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. However, 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 and the physical fitness testing and standards required by ambulance services in Australia, New Zealand, South Africa, the United Kingdom (UK), Ireland and Canada for the paramedic role. Methods: A scoping review was conducted and reported following PRISMA-ScR guidelines. Electronic databases (MEDLINE, CINAHL, Scopus, ERIC, Emcare, Informit) and grey literature sources (organisational documents) were searched, with searches completed October 2025. Results: Paramedics are reported to have poorer general health when compared to the average population despite a physically demanding role. Sixty-six organisational documents were reviewed as part of this scoping review. Most ambulance services required 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, with five of the eight sourced test protocol documents including a musculoskeletal assessment, six including a strength assessment, and five including a cardiovascular fitness assessment. Conclusion: 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. The integration of evidence-based practices in physical fitness testing and training will be crucial in shaping the future of the paramedic profession.