​Wake County EMS is a county-operated EMS provider agency. The organization began operation on July 1, 1976, and celebrates its 35th year of service in 2011. Wake County EMS Division is the largest of the four agencies comprising the Wake County EMS System and the sole public-sector provider.
Wake County EMS operates 35 advanced life support ambulances from 10 discrete stations and eight stations shared with local fire departments. Schedules consist of 12-hour and 24-hour shifts, with various start times to meet call-volume demand. Ambulances are primarily Type III van-modular units, with medium-duty Type IV units added in 2008.

Four district chiefs on each shift supervise daily EMS operations. Each district chief operates a Chevrolet Suburban or similar, state-licensed, quick-response vehicle equipped with a full complement of ALS and incident management equipment.