The primary component of the Wake County EMS System is a fleet of paramedic ambulances that respond to all 9-1-1 calls for medical help. Paramedics are the highest trained pre-hospital caregivers. They use advanced skills, medications and procedures to begin emergency treatment for patients before and during transport to one of the six local emergency departments.

Local 9-1-1 centers use advanced dispatch systems to triage calls and provide callers with important medical instructions. The closest resources to the emergency are selected by GPS and are dispatched while the caller is given lifesaving instructions.

"First Responders" are dispatched along with the ambulance to provide initial medical care until the paramedics arrive on the ambulance.

To the general public, the term first responder is often thought of as any emergency responder; however, within the EMS system, the term refers to a medical responder who frequently can arrive first and provide basic medical intervention while the paramedics are on the way. All fire departments within Wake County serve as first responders for the EMS system.

The Wake County EMS System is headed by Dr. Jose Cabanas. He is ultimately responsible for operations, department direction, and medical oversight of all clinical care provided in the EMS System.

Wake County uses a digital Motorola Smartzone 800-MHz system for all communications. This allows for different agencies from EMS, law enforcement and fire to talk to each other at the scene of an emergency.

Wake County uses a GPS-based vehicle tracking system to automatically assign all medical calls to the closest EMS responder.

Advanced Practice Paramedics hit the streets in January 2009. This program, in partnership with public health, seeks to make the EMS System more efficient by reducing the occurrence of, or minimize, medical crises for people with specific medical conditions.