The first Middletown Fire Department was formed in 1922. It began with a Fire Chief, five call men, and a 300-gallon combination pumper that was housed on Paradise Avenue. During its first year, the department responded to 8 fires. Since that first year, the department has grown in staffing, equipment, and responsibilities. Three full-time firefighters were added between 1942 and 1953 to create a force of one chief, three permanent firefighters, and seven additional members on call to assist in fighting fires.

By the 1950's the equipment consisted of 1 triple combination 500-gallon combination pumper with an 800-gallon water tank, and a 1000 gallon reserve tank truck. In 1952 Middletown Fire responded to 132 fires.

In 1952 the voters approved a two-way radio system that was installed in conjunction with the Newport County Fireman's League. This system alerted all county fire departments to all fires that occurred within the county.

At the 1953 annual financial town meeting, the taxpayers approved the purchase of land at Wyatt Road and Berkeley Avenue as a site for a combination fire and police headquarters and appointed a committee to study plans for a suitable building. In 1955 Construction was completed and the Middletown Fire and Police Departments moved to this location.

From 1955 to 1985 Middletown Fire has added equipment, apparatus, and staffing to meet the increasing number of calls and responsibilities as the community grew and the makeup of the town changed. These changes provided an increased level of fire protection and rescue abilities to Middletown's growing population.

In 2016 Middletown completed a renovation/addition project that created a more efficient space for all fire department emergency apparatus, firefighters, and office staff. All mechanical systems were updated. This project also created a new training room that also serves as Middletown's newest community room. This space helps fulfill the need for additional meeting space for official Middletown business as well as local community non-profit organizations.

The Fire Department currently provides fire and rescue medical service by maintaining a minimum staffing level of 1 Captain, 4 Firefighters, and 1 Dispatcher on duty 24/7/365.