Background: Large-scale emergencies and mass-casualty incidents place considerable pressure on prehospital emergency services, demanding rapid clinical decisions, efficient resource utilization, and coordinated responses under uncertain and rapidly changing conditions. Paramedics play a critical role in initial casualty assessment, field triage, immediate stabilization, and the safe transfer of patients to definitive care. In Saudi Arabia, strengthening these capabilities is particularly relevant to the operational responsibilities of the Saudi Red Crescent Authority (SRCA) and the healthcare transformation objectives of Saudi Vision 2030. Methods: A narrative review approach was used to examine the evolving role of paramedics in disaster medicine and mass-casualty preparedness in Saudi Arabia. The review focused on prehospital triage, incident command, emergency resource allocation, interagency communication, advanced prehospital interventions, mass-gathering medical services, and the psychological and organizational challenges associated with high-intensity emergency operations. Findings: Effective disaster response depends on the integration of clinical competence, operational coordination, and organizational preparedness. Key priorities include accurate casualty prioritization, timely prehospital stabilization, efficient deployment of personnel and equipment, interoperable communication systems, and clearly defined command structures. Mass gatherings and prolonged incidents further highlight the need for adaptable response protocols, multidisciplinary collaboration, and appropriate psychological support for emergency personnel. Simulation-based education, standardized procedures, interagency exercises, and continuous performance evaluation represent important strategies for strengthening workforce readiness and operational resilience. Conclusion: Enhancing paramedic preparedness requires a coordinated approach that combines advanced clinical training, effective emergency governance, reliable communication infrastructure, and sustained collaboration among emergency response organizations. Aligning these priorities with Saudi Arabia's healthcare transformation objectives may strengthen prehospital service capacity, improve casualty management, and support more resilient responses to major emergencies. Further evaluation of training models, operational performance, and interagency preparedness is needed to identify effective strategies for improving disaster response outcomes.