Older adults are disproportionately exposed to increased harm and adverse outcomes in abusive contexts. This systematic review aimed to explore and evaluate current literature on the role of paramedics responding to older adults in abusive contexts, with a specific focus on the vulnerability-reducing and protective potential of paramedics. A systematic review of the literature was undertaken using the Joanna Briggs Institute Systematic Review Guidelines. From an initial yield of 584 results, 18 sources of evidence met the criteria for inclusion and subsequent data extraction. Predominantly North-American literature indicated that older adults experience nuanced, disproportionate and complex vulnerability in abusive contexts, and that paramedics have a poorly defined and inconsistently applied duty of care. Consequently, this systematic review provides key recommendations for enhancing the capacity of paramedics to respond to the unmet needs and vulnerabilities of older adults either experiencing or at risk of abuse or neglect.