Older adults are disproportionately exposed to harm and adverse outcomes in humanitarian emergencies, with the potential to lead, inadvertently, to their subjective and collective health insecurity during and after the emergency. This systematic review aims to explore and evaluate contemporary evidence on the role of paramedics in responding to humanitarian emergencies, with a specific focus on the vulnerability-reducing potential of paramedics for older adults. A systematic review of the literature was undertaken using the Joanna Briggs Institute evidence summary and the PRISMA guidelines. From an initial yield of 4,440 results, 16 sources of evidence met the criteria for inclusion and data extraction. Predominantly North American, the literature confirmed that older adults experience disproportionate and complex vulnerability in humanitarian emergencies. As frontline healthcare workers, paramedics are uniquely positioned to respond to community and individual vulnerability before, during and after emergency exposure, but experience significant impediments to optimizing practice. There is an unmet professional need to improve paramedic’s capacity to address older adults’ vulnerabilities, to enhance their rights to healthcare, personal protection, and health and social security. This review provides key recommendations for reconceptualising the duty of care and improving the capacity of paramedics to respond to the vulnerabilities of older adults manifested by humanitarian emergencies.