In 1985, under 190.015 RSMo, the residents of Ripley County Missouri voted in favor of officially forming Ripley County Ambulance District. The District is organized as a political subdivision under 190.010 RSMo. From 1985 until 2007 the District collaborated with various entities to provide ambulance services to the residents and visitors of Ripley County. April of 2007 brought major changes to the District as the Board of Director's voted to hire appropriate personnel to manage and staff the District's ambulances as a stand alone entity.
The District is comprised of the majority of Ripley County Missouri, except for the southeast corner which is operated by Naylor-Neelyville Ambulance District, located in Naylor, Missouri. The service is divided into six sub-districts, with each electing a citizen to serve on the Board of Directors for a period of three years. The terms are staggered so that only two positions are open for election each year. District board meetings are held on the third Monday of each month at 7:00 p.m. at the District's headquarters located at 1003 Walnut Street in Doniphan, Missouri.
The District's ambulance base is located in the City of Doniphan, which sits on the banks of the beautiful Current River, a popular attraction for locals and those visiting from surrounding areas. The District serves a population of 12,000 people, covering an area of 632 square miles. Normal operations are provided by two Advance Life Support Crews, 24 hours per day, with a third crew available as needed. These crews respond to an average of 1800 calls for assistance annually, with over 1400 patients being transported to nearby medical facilities in Poplar Bluff, Mo and Pocahontas, Ark.
In 2020, voters of the ambulance district overwhelmingly voted in a 1/2 cent sales tax to support the operations of the service. Under Missouri Statute 190.040.3, the ambulance district reduces property tax revenues by an amount equal to 50% of the amount of sales tax collected in the previous year.