Local area governments have experienced increasingly stringent budget constraints in recent years. Innovations in service delivery provide one avenue for increasing the effectiveness of resource allocations. This paper explores the potential savings available from regionalizing emergency medical service provision. A mixed integer programming model incorporating peak demand considerations is used to minimize service cost given a desired maximum response time. Changes in the weighted average response time measure the quality degradation required to attain the savings from cooperative provision. The results indicate that the benefits are substantial but that distribution of these gains is a possible barrier to implementation.