Wake County EMS Proposes Overhaul for Strained Response System

Knightdale Fire Department Station 1

Wake County EMS is preparing to launch a major overhaul of its countywide emergency response system; a shift Wake EMS officials say is aimed at improving safety by reducing unnecessary lights‑and‑sirens traffic and getting the “right resource to the right patient in the right amount of time.”

Knightdale Town Council received a detailed briefing on the changes during its Jan. 5 work session, where Fire Chief Loren Cone outlined how the new model will reshape dispatch priorities, response times, and the role of first responders.

A System Under Strain

Wake County EMS is responsible for all medical calls, while firefighters are trained EMTs and are often dispatched to medical calls they can reach first as part of the countywide first responder program. Firefighters can provide lifesaving care while an ambulance is enroute.

As Wake EMS resources have been stretched in recent years, their response times are getting longer. Fire units often wait extended periods on scene for an ambulance to relieve them, leaving them unavailable for fire emergencies.

Proposed Changes

Under the proposed model, EMS calls will be sorted into four categories (E1 down to E4) with different response targets. The highest priority calls (E1) are expected to be 20% of the total calls and these are the only calls where EMS would use lights and sirens (down from about 80%).

Wake EMS hopes to divert more of their less urgent (E4), calls to their Nurse Navigation Line. Reducing the number of EMS trips by increasing usage of the Nurse Navigation Line from 4% of calls to 18%.

Impact on Knightdale Fire Department

First responders will continue to be dispatched to calls “where minutes matter,” including all Priority 1 incidents and medical issues within the EMT scope of practice such as allergic reactions, overdoses, and bleeding. However, many low‑acuity medical calls—some chest pain, diabetic issues, headaches, and certain stroke symptoms—will no longer receive a fire response. KFD would be added to calls for physical assistance (to help residents who have fallen). This would be a new area of service for KFD and other fire departments. Protocols will need to be established around completing these services.

Wake County EMS concedes that the true impact on response times and unit availability will only become clear after implementation but hope for a net 10% decrease in calls for first responders and assume that will result in less time unavailable for fire calls. KDale Times has requested the County’s presentation but has not received it. The County is offering in-person presentations next week for municipal officials to help them better understand the proposal.

Chief Cone reiterated during his presentation that municipal fire services across the county and Wake County EMS are aligned in their desire to best service our residents. During the Knightdale presentation the council and staff articulated a similar commitment to being good community partners and intent to maintain high public safety standards in Knightdale.

Officials indicated that they are confident in KFD’s protocols regarding lights and sirens and are concerned the mix of calls coupled with slower responses due to not using lights and sirens, that this will result in more time on medical calls and less availability for critical fire calls.

According to an October 2025 article by Eric Miller with WRAL, Wake County Commissioner Shinica Thomas asked about the effect on average response times overall. Wake EMS was unable to answer during that presentation.