Consultants find rising demand, staffing strain in Forsyth County emergency services; recommend peak‑time ambulances and facility upgrades

Forsyth County officials on Wednesday heard the results of an independent assessment of the county’s emergency services that found rising demand and service pressures across EMS, 9‑1‑1 and fire operations.

The county hired NC Fire Chief Consulting in February to review multi‑year data, interview staff and recommend improvements. “Your demand is over 62,000 incidents per year,” consultant Greg Grayson told the Board, and the firm analyzed more than 240,000 priority incidents to determine system performance.

Why it matters: The consultants reported that Forsyth County’s 90th‑percentile EMS arrival time for priority incidents is 17 minutes, 56 seconds — well above industry benchmarks used for urban areas — and that travel times and call volume have trended upward. Those performance measures, combined with aging vehicles and facility shortfalls, are driving staff workload and retention problems, the report concluded.

Key findings and recommendations

- Demand and response times: The consultant team said call volume has increased and travel time is rising; the county’s calculated 90th‑percentile response for priority EMS incidents is 17:56. The busiest hours are roughly 10 a.m.–6 p.m., and the team recommended targeting peak‑time staffing changes. Grayson: “When you start at midnight ... those look pretty good, right? But when you move up into the higher demands … you’ve quickly exceeded the 12 [ambulances].”

- Unit availability and workload: The report said Forsyth operates 12 county ambulances from the county bases and estimated that, based on current demand patterns, the system would need up to about 20 ambulances during peak hours. Consultants reported that multiple EMS calls occur simultaneously about 89% of the time and that all in‑county units are exhausted roughly 21% of the time. The team calculated an observed unit‑hour utilization of 0.63, higher than a commonly‑cited “healthy” target of 0.5.

- Facilities and fleet: Reviewers described facility space shortfalls across EMS bases (ages range from about five to 50 years), and said many ambulances show deferred maintenance; consultants recommended a dedicated emergency vehicle technician in the county garage to address mechanical issues. Grayson noted some base buildings had accessibility or staffing‑support problems (for example, restricted access at a facility that leaves crews exposed to elements).

- Mental‑health and workforce supports: Staff interviews repeatedly raised behavioral‑health/peer support needs for EMS, 9‑1‑1 and fire personnel who face frequent high‑stress incidents; the consultants recommended strengthening peer‑support and mental‑health resources.

- 9‑1‑1 and dispatch: The consultants recommended creating an assistant director position in 9‑1‑1, increasing telecommunicator staffing (they suggested a goal of eight on duty), updating training materials and reviewing call‑processing protocols with the medical director. Regina Crawford, who led the EMS portion and is a former chief of the North Carolina Office of EMS, said 9‑1‑1 staff were “very capable” but under strain.

- Organizational structure and near‑term steps: The consultants recommended retaining the recently adopted three‑division structure (fire, EMS and telecommunications) and adjusting spans of control and administrative staffing; they also encouraged using analytics to monitor peak‑time performance and to implement incremental “peak‑time” ambulance deployments rather than a single, large change.

County actions and immediate context

County staff said the manager’s office had already responded to interim findings. Kyle Haney of the manager’s office told the board that after an earlier resignation the county had not immediately refilled the emergency services director slot; the three deputy chiefs (now promoted) led their divisions during the assessment and the manager’s office made those promotions permanent on July 1. The county also contracts NC Fire Chief Consulting to produce the assessment.

Officials signaled several follow‑up steps. County staff said they will provide a written update listing items already completed, items in progress and longer‑term tasks. Commissioner discussion emphasized benchmarking against peer urban counties and prioritizing lower‑cost “near‑term” actions such as leave and scheduling policy revisions.

Direct quotes

- “Your demand is over 62,000 incidents per year,” Greg Grayson, NC Fire Chief Consulting. - “When you start at midnight ... those look pretty good, right? But when you move up into the higher demands … you’ve quickly exceeded the 12,” Grayson on peak‑hour ambulance needs. - “We do have the franchises. So during the daytime, they provide 2 ambulances per 3 of the franchises,” Andrew Davis, Director of EMS, explaining the role of franchise ambulance providers and clarifying that the consultant analysis focused on county‑operated ambulances.

What the assessment did not decide

The consultant report was advisory; it did not set policy or create new positions without board approval. Several recommendations — such as adding peak‑time paramedic ambulances, hiring vehicle technicians and upgrading facilities — would need budget approvals and additional operational planning. The consultants also noted permitting, procurement and capital‑replacement lead times for apparatus and facility projects.

Ending

County leaders said they valued the independent review and that several items are already under way; the manager’s office committed to returning to the board with a written status report. The consultants offered data comparison files and said they could share statewide benchmarking results that were collected for a presentation in August.