Paramedic Physical Fitness Requirements, Standards and Preparation: A Scoping Review

Introduction: Paramedics are at high risk of musculoskeletal injuries associated with the physical demands of the role. Paramedic physical fitness is an important requirement to complete the essential daily tasks of the role and potentially reduce injury risk. It is unclear what the specific fitness requirements should be across many ambulance services and how to assess or prepare for them. Objective: This scoping review explored the existing evidence in relation to paramedic physical fitness, testing and standards required by ambulance services in Australia, New Zealand, South Africa, the United Kingdom, Ireland and Canada. Methods: A scoping review was conducted and reported following PRISMA-ScR guidelines. Electronic databases (MEDLINE, CINAHL, Scopus, ERIC, Emcare, and Informit) and grey literature sources (organisational documents) were searched, with searches completed in October 2025. Results: Paramedics are reported to have poorer general health when compared to the average population despite a physically demanding role. Most ambulance services require candidates to complete some form of pre-employment physical fitness test. No ambulance service identified required regular, ongoing physical fitness testing for all its paramedics. Each pre-employment physical fitness test identified was unique in its format. Conclusions: By prioritising, supporting and accurately assessing the physical health and fitness of paramedics, organisations can enhance job performance readiness and potentially reduce injury rates or injury risk.