Abstract
<p>BackgroundParamedics are often the first point of professional contact for autistic people during acute medical, behavioural, and mental health crises, yet encounter them in unfamiliar, time-pressured settings and with limited autism-specific guidance. Autistic people have elevated rates of co-occurring health and mental health conditions and substantially higher emergency service contact, but the nature and evidence base of paramedic practice with this population has not been systematically mapped, particularly within the Australian policy and practice context.MethodWe conducted a scoping review following PRISMA-ScR guidelines. Seven databases were searched from inception to 20 April 2026, alongside grey-literature searching of repositories (Overton, Trove) and targeted searching of Australian ambulance services, peak professional bodies, and autism organisations. Empirical studies were eligible if they involved paramedics or pre-hospital EMS providers and addressed autism as a distinct population or named subgroup. Data were charted and synthesised narratively; grey-literature sources were charted separately.ResultsTen empirical studies (published 2013–2024) met inclusion criteria: seven from the United States, one from Canada, and two from Australia, with none identified from the United Kingdom or Europe. Studies were heterogeneous in design and paramedics were rarely the primary participant group; no study recruited autistic adults directly. Across studies, paramedics reported limited autism-specific knowledge and training, with training evaluations largely restricted to immediate self-reported change. Clinical tools such as communication boards and sensory kits were perceived as useful, though evaluated primarily through provider report. Grey-literature searching identified limited and fragmented autism-specific guidance; where autism appeared in Australian clinical practice guidelines, it was situated almost exclusively within behavioural-disturbance frameworks, and no Australian ambulance service had a dedicated, co-produced autism strategy comparable to examples identified in the United Kingdom.DiscussionThe evidence base on paramedic practice with autistic people is small, heterogeneous, geographically concentrated, and largely absent of autistic voices, with mental health and suicide-related presentations particularly underexamined. Australia's nationally registered paramedicine system offers a potential lever for systemic, neuroaffirming reorientation of practice that is not reducible to increased training volume alone. Co-produced research, clinical tools, and care pathways, evaluated against observed practice and autistic-reported experience, are priorities for future work.</p>