The Southern Marin Emergency Medical Paramedic System (SMEMPS) was established in October of 1980 to better serve the emergency medical service (EMS) needs of the residents and visitors of Southern Marin County. Prior to that time, EMS delivery was provided by firefighters that were certified as Emergency Medical Technicians. If your condition required you to go to the hospital, a private company managed the ambulance transportation.

Realizing that a better system was possible, the local jurisdictions came together and formed a Joint Powers Authority. The intent was to create a system that would provide paramedic service to the community.

The original paramedics were trained at the Stanford University Hospital paramedic program. When they graduated, they were stationed at a single firehouse and responded in a utility vehicle to medical emergencies and vehicle accidents. Additionally, SMEMPS purchased and outfitted three ambulances that were used to transport patients to the hospital.

The original paramedic system was patterned after a model used in Los Angeles. Several years later, to reduce their "response" time to the emergency scene, paramedics were re-assigned to the three ambulances. This increased the likelihood that a paramedic would always be available to respond – even if one of the ambulances was at the hospital.

The next major evolution in the system occurred in late 2003. A medium-duty Rescue vehicle was purchased and outfitted with specialized equipment designed to meet the ever-increasing responsibilities of the fire department in the provision of medical care. The personnel that staff this unit are trained in water and confined space rescue techniques. Additionally, they are all well versed in the management of freeing trapped patients from vehicles and rescuing persons that have fallen from steep cliffs.

A Board of Directors that represents Tiburon Fire District, City of Belvedere, Southern Marin Fire District, and the County of Marin oversees the Authority. The Board meets quarterly and invites members from the public to attend. The activities of the Board are based upon recommendations provided by the fire chiefs in each of the jurisdictions.

SMEMPS personnel see an average of 2,650 patients each year. Medical oversight for the system is provided for in the form of a Medical Director, Continuous Quality Improvement Coordinator and a Fire Captain Specialist.