This research study investigates the role of information systems in enhancing end-to-end performance of rural Emergency Medical Services (EMS) systems. This study uses an embedded case study approach with multiple methods and within the context of rural Minnesota. Interviews and data analysis of the EMS process identified four elements: mayday call, routing and dispatch, response, and treatment. These data were then used to perform a preliminary simulation of rural EMS systems performance under normal and crisis conditions as a proof of concept for analyzing end-to-end performance. This process allowed for further contextual analysis of the interviews, which revealed the need for a more dynamic and comprehensive management information system as well as a forum for sharing EMS performance information across the full range of organizations involved in EMS. Constraints to enhancing EMS systems were also identified, such as a lack of funding for new technologies and an apparent disconnect between information systems coordination and service coordination. The case study reveals that while local EMS providers may have an intuitive understanding of how the entire system performs, there is a lack of systematic data to support, confirm or refute perceptions about overall performance. The paper concludes with recommendations for future related research activities.