Simulation is a widespread modality in the field of medical education. Within the paramedic sphere, simulation is valuable in providing exposure to high-acuity, low occurrence incidents encountered rarely in practice, affording unique educational opportunities. Recognising this importance, this scoping review seeks to establish the contemporaneous evidence base for the use of simulation-based assessment in the context of paramedic education, systematically map the research done in this area and consider the implications for future educational programmes. A scoping review of peer, and non-peer reviewed literature across a broad range of medical literature databases for both published and grey material utilising previously published search filters for the paramedic field. The review was conducted aligned to the PRISMA Extension for Scoping Reviews checklist. Studies were selected based on relevance to the research question. Twenty four unique papers were identified, filtered via the application of inclusion and exclusion criteria to five included papers. The application of forward snowballing methodology revealed three additional papers included for appraisal. Thematic analysis of the eight papers revealed the domains of assessment acceptability and assessment validity as key considerations for the design and use of simulation-based assessment in the field. Simulation-based assessment has a role in paramedic education; additional research is necessary to empirically establish the validity and reliability of the modality in the field.