Chapter one is an extension report prepared for local level policy makers involved in the delivery of emergency medical services (EMS) in Hillsdale County, Michigan. The report originated out of a request, from officials to the Kellogg Leadershiop and Local Government Education Project, for aid with a public policy crisis in the delivery of ambulance services in Hillsdale County. It attempts to outline the public policy issues associated with ambulance delivery and to, in more detail, describe the organization of ambulance services in Hillsdale County. The report is meant to be a starting point for discussions between extension personnel and local leaders to address their questions and concerns about Hillsdale County ambulance delivery.