Southern Marin Fire Protection District is responsible for providing fire and emergency medical service for its constituents in the District. Five engines, one ladder truck, one rescue squad, and three ambulances respond from the Southern Marin Fire Protection District's three stations located in Strawberry, Tamalpais Valley, and Sausalito. The personnel responding on these units are either a Paramedic (advanced life support) or Emergency Medical Technicians (EMT) who are trained in the use of the automatic external defibrillator (AED).

Operational guidelines are provided by the Southern Marin Emergency Medical Paramedic System (SMEMPS), a Joint Powers Agency (JPA) in which other fire agencies in the area participate. Emergency medical care is managed through a number of programs including standard operating procedures, standing orders, in-service training, and various other methods. These programs ensure consistent quality control of medical service. Fire district personnel participate in continuing education programs for both EMTs and Paramedics to assure that personnel are trained to appropriate knowledge and skill levels. SMFD utilizes modern state-of-the-art equipment that meets and often exceeds industry standards. Medical equipment is continually evaluated and updated when appropriate.

Transportation of patients is generally to the nearest medical facilities in Marin County, which are Marin General Hospital in Greenbrae and Kaiser Terra Linda. Southern Marin will also, in some cases, transport patients to medical facilities in San Francisco.