COMMITTEE ON LEGISLATIVE RESEARCH
OVERSIGHT DIVISION
FISCAL NOTE
L.R. No.:0979S.01I Bill No.:SB 166 Subject:Education, Elementary and Secondary; Emergencies; Health, Public Type:Original Date:February 16, 2025Bill Summary:This proposal requires public schools to develop cardiac emergency response
plans.
FISCAL SUMMARY
ESTIMATED NET EFFECT ON GENERAL REVENUE FUNDFUND AFFECTEDFY 2026FY 2027FY 2028Total Estimated Net
Effect on General
Revenue $0$0$0
ESTIMATED NET EFFECT ON OTHER STATE FUNDSFUND AFFECTEDFY 2026FY 2027FY 2028Total Estimated Net
Effect on Other State
Funds $0$0$0
Numbers within parentheses: () indicate costs or losses. L.R. No. 0979S.01I
Bill No. SB 166
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ESTIMATED NET EFFECT ON FEDERAL FUNDSFUND AFFECTEDFY 2026FY 2027FY 2028Total Estimated Net
Effect on All Federal
Funds $0$0$0
ESTIMATED NET EFFECT ON FULL TIME EQUIVALENT (FTE)FUND AFFECTEDFY 2026FY 2027FY 2028Total Estimated Net
Effect on FTE 000
☐ Estimated Net Effect (expenditures or reduced revenues) expected to exceed $250,000 in any
of the three fiscal years after implementation of the act or at full implementation of the act.
☐ Estimated Net Effect (savings or increased revenues) expected to exceed $250,000 in any of
the three fiscal years after implementation of the act or at full implementation of the act.
ESTIMATED NET EFFECT ON LOCAL FUNDSFUND AFFECTEDFY 2026FY 2027FY 2028
Local Government(Unknown)
(Unknown, Could
exceed $1,204,000)(Unknown)
*Costs to school districts for the establishment of cardiac emergency response teams and the
placement of automated external defibrillators (AEDs) throughout the school campuses. L.R. No. 0979S.01I
Bill No. SB 166
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February 16, 2025
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FISCAL ANALYSIS
ASSUMPTION
Section 160.482 Cardiac Emergency Response Plans
Officials from the Department of Elementary and Secondary Education assume the proposal
will have no fiscal impact on their organization. Oversight does not have any information to the
contrary. Therefore, Oversight will reflect a zero impact in the fiscal note.
Officials from the Kansas City Police Department and St. Louis County Police Department
both assume the proposal will have no fiscal impact on their organizations. Oversight
have any information to the contrary. Therefore, Oversight will reflect a zero impact in the fiscal
note.
Officials from the Phelps Count Sheriff assume the proposal will have no fiscal impact on their
organization. Oversight does not have any information to the contrary. Therefore, Oversight will
reflect a zero impact in the fiscal note.
Oversight notes the proposal specifies certain guidelines that a cardiac emergency response plan
shall integrate, including the establishment of a cardiac emergency response team and the
placement of automated external defibrillators (AEDs) throughout the school campus. Based on
a brief review, AEDs range in cost from $1,000 to $3,000. Oversight assumes if 50% of the
2,408 public school buildings installed AEDS, the cost is estimated at $1,204,000 using the
lower end of the price range ($1,000 * 1,204). Oversight will show a cost that could exceed
$1,204,000 to install AEDs in FY 2027. This amount does not include costs for maintenance,
accessories, or staff training.
Regular maintenance costs, including those for replacing batteries, pads, and other supplies as
required are difficult to determine and will vary by device and manufacturer specifications.
Therefore, Oversight will reflect an unknown cost in FY 28 to replace, maintain or repair AEDs
to the school districts on the fiscal note.
This proposal also requires the appropriate school personnel shall be certified in first aid, CPR,
and AED use that follow evidence-based guidelines set forth by the American Heart Association
or nationally recognized guidelines focused on emergency cardiovascular care. AED training is
often provided simultaneously with cardiopulmonary resuscitation (CPR) training. Their costs
vary depending on the provider and method of delivery. However, public school employee
training costs will vary depending on the implementation decisions and training arrangements
school districts make and the number of additional staff that need the training. Therefore,
Oversight will show an unknown cost for staff training beginning in FY 2026. L.R. No. 0979S.01I
Bill No. SB 166
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Oversight did not receive any responses from school districts related to the fiscal impact of this
proposal. Oversight has presented this fiscal note on the best current information available. Upon
the receipt of additional responses, Oversight will review to determine if an updated fiscal note
should be prepared and seek the necessary approval to publish a new fiscal note. Oversight only
reflects the responses received from state agencies and political subdivisions; however, school
districts were requested to respond to this proposed legislation but did not. A listing of political
subdivisions included in the Missouri Legislative Information System (MOLIS) database is
available upon request.
FISCAL IMPACT – State GovernmentFY 2026
(10 Mo.)
FY 2027FY 2028$0$0$0FISCAL IMPACT – Local GovernmentFY 2026
(10 Mo.)
FY 2027FY 2028PUBLIC SCHOOLSCosts - to install AEDs in public
schools - §160.482.4(3)
$0
(Unknown,
Could exceed
$1,204,000) $0
Costs – AED maintenance and repairs -
§160.482.4(3)$0$0(Unknown)
Costs – First aid, CPR, AED training -
§160.482.6(Unknown)(Unknown)(Unknown)ESTIMATED NET EFFECT ON
PUBLIC SCHOOLS(Unknown)
(Unknown,
Could exceed
$1,204,000) (Unknown)
FISCAL IMPACT – Small Business
No direct fiscal impact to small businesses would be expected as a result of this proposal. L.R. No. 0979S.01I
Bill No. SB 166
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FISCAL DESCRIPTION
For the 2026-27 school year and all subsequent school years, this act requires every public
school to develop and implement a cardiac emergency response plan that addresses the
appropriate use of school personnel to respond to incidents involving an individual experiencing
sudden cardiac arrest or a similar life-threatening emergency while on a school campus.
Members of each public school's administration shall coordinate with local emergency services
providers to integrate the public school's cardiac emergency response plan into the local
emergency services providers' protocols. A cardiac emergency response plan shall integrate
evidence-based core elements, such as those recommended by the American Heart Association
guidelines, Project ADAM (Automated Defibrillators in Adam's Memory), or another set of
nationally recognized, evidence-based standards or core elements.
The act outlines certain guidelines that a cardiac emergency response plan shall integrate,
including the establishment of a cardiac emergency response team and the placement of
automated external defibrillators (AEDs) throughout the school campus. Appropriate AED
placement shall be dictated by the cardiac emergency response plan and in accordance with
guidelines set by the American Heart Association or nationally recognized guidelines focused on
emergency cardiovascular care.
For schools with an athletic department or organized school athletic program, an AED shall be
clearly marked and easily accessible in an unlocked location at each athletic venue and event.
The AED shall be accessible during the school day and any school-sponsored athletic event or
team practice.
Appropriate school personnel shall be certified in first aid, CPR, and AED use, as provided in the
act. The school personnel required to be trained shall be determined by the cardiac emergency
response plan and shall include, but shall not be limited to, athletic coaches, school nurses, and
athletic trainers.
This legislation is not federally mandated, would not duplicate any other program and would not
require additional capital improvements or rental space. L.R. No. 0979S.01I
Bill No. SB 166
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SOURCES OF INFORMATION
Department of Elementary and Secondary Education
Phelps County Sheriff’s Office
Kansas City Police Department
St. Louis County Police Department
Julie MorffJessica HarrisDirectorAssistant DirectorFebruary 16, 2025February 16, 2025