By Jordan Meadows
Staff Writer
Wake County officials reviewed changes to the county's emergency medical services system during a presentation Monday at a Wake County Board of Commissioners Public Safety Committee meeting. The presentation focused on EMS response times, emergency call prioritization, coordination with local fire departments, and patient outcomes as the county continues to grow.
With a population of approximately 1.2 million people spread across 857 square miles, Wake County's emergency medical services, fire departments and 911 communications centers are adjusting how they respond to calls, prioritize emergencies and coordinate care. Wake County EMS serves Raleigh, 11 municipalities and the county's unincorporated areas. Established in 1976, the agency now handles hundreds of calls each day.
One of the most significant changes underway involves how 911 dispatchers determine which medical emergencies receive an ambulance first. Rather than relying primarily on a first-come, first-served approach, Wake County EMS is implementing a more detailed triage system designed to identify patients experiencing the most serious medical emergencies and prioritize resources accordingly.
The change followed a review of dispatch data that began nearly two-and-a-half years ago. Officials found that Wake County EMS handled about 380 calls for service each day, but only about one in 10 callers faced an imminent threat to life.
"We need a better system, where if the fifth person who calls is the most sick, they get the quickest, most appropriate response," said Wake County EMS System Director Jonathan Studnek, Ph.D., NRP.
Under the updated system, medically accredited dispatchers ask callers additional questions to better understand their symptoms and determine the appropriate level of response. The system is being introduced in phases and uses four levels of medical urgency, with Level 1 representing the most serious emergencies.
Patients categorized as Levels 1, 2, and 3 will continue to receive an ambulance, although those classified at Levels 2 and 3 may experience slightly longer waits depending on the severity of their condition and the availability of resources. Level 4 calls involve patients who may not require an ambulance and could instead benefit from a less urgent medical evaluation.
The goal is to make emergency responses more closely reflect the severity of a patient's condition rather than the order in which calls are received.
However, the changes also prompted questions from county commissioners about how patients with injuries that are not immediately life-threatening could be affected.
Commissioner Vicki Adamson expressed concern that someone with a broken leg, for example, could face a longer wait because another caller is experiencing a more serious emergency. She questioned whether those delays could create additional risks for patients who still need medical attention, particularly if they consider driving themselves or using public transportation while injured or experiencing a medical problem.
Studnek explained that callers can contact 911 again if their symptoms worsen or their circumstances change. Dispatchers can update the patient's medical information and reassess the call's priority level. If a patient's condition becomes more serious, the call can be moved to a higher urgency level so emergency resources can be dispatched more quickly.
County officials have also examined how changes to EMS operations affect local fire departments, particularly when firefighters respond to medical emergencies and must wait for an ambulance to arrive.
Data presented to officials compared fire department call volumes before and after operational changes. Raleigh recorded the largest reduction in daily responses, decreasing from an average of 112.6 calls per day to 99.5, a reduction of approximately 13 calls daily.
Cary's average decreased from 22.1 to 20.6 responses per day, while Garner declined from 15.1 to 13.2. Morrisville's average dropped from 4.5 to 3.8 calls per day. Northern Wake experienced a slight increase, while Rolesville also recorded a decrease.
Officials also reviewed how long fire departments wait for EMS personnel to arrive at incidents requiring medical assistance. The reported average wait decreased from approximately six minutes and 30 seconds in June 2025 to just over five minutes in August 2026.
Raleigh, Garner and Western Wake District recorded some of the shortest waiting periods, generally between three and four minutes. While the figures indicate a reduction in the time firefighters spend waiting for EMS, response times continue to vary depending on the location and circumstances of an emergency.
During the presentation, Commissioner Cheryl F. Stallings asked how Wake County's EMS system compares with those in other large communities.
Studnek explained that response time expectations cannot necessarily be applied equally across different communities because geography, population density, and road infrastructure all influence emergency response.
"EMS systems are designed for service around a particular geography and population density of the community they serve. What may be an achievable and rational response time target may be different in Wake County than in a community that has different road infrastructure, or a more dense population in a central urban district," Studnek said.
Commissioner Shinica Thomas also emphasized the importance of community engagement and public input as EMS continues to make operational changes.
Studnek agreed that additional communication with residents would be beneficial, providing greater transparency while allowing the department to hear directly from the people affected by its policies. He said community feedback could help EMS determine whether the changes are working as intended and whether adjustments are necessary.
Wake County EMS has also received national recognition for patient outcomes, particularly in treating cardiac arrest, heart attacks and strokes. In 2025, the agency reported a 15% survival rate among cardiac arrest patients, exceeding the national average of 10.5%. The agency also reported saving 118 lives during the year.
"We understand that EMS plays a vital role in Wake County's healthcare system," Thomas said. "Building a safe and healthy community means investing in EMS staff and strengthening hospital partnerships, so our frontline crews can focus on what they do best – saving lives."
In addition to emergency response operations, officials highlighted the financial considerations residents may face when requiring ambulance transportation.
A single ambulance trip in Wake County can bill more than $1,500, depending on the distance traveled and treatment provided. According to the county's website, "a typical emergency ambulance transport can exceed $500, and most insurance providers, including Medicare, will not cover the full amount of an ambulance bill."
To help residents manage those expenses, Wake County offers an EMS Subscription Program. For $60 annually, a household can receive protection from out-of-pocket expenses remaining after insurance pays its portion of a qualifying emergency ambulance transport.
"Navigating the healthcare system can be complicated. Wake County's EMS Subscription makes one thing simple," Wake County Commissioner Safiyah Jackson said in a news release. "In an emergency, where life is on the line, this program eliminates the worry about the cost of an ambulance."
The subscription does not cover non-emergency medical transportation or air ambulance services. It also does not guarantee coverage when an ambulance operated by an agency other than Wake County EMS responds to an emergency. Residents must have health insurance to enroll in the program. Those without insurance are not eligible. Participation is voluntary, and residents who do not subscribe can still receive emergency services.
