Purpose: With aging, the risk of requiring emergency care increases. Elderly patients who need Emergency Medical Services (EMS) are often vulnerable and dependent, especially when their decision-making ability is reduced, which may intensify the risk of important ethical values being violated. Studies about paramedics’ views on elderly people’s self-determination within EMS settings are scarce. The aim of this study was to explore the attitudes and perceptions of paramedics in a US context regarding self-determination in elderly patients who need emergency care provided by EMS.

Design/methodology/approach: The study had an exploratory design, and data were collected using a Delphi technique. A panel of experts consisting of US paramedics was recruited to answer a questionnaire sent out in three rounds. The questionnaire comprised 108 items, derived from a Swedish study on the same topic, rated with a five-point Likert scale ranging from agree to disagree with a predetermined consensus level of 70%.

Findings: In total 21 experts agreed to participate, 15 completed all three rounds, leaving a total response rate of 71%. Finally, 87 out of 108 items reached consensus, of which 60 were “agree” and 27 were “disagree.”

Originality/value: The paramedic–patient relationship is a core in assessing and handling ethical challenges within an advanced practice influenced by the paramedics’ educational level and/or the patient’s physical/mental status. Within a “find it fix it” modus operandi, there is a need to increase paramedics’ competence in understanding and handling advanced ethical challenges in relation to ethical values such as autonomy and self-determination in elderly patients.