Since 1997, Emergency Health Services in Nova Scotia (NS) has evolved from a program providing prehospital care for patients in transport to a system providing integrated healthcare in both traditional (ie, ambulance) and non-traditional settings (eg, patient homes, hospital settings). This article highlights (1) the reorganization of the emergency medical service system design, (2) the strategies enabling efficient operation of this design, and (3) resultant innovations evolving from both system redesign and strategy application. Emergency Health Services has utilized a Public Utility Model (PUM) design providing prehospital healthcare, public safety, and public health responses to the population of NS. The success of the PUM has been complimented by three strategies: (1) co-leadership model operations, (2) common languages to translate evidence into practice, and (3) collaborative and integrated relationships with other regulated healthcare providers. This prehospital system design and application strategies could be applied in other sectors of community and hospital systems of care.