What Changed

On September 9, 2026, JEMS published a report on Durham County, North Carolina, where the county's EMS system is struggling to keep up with residential growth. The day before, JEMS reported that Folsom, California, had put a fire engine back in service by changing how its ambulances are staffed.

Both affect how long a badly injured person waits for a paramedic, and who treats them until one arrives.

The Numbers

As reported, with status noted:

  • Durham County population: more than 347,000, up 15.4% over the past decade, or about 40,000 people since 2016.
  • Call volume: over 60,000 calls in each of the last two fiscal years.
  • Ambulances: 12 to 19 in service at peak times. The report says roughly 32 would be needed.
  • Response: an average of about 8 minutes, and holds of around 35 minutes on non-critical calls.
  • Staffing: the county added 12 EMS positions in the fiscal year that started July 1 and raised pay. It competes with neighboring systems for the same staff.
  • Vehicles: each fully equipped ambulance costs more than $415,600. Manufacturing delays stretched from about six months to three years during the pandemic. The county expects to have replaced 28 ambulances by the end of 2028.
  • EMS Director Mike Lockhart: "The county's growth and our call volume go hand in hand."
  • Folsom, Calif.: an engine was cut in October 2025. Ambulances now run with one paramedic and one EMT, not two firefighter-paramedics. That change, which is in effect, frees up staff to reopen the engine and saves the city more than $46,000 a year.

Why It Matters Operationally

An eight-minute average says nothing about the worst calls. Averages hide the calls where the closest ambulance is already committed, and a system running well short of the ambulances it says it needs at peak will have more of those.

Trauma patients don't have much time to spare. The Joint Trauma System's Damage Control Resuscitation CPG calls for surgical care as soon as possible, under an hour, and says early blood product resuscitation, "ideally within 36 minutes of injury," is associated with the lowest mortality. That's military data. A civilian with a major arterial bleed is on the same timeline.

When the ambulance is delayed, someone else is treating the patient first, and on a shooting or stabbing call that's usually a patrol officer. C-TECC guidance gives every provider level the same Direct Threat Care actions: get the wounded to relative safety and control massive bleeding with a tourniquet. For a patient with a major bleed, that may be all the care they get before EMS arrives.

ODM's Position

Position: Law enforcement agencies should treat the local ambulance gap as a medical-readiness planning problem and train officers against real response data, not an assumed eight-minute arrival.

Evidence: Durham's numbers show demand outgrowing ambulance capacity. Folsom shows the trade-offs of tight budgets. Neither decision is unreasonable or made by police, but both change what officers must do on scene.

Strongest counterpoint: Emergency medical care belongs to EMS, and asking police to fill the gap risks shifting a funding problem onto officers who are already stretched. EMS leaders are also right that more ambulances and medics are the real fix. Folsom's staffing model may be a reasonable use of limited paramedics as well.

Our take: All of that is fair, and officers shouldn't become the ambulance service. But bleeding control can't wait for the ambulance debate to be settled. Ambulances and officer training both come out of budgets, and both affect the same patient.

What good looks like:

  • Police and EMS leaders reviewing the same response-time data, including the worst 10% of calls
  • Officer bleeding-control training built around the actual expected wait times in your area
  • Joint drills where officers hand off to whichever crew configuration really arrives
  • Elected officials briefed on both the ambulance budget and who treats patients until an ambulance gets there

What Your Agency Should Do Now

  • Ask your EMS provider for response times by area and by hour, not the countywide average.
  • Identify where the gaps are, such as fast-growing areas, rural edges, and overnight hours, and make sure officers covering them have current tourniquet and wound-packing skills.
  • Stock patrol kits for a longer wait: at least two tourniquets, hemostatic gauze, pressure dressings, and a hypothermia wrap.
  • Train for a patient who is still with you after ten or fifteen minutes, including reassessing tourniquets, managing the airway, and keeping the patient warm.

Bottom Line

Durham is adding residents faster than ambulances, and Folsom changed how its ambulances are staffed so it could reopen an engine. Those choices are being made in many places, and a trauma patient's survival still depends on what happens in the first few minutes.

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