Acute rheumatic fever (ARI) is defined by Mosby (2010) as a systemic inflammatory disease that develops with inadequate treatment of respiratory tract infections higher group A beta-hemolytic streptococci. Repeated episodes of AKI can cause autoimmune reactions in the heart, which in turn inflict damage to the heart muscle and heart valves, a condition called rheumatic heart disease (RHD) (Mosby, 2010). Cases of ARF and RDH mainly affect people living in developing countries. Steer and Carapetis (2009) linked this problem to declining socio-economic conditions, household overcrowding, inadequate health care and poor hygiene. In comparison, ARF and RHD have been virtually eliminated in industrialized countries (Steer & Carapetis, 2009). It is therefore of great concern that New Zealand's indigenous populations remain highly affected by ARF and RHD, potentially affecting 1 in 3 Māori and Pacific children with significant morbidity and mortality in young adults (The National Heart Foundation of New Zealand, 2007). In conjunction with this statistic, this essay will examine the pathophysiology and epidemiology of ARF and RHD in New Zealand. Additionally, the role of paramedics and the contributions that paramedics could make to reduce the burden of ARF and RHD on New Zealand society will be presented in the discussion. Group A streptococcal (GAS) pharyngitis infections have a strong correlation with ARF and RHD. Group A Streptococcus (GAS) is a derivative of beta-hemolytic streptococci, based on the difference in the structure of cell wall polysaccharides. GAS is again classified based on its M type, which defines the virulence of the particular bacteria. The M protein was searched...... middle of article ......sician, 41(1-2), 31-35Steer, AC, & Carapetis, JR (2009). Acute rheumatic fever and rheumatic heart disease in indigenous populations. Pediatric Clinics of North America, 56(6), 1401-1419. doi:10.1016/j.pcl.2009.09.011St John New Zealand. (2013). Clinical practice guidelines 2013-2015. Wellington, New Zealand: St John New Zealand. National Heart Foundation of New Zealand (Heart Foundation), (2007). A summary of the New Zealand guidelines for rheumatic fever. Retrieved February 27, 2014 from http://www.heartfoundation.org.nz/Webb, R. and Wilson, N. (2013). Rheumatic fever in New Zealand. Journal of Pediatrics and Child Health, 49(3), 179-184. doi:10.1111/j.1440-1754.2011.02218.xWilson, N. (2010). Rheumatic heart disease in indigenous populations - New Zealand experience. Heart, Lung and Circulation, 19(5), 282-288. doi:10.1016/j.hlc.2010.02.021