The growing demand for rapid, accurate, and coordinated emergency care has accelerated the transition from traditional Emergency Medical Services (EMS) to smart, technology-enabled systems. Within these systems, paramedics play a pivotal role as frontline clinicians and operational integrators who translate digital intelligence into time-critical interventions. This review examines current evidence on the integration of paramedics within smart EMS systems and its influence on rapid response performance, patient outcomes, and system efficiency in modern emergency care. An integrative review approach was adopted, synthesizing empirical and conceptual studies published between 2016 and 2025 that address paramedic practice, smart dispatch, digital decision support, telemedicine, and system-level coordination. The reviewed evidence demonstrates that smart EMS–enabled paramedic integration is associated with reduced response times, improved prehospital decision-making, earlier initiation of life-saving interventions, and enhanced continuity of care from scene to hospital. Technologies such as artificial intelligence–supported dispatch, electronic patient care records, teleconsultation, and smart routing systems significantly strengthen paramedic effectiveness in high-acuity emergencies. Despite these benefits, challenges related to workforce training, interoperability, governance, and ethical use of digital tools persist. This review highlights the central role of paramedics in smart EMS systems and underscores the importance of aligning technology, policy, and workforce development to optimize rapid emergency response.