Since 2009, the Wake County EMS Advanced Practice Paramedic Program has been making a positive impact in the Capital County of North Carolina. They do this by focusing on three main objectives. They respond to high acuity calls, reduce reliance on the 911 system by connecting high volume utilizers with community resources, and redirect patients away from the emergency department, when appropriate. In this talk we will dive in to where this program started, where it is today, and the impact it has had on thousands of patients over more than a decade.