Most day-to-day decision making of paramedics is made in an environment where resources are not truly scarce, or not soon likely to be. Paramedics are therefore able to apply an ethical approach to their work that upholds their duty to provide patient-centred care that is in the best interests of the patient. Paramedics can and do apply a broader community-minded approach to triage at mass casualty events. However, what may be new and associated with the unprecedented public health emergency that is COVID-19 is that paramedics will now be required to make such rationing decisions across a much longer period of time for a far larger number of people. This short commentary aims to begin the discussion about the legal and ethical changes to paramedic practice that are likely to occur over the next 6 to 12 months in response to the COVID-19 crisis.