In Japan, the paramedic system is a relatively new medical qualification established in 1991 regarding changes in public awareness of the pre-hospital care system. Pre-hospital care has been provided mainly by fire departments, but the work was not beyond the "delivery service" scope of the emergency medical team. During the establishment of the system, paramedics were defined as individuals who provide emergency medical care to patients with injuries and sickness in pre-hospital settings until they are transported to a hospital and placed under the care of a physician. As pre-hospital care professionals, paramedics provide emergency medical care to patients with cardiopulmonary arrest, such as defibrillation using a semi-automatic defibrillator, airway using a closed esophagus device, and intravenous fluids to secure the venous system, following the specific instructions of a physician. However, regarding the changing needs of the public, the scope of the procedures has been expanded to include adrenaline administration to patients with cardiopulmonary arrest, such as tracheal intubation using an endotracheal tube, fluids transfusion to patients before cardiopulmonary arrest, and glucose solution to patients with hypoglycemic injuries. Additionally to the treatment scope expansion, the professionalism of paramedics has also been required to change recently with the lifting of the ban on performing emergency care in the emergency room after the patient has been admitted to the hospital. The paper outlines the history of the paramedic system in Japan from its inception until its current professional expansion and discusses the professionalism of paramedics.