The Operations Division, overseen by the SMCFD Operations Division Chief, is responsible for emergency response and incident mitigation for fires, medical emergencies, hazardous materials, urban search, rescue, and other emergencies. Daily operations maintain a seventeen person daily minimum staffing who staff one Battalion Chief, four Engine Companies (ALS) and one Truck Company (ALS).

San Mateo County Fire Department is a member of the San Mateo County Pre-Hospital Emergency Medical Services Joint Powers Agreement (ALS JPA), providing fire-based advanced life support paramedic services 24 hours per day, 365 days per year basis throughout the unincorporated areas of the County (outside of a fire district).