Wake County EMS outlines four-tier telephone-triage plan to prioritize life-threatening calls
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Summary
Wake County EMS told Garner council it will phase in evidence-based telephone triage (E1'E4) this spring to prioritize the sickest patients, expand nurse-navigation and reduce nonessential lights-and-sirens while measuring effects on response times and outcomes.
Jeff Williams, interim medical director for Wake County EMS, told the Garner Town Council on Feb. 3 that rapid population growth and rising 911 volumes require a new approach to dispatching.
Williams said Wake County now averages roughly 400 EMS calls a day and expects about 150,000 calls in 2026. To direct resources to the most time-sensitive emergencies, staff propose a four-level telephone-triage response plan labeled E1 through E4. "If you treat everything like an emergency, it's hard for anything to be an emergency," Williams said, arguing a prioritization system will get life-saving care to the sickest patients first.
Under the proposal, E1 calls would continue to receive immediate lights-and-sirens response with first-responder partners; E2 calls would receive rapid EMS response with fire assistance in some cases; E3 calls would receive nonurgent ambulance response; and E4 calls would be routed to a nurse-navigation program that can provide telehealth, urgent-care transport or self-care instructions. Williams said about 20% of current calls already run without lights and sirens, and the county aims to increase that share where clinically appropriate.
The plan builds on programs Wake EMS already runs — including a nurse-navigation pilot launched in 2022 — and recent clinical research county staff contributed to that helps predict which callers are most likely to need time-critical interventions. Williams said the county will phase the rollout beginning in spring 2026, pair changes with public meetings and monitor performance metrics including time on scene, call volumes and patient impact to ensure clinical outcomes do not worsen.
Council members asked whether the approach is experimental and how it compares to other systems. Williams said telephone triage is in use elsewhere, noting Charlotte has used similar models. He emphasized the county will coordinate closely with 911 centers and fire first responders and has a working group to address operational concerns raised by fire departments.
Williams also said the plan will reduce unnecessary use of emergency lights and sirens, both to lower risk to the public and to reserve that level of response for cases that demonstrably benefit. "We only want to use our lights and sirens when it's going to benefit people and not when that risk outweighs benefit," he said.
The presentation closed with an invitation for questions and a plan for community meetings across Wake County this spring and summer. Council members expressed appreciation for the briefing and said they look forward to seeing performance data as changes are tested and rolled out.
