The Initial Response Paramedic System reduces the number of calls to which ambulances respond, and reduces the number of times when those responses are with lights and sirens. By reducing emergency traffic for ambulances, the service life of the vehicles and safety of the personnel are both increased. Orange County's Board of Commissioners franchises convalescent ambulance transportation service. The only current franchisee, Johnston Ambulance Service, operates several non-emergency ambulances and wheelchair vans in the county. Johnston Ambulance Services' corporate offices are in Smithfield, but units operate out of a facility in Chapel Hill.
Aeromedical transport is readily available for critically injured trauma patients in Orange County.
Both Duke University and the University of North Carolina operate flight programs, and weather permitting, there is nearly always an aircraft available. Because of the unique Initial Response Paramedic system, transportation is not the primary focus of the EMS Division. Many patients to whom EMS is summoned do not require ambulance transportation. Initial Response Medics work with the patient and the patient's own physician to determine the most appropriate means of transport. Sometimes the most appropriate means is by private vehicle or public transportation service.