The purpose of this study is divided into two main sections. The first section consists of a complete review of the current Cache County Emergency Medical Services (CCEMS) system to include an evaluation of the existing inter-local agreement and a consideration of changes to that system. The second section consists of a complete a full assessment of the potential advantages and disadvantages of a combined Cache County Fire District and CCEMS system. The assessment shall provide Cache County decision-makers a recommended preferred organizational and operational structure that would be most effective and efficient in providing combined Fire and EMS services to residents of Cache County, Utah.