Introduction: The potential national registration of paramedics is a significant issue. Despite widespread support of paramedics joining other registered health practitioners under the National Registration and Accreditation Scheme, New South Wales continues to oppose. Methods: This paper considers the New South Wales submission to the Senate Committee’s inquiry into the establishment of a national registration system for Australian paramedics. It evaluates the reasons for New South Wales Health’s opposition to national registration. Results: New South Wales Health’s reasons for opposing national paramedic registration includes the cost to implement a registration scheme, the desire to maintain vocational entry to employment and the purported efficiency of their current regulatory system. Conclusion: NSW Health’s position fails to address the challenges of employer-based regulation and the significant public protection benefit of national statutory regulation.