Wake County EMS is a county-operated EMS provider agency, which began operation on July 1, 1976. 

Wake County EMS operates 35 advanced life support ambulances.  All shifts are 12 hours, and they operate on a "2 on 2 off" basis, with the weekend adding in a third day. For example, work Monday/Tuesday, off Wednesday/Thursday, work Friday/Saturday/Sunday. The next week is the opposite. There are various start times to meet call-volume demand. Ambulances are Type III van-modular units.

District chiefs on each shift supervise daily EMS operations. Each district chief operates a  state-licensed SUV equipped with a full complement of ALS and incident management equipment.