Many challenges face Emergency Medical Services (EMS) today, in particular the pre-hospital phase. Among these are a mal-distribution of providers by both number and level of training, delays in offloading patients at the hospital and ambulance diversion. In rural areas, these challenges are exacerbated by the nature of the pre-hospital care workforce, the barriers caused by time and distance, and the limitations of rural economics and available resources. Research in the pre-hospital phase has been limited and largely focused on specific clinical interventions rather than system design issues. Best practice models have not been well documented and/or replicated. For this project, WTI and the Critical Illness and Trauma Foundation (CIT) will partner in a multi-phase research effort to develop one or more model response systems for EMS in rural areas that meet the Institute of Medicine’s vision of systems that are “regionalized, coordinated and accountable” and which are, additionally, sustainable. The models will integrate principles of general systems theory, logistical design, economics, transportation and sociology. In Phase I, the team will develop the framework and methods for modeling EMS systems. Phase II will involve a table top exercise based on input variables from an actual region in Montana. Field test trials will follow phase I and II, contingent upon regional willingness and financial support. This project encompasses the tasks of Phase I.