adjustment widens the gap again. An EMS-only matrix sets parity floors and moves paramedics into the local municipal market band ($60k–$84k).

3

Dedicated recurring tax tool the city already has the model

Prop P generates $16.7M/year for police. A ⅛-cent dedicated EMS sales tax would likely yield $4M–$5.25M/year. A ¼-cent option: $8M–$10.5M/year. St. Louis already has proof of concept. Proxy estimates — refine with Budget Division before legislation.

4

One-time money — startup and transition only not for permanent payroll

City holds $153.6M in unrestricted reserves. Rams settlement: $280M+ with $20M+ interest. ARPA interest: $22.1M. Use for ambulances, equipment, academy expansion, billing modernization only. One-time money cannot be the salary plan.

The first money is EMS money. The second money is structural pay protection. The third money is tax money. The last money is one-time transition capital. The policy tools exist. The sequence is clear.

Sources: STLFD FY24 Annual Report · FY26 City of St. Louis Budget · FY24 AOP. Pay scenario cost tables derived from supplied staffing model. Tax yield estimates are policy proxies — not official revenue forecasts.

Slide 8 of 9  ·  Topic 4: Call to Action
04
Independent analysis — not official. Not produced by, sponsored by, or affiliated with the City of St. Louis, STLFD, IAFF Local 73, the Division of EMS, or any city agency or labor organization. Figures derived from publicly available city budget documents, annual reports, and cited sources. Revenue estimates are planning figures, not audited results.

Funding · Policy · Call to action

The money
is already
there.

St. Louis does not need to find new money from scratch. It needs to stop losing EMS revenue, stop treating EMS pay as a generic city-pay problem, and authorize a deployment model that reflects the workload the city already carries.

Three credible paths — pick a lane

Scenario A · Stabilization

16 ambulances
+ EMS pay matrix

Fund via: retained direct billing + GEMT ring-fenced for EMS + billing rate modernization. Minimum credible step to stop being a training ground for competing agencies.

Attacks turnover engine

Scenario B · Control your core

20 ambulances
+ EMS pay matrix

Fund via: EMS revenue recapture + ring-fenced GEMT + modest dedicated EMS tax. Most plausible near-term model. Materially reduces private dependence.

Owns more of the city's volume

Scenario C · Progressive self-reliance

24 ambulances
+ EMS pay matrix

Fund via: EMS billing + GEMT first, then ⅛-cent dedicated EMS sales tax, then one-time capital for startup only.

Aligns with UHU benchmarks

EMS Stabilization Ordinance — five things at once

Action 1

Create an EMS-only pay matrix

Remove EMS from the general city schedule. Establish public-safety parity floors. Move paramedic entry pay into the local municipal market band. Add differentials for field training, precepting, lead medic, and advanced credentials.

Action 2

Ring-fence EMS billing and GEMT

Formally prohibit using EMS-generated revenue to balance unrelated priorities before EMS is stabilized. EMS billing and GEMT go to EMS first: staffing, fleet readiness, training, and deployment.

Action 3

Authorize phased fleet expansion

Authorize 20 ambulances immediately and 24 ambulances as the funded operating goal. Do not wait for 100% fill before ordering trucks. Ambulances on hand create deployment options. Twelve do not.

Action 4

Assign one-time money correctly

Use reserves and Rams settlement funds for capital only: ambulances, equipment, academy expansion, billing modernization. Do not use one-time money for recurring salary.

Action 5

Place a dedicated EMS revenue option before voters

St. Louis already has proof of concept with Prop P at $16.7M/year for police compensation. A ⅛-cent EMS tax would yield an estimated $4M–$5.25M/year — paired with revenue recapture, likely the first combination that makes 24 trucks at fair-pay sustainable on a recurring basis. Every one of these steps is more defensible than continuing to fund the consequences of failure through overtime, private diversion, and churn.

This has to be personal. Because the risk is personal.

St. Louis has already seen what delayed ambulance availability looks like. A fire truck arrives. Care starts. But transport does not.

The next time that happens, it will not matter whether the patient is an abstraction in a budget debate. It could be your mother on a kitchen floor. Your child in respiratory failure. Your spouse after a crash. Your neighbor in cardiac arrest.

Lawmakers are already spending money on this problem — in overtime, in private diversion, in stale rate structures, in churn. The only choice left is whether to spend it before the next delay, or after another family learns what "no unit available" means the hard way.

The tools exist. The sequence is documented. The number is known. Authorize the trucks.

Sources: STLFD FY24 Annual Report · FY26 City of St. Louis Budget · FY24 AOP · City Ordinance 71963 · ICMA study · AAA 2022 Workforce Report · EMS1/Post-Dispatch reporting. Tax yield estimates are policy proxies — not official revenue forecasts. SCCAD litigation detail unresolved — do not cite without case caption.

Slide 9 of 9  ·  Topic 4: Call to Action