The San Mateo Consolidated Fire Department provides emergency medical services to the communities we serve, including: 

• Basic emergency medical support and care, delivered by EMT-trained personnel on every SMCFD response — every engine and truck company across our nine stations in San Mateo, Belmont, and Foster City is staffed to provide immediate patient assessment, airway management, bleeding control, and other essential interventions the moment we arrive on scene. 

• Paramedic-based Advanced Life Support (ALS), providing a higher level of clinical intervention for critical patients — every SMCFD apparatus is staffed with Paramedics, delivering cardiac monitoring, IV/IO access, advanced airway management, and emergency medications under county-approved standing orders on every call, across all nine stations in San Mateo, Belmont, and Foster City. 

• Automatic External Defibrillation (AED), ensuring rapid response to cardiac emergencies — every SMCFD apparatus is equipped with an AED, so a trained crew and a defibrillator are never far away for residents experiencing sudden cardiac arrest. 

Maintaining EMS Standards

San Mateo County EMS guidelines and performance are managed through a number of programs, including: 

• Standing orders, which establish approved treatment protocols for field personnel, issued and approved by the San Mateo County EMS Agency's Medical Director. These orders are based on evidence-based recommendations for prehospital care and align with California Code of Regulations Title 22, ensuring EMTs and Paramedics can deliver immediate, protocol-driven treatment before contacting a base hospital. 

• Policies and procedures, which guide consistent, high-quality patient care across the county's EMS system — including destination and triage guidelines for time-critical conditions such as trauma, STEMI (heart attack), and stroke, so patients are routed to the most appropriate receiving hospital. The San Mateo County EMS Agency submits an annual EMS System Plan Update in accordance with California Health and Safety Code Section 1797.254, and all policies, protocols, and field procedures are publicly available on the San Mateo County EMS website.

• In-service training, which reinforces skills and keeps personnel current on best practices through regular drills, protocol updates, and skills verification — supporting the department's participation in the county's broader Quality Improvement (QI) program aimed at continuously evaluating and improving patient outcomes. 

Continuing education programs for both EMTs and Paramedics are conducted in-house and overseen by our EMS Manager, ensuring all personnel are trained and evaluated to appropriate knowledge and skill levels, consistent with county and state EMS requirements. 

For more information on training, please visit our Training Division page.

Why Does a Fire Engine Respond to Medical Calls?

When you call 911 for a medical emergency in San Mateo County, you may see both a fire engine and an ambulance arrive. This isn't a mistake — it's how the county's emergency medical system is designed to get you help as fast as possible. 

Your call goes to one dispatch center: All fire and medical 911 calls in San Mateo County are answered by the county's Public Safety Communications Center, which serves every city and fire agency countywide. Dispatchers ask a series of questions to determine what's wrong and send the closest, most appropriate help — often before you've finished describing the emergency. 

The closest resource responds first: San Mateo County Fire Agency engines and trucks are staffed with firefighter-paramedics and positioned throughout the community specifically so help can arrive quickly, no matter where an emergency happens. Because fire stations are spread across the county, a fire crew can often reach you in just a few minutes — faster than a centrally-based ambulance. 

Engine paramedics stabilize and ambulance paramedics transport: The arriving fire crew begins patient care immediately — assessing your condition, starting treatment, and preparing you for transport. At the same time, an ambulance from AMR (American Medical Response), the county's contracted ambulance provider, is en route to take over transport to the hospital. 

Two agencies, one coordinated response: This partnership between fire agencies and AMR — sometimes called the county's public-private EMS model — combines fast first response with dedicated ambulance transport, so residents get paramedic-level care as quickly as possible and reliable transport to definitive care.