A proposal to strengthen emergency medical services for Millstadt and surrounding communities is finally being brought before St. Clair County voters on the March 17 ballot after over a year of ups and downs.

On the fairly quiet ballot for St. Clair County voters are three referendum items, one of which is a proposition for establishment of the Southwestern St. Clair County Emergency Services District.

The ballot item asks whether the Millstadt and Smithton fire protection districts as well as the St. Clair County portions of the Hecker and Waterloo fire protection districts should be organized as the aforementioned emergency services district, authorized to levy and collect property tax not to exceed 0.40 percent.

An overview of the proposal was recently posted on the Hecker Fire Department Facebook page, describing how establishment of this district would provide full-time EMS coverage to this area of St. Clair county via the staffing of two advanced life support ambulances – one in Millstadt and the other in Smithton.

The post further indicates that, though Millstadt EMS is currently funded via a portion of the Millstadt Fire District tax levy, the three other districts in the proposed emergency services district currently pay no taxes for current EMS services.

It additionally notes the Smithton Fire District and much of the Hecker Fire District are currently covered by Medstar EMS, which respond from the Freeburg and New Athens bases and can often find themselves stretched thin responding to other calls in their wide coverage areas.

The Republic-Times previously covered the ambulance district proposal last year as the charge has been led by the Millstadt Ambulance Service headed by EMS Chief Jennifer Goetz.

Early last year, she described how Millstadt EMS has come to cover a wide area beyond the village, handling calls for many unincorporated and rural areas outside Waterloo, Columbia, Dupo, Smithton and Belleville while also providing mutual aid for other nearby ambulance services.

She described then how the department’s service area had more than doubled since 2010. The department’s call volume has likewise increased, with 300 calls for service in 2013 compared to – per a Jan. 1 Millstadt Ambulance Service Facebook post – 773 in 2024 and 879 in 2025.

With this increase in coverage area, call volume and overall activity, the department’s resources have struggled to keep pace.

Goetz has spoken on several occasions about her department’s struggles to maintain new, up-to-date equipment and both attract and retain qualified personnel in recent years given the severely increased costs of both gear and labor.

As she has previously described how the department would benefit from being able to levy its own taxes, she particularly noted the good that could be done with an additional ambulance in Smithton.

“Smithton approached us, asking us to put an ambulance in their district because they don’t have a reliable service right now,” Goetz said. “With this vote, it will increase our tax money to be able to add another ambulance to put full-time in Smithton, it will continue to pay to have us here in Millstadt, full-time EMS unit 24-7, and be able to buy new trucks and things as our trucks are getting older, breaking down more.”

More recently, Goetz spoke about some of the work that’s gone into sharing information regarding the March 17 referendum, also voicing hopes for support from folks in the proposed district.

“We’re just trying to get everything out there, be completely open and honest and talk about how much we can improve our emergency response times and add to give Smithton what they need for emergency services,” Goetz said. “Everything is in line and ready to go. Our plan’s already been started. I’m hoping that this is going to pass the first time.”

She added the district will likely be pursued again in the future should the referendum fail to pass on this year’s ballot.

Goetz also reiterated her department’s struggles to keep up with demand, citing an even greater call volume so far in 2026 compared to this time in 2025.

“With the costs rising, everything rising, we’re just not gonna be sustainable at the 0.09 percent tax that we get right now,” Goetz said. “We’ve had a lot of increased call volume… Just this month alone, we were up 20 percent over last year, and it’s just continuing to grow.”

As previously reported, the journey to get this referendum on the ballot was something of a roller coaster all through last year.

Public talks about the proposal really began in late 2024 as it was noted the push had come too late to land a referendum on the 2025 ballot.

There was plenty of enthusiasm for the idea of an independent ambulance district, however, with the 2024 implementation of Illinois House Bill 4179 which offered the chance for such independent districts to set up successfully in New Baden and other communities in Clinton County.

The effort then hit a snag in the spring as it was realized the independent ambulance district would be unable to form given the existence of the fire protection district, Millstadt’s particular situation seemingly having not been addressed in the aforementioned legislation.

Momentum was restored just a few months later with the passage of Illinois House Bill 2142, which expressly allowed for the establishment of an EMS district within an existing fire protection district providing the fire district cease levying taxes for EMS and the ambulance service operates in the area within the fire district.

All through the process, Goetz emphasized the strain on the department, the support they’ve received from the community and their dedication to provide the care their coverage area needs.

“We are not-for-profit, we are not going to be for-profit,” Goetz said. “We will always be non-profit. Providing healthcare for these communities, that is our goal.”