An increase in capability and community expectation coupled with an increase in demand has placed both external and internal pressures on paramedics with discernible similarities between Australia and the UK (Armitage, 2010; Mahtani et al, 2018). Where paramedic performance is measured, paramedic wellbeing has been less considered (Gayton and Lovell, 2012). Ongoing caseloads, daily exposure to human suffering and continual shift extensions or missed meals can cause a physical and emotional toll (Armitage, 2010; Gayton and Lovell, 2012; Mahtani et al, 2018). A recent review of paramedicine personnel determined that paramedic stress and burnout are among the highest within the emergency service network when compared with police and fire (Maguire et al, 2014; Varker et al, 2018). Further data conclude that ongoing exposure to traumatic events coupled with broken rest can lead to psychological impairment (Bradford, 2002; McFarlane, 2010). Although resilience in paramedic staff is a testament to the profession’s character, the increasing operational demand, lack of apparent regard for operational fatigue management, and ongoing traumatic exposure will likely negatively impact paramedics’ capacity to respond with ideal performance (O’Meara and Boyle, 2008; Scully, 2011; Woollard, 2015). The question arises of how to measure these intrinsic factors in paramedics, which might be contributing to fatigue, decreased resilience, and burnout. The demands of paramedic job performance are influenced by a multitude of factors, many which have not received extensive attention in the literature. What is known is that the demands of this role can be physical, emotional (Blau et al, 2012) and cognitive (LeBlanc et al, 2005), with high rates of injury and many markers of poor health present in paramedics (Sterud et al, 2006; Studnek et al, 2010; Maguire et al, 2014). An as yet underexplored area are the links between job performance, physiological response and resilience. There is also growing evidence that paramedics risk developing work-related health problems such as post-traumatic stress disorder (PTSD) (Sterud et al, 2006; LeBlanc et al, 2011; Halpern et al, 2012) and may not have longevity in their career compared with other health occupations (Rodgers, 1998a; 1998b). This was the impetus for the ‘Fit for Duty’ research project recently completed by the lead author (SM) studying New South Wales (NSW) Ambulance paramedics in this region of Australia.