Rural Emergency Medical Services Integration Guide is a guide for rural EMS considering collaboration and integration with other organizations. This document is a practical guide for ambulance services (agencies) to use in their pursuit of sustaining effective and efficient delivery of patient care and developing into an integrated system with other agencies. Integration is intended to provide and sustain improved patient care by capitalizing on efficiencies. It will provide insights into various means, which have been used by agencies within the industry to promote integration between agencies to the benefit of the agencies, the staff, and, most importantly, to the patients.