Background: The dynamic and uncontrolled nature of paramedic work frequently exposes these workers to physical and psychological injury. Often paramedic injury rates are estimated based on national injury surveillance data or compensation databases. These data sources tend to only capture cases of a more serious nature and overlook the broader factors that contribute to injury. This limits our understanding of the true burden of paramedic injury and the characteristics associated with increased injury severity. Objectives: To describe the incidence and proportions of paramedic occupational injury in Victoria, Australia, and to determine the injury-related characteristics associated with lost time from work. Methods: A retrospective analysis of paramedic injury report data from the single state-wide ambulance service in Victoria, Australia–Ambulance Victoria. Injuries reported between 1 January 2015 and 30 June 2020 were included. Chi-square tests of independence were used to explore shift and injury characteristic variables that may be associated with time lost from work. Results: Over the study period, 7,591 paramedic injuries were reported that met the inclusion criteria, of which 2,124 (28%) resulted in lost time from work. The cumulative incidence of paramedic injury was 333.8 injuries per 1,000 FTE workers per year, and the rate of lost time injury was 93.0 per 1,000 FTE workers per year. Musculoskeletal injuries were the most frequently reported injury type irrespective of lost time status. Manual handling followed by psychological stressors were the two leading mechanisms of injury based on incidence. Psychological injury was associated with lost time from work (X2= 384.2, p < 0.001). Conversely, injury to the head and neck (X2= 7.5, p = 0.006), and upper limb injuries (X2= 104.5, p < 0.001), were more strongly associated with no lost time from work. Conclusions: Paramedics working in Victoria have a higher rate of work-related injury than other Australian workers. Injury-related factors that are often overlooked, such as time, shift type, location, and injury characteristics, all contribute to an increased risk of lost time injury. An understanding of the factors that contribute to an increase in injury severity may facilitate the development and targeting of appropriate interventions.