The Operations Division is responsible for the day-to-day delivery of critical emergency medical services (EMS), fire suppression, hazardous materials, and technical rescue mitigation to the residents and visitors of Montgomery County.

The overall responsibility for Fire and Rescue Service operations lies directly with the Fire Chief. The Division Chief of Operations is assigned by the Fire Chief to manage the division. The career and volunteer components of the combined service work in an "Integrated Emergency Command Structure" that defines the authority and responsibility for all members of the service. MCFRS responds to approximately 130,000 emergency incidents annually. Requests for emergency medical assistance comprise the majority of those incidents; approximately 100,000 calls resulting in the transport of 75,000 people to local hospitals. There are approximately 27,000 fire incidents, technical rescue, and hazardous materials incidents annually.

The Operations Division is organized into four major sections, including Field Operations, Emergency Communications Center (ECC), Special Operations (SOPs), and Emergency Medical and Integrated Healthcare Services (EMIHS). MCFRS personnel operate from 37 Fire and Rescue stations. Thirty-five paramedic engines, 15 aerial units, six heavy rescue squads, 11 Advanced Life Support medic units, three paramedic chase cars, and 32 Basic Life Support (BLS) ambulances make up the primary fleet of first response apparatus. There are additional units that can be placed in service with available volunteer or recalled career personnel to increase the MCFRS capability.