Background: Internationally, paramedicine has evolved significantly over two decades. As paramedicine moves towards professionalism, enhancing practical skills and increasing collaborative, respectful partnership working with patients are required. The concept of person-centredness represents a global movement that emphasises the importance of placing the person at the centre of healthcare systems and may offer a helpful framework to develop practice. Aim: To explore international literature on paramedics' conceptualisation and implementation of person-centredness in practice. Method: This integrative review employed a five-layer multi-system approach (Whittemore and Knafl 2005). Five academic databases were searched with no data restriction to unearth studies related to paramedicine and person-centredness. Research papers were screened against agreed-upon inclusion criteria, and data were extracted using quality appraisal and Braun and Clarke’s thematic analysis approach. Findings: Seventeen papers of the initial seventy-seven revealed six themes: Lack of shared understanding; Emotional Regulation; The power of powerlessness; Autonomy and engaging in shared decision-making;  Being in temporary presence;  and Ethical risk management. Discussion: Person-centred practice in paramedicine is poorly understood, with studies melding person-centred care with broader principles of person-centredness. Paramedics view person-centredness as something externally imposed, rather than aspects of the care they intuitively provide. Biomedically-driven assessment prioritises protocols over relational care, creating tension between procedural adherence and patient needs. A paradox emerges where patients seek self-determination yet experience powerlessness, while paramedics navigate conflicts between ethical appropriateness and medical protocols. Conclusion: This review identifies several significant challenges in implementing person-centredness within paramedicine. Despite paramedics instinctively providing aspects of person-centred care, a lack of shared understanding, instinctive relational dimensions, and ethical risk management conflicts provides complexities in the care environment, creating dilemmas related to protocol adherence. A variance in paramedic education and the evolution of practice from pre-hospital to comprehensive out-of-hospital care delivery reveals that further research is required to develop healthful, person-centred cultures.