This study investigated fatigue, sleep quality, mental health and physical activity in paramedic shiftworkers. Although limited, previous studies have established high fatigue levels and poor health in this sector from shiftwork rostering and occupational demands. A modified version of the Standard Shiftwork Index was completed by 342 paramedics (243 male and 98 females). Single sample t tests found significantly higher levels of fatigue, depression, anxiety, and stress, and significantly poorer sleep quality than reference samples. Paramedics also reported less physical activity than community samples. Depression and sleep quality explained the greatest amount of variance in fatigue scores, followed by level of exercise. No differences were detected in levels of depression or fatigue on the basis of gender. The findings suggest that ambulance paramedic shiftworkers are at particular risk for increased levels of fatigue and depression (regardless of age or gender) and poor quality sleep. Organisational intervention was suggested.