Introduction: Popularity of paramedicine undergraduate programs continues to rise in Australia and New Zealand. While this is important in the professionalisation of paramedicine, it has also raised a number of issues, particularly those surrounding the issue of national clinical placement standards and consistency between university providers. Therefore the purpose of this cross-sectional study was to investigate paramedicine student perceptions of the learning environment during their university studies. Methods: The Dundee Ready Education Environment Measure (DREEM) is a validated questionnaire that measures students' perceptions of the educational environment. Convenience sampling was used to recruit 682 undergraduate paramedicine students enrolled at five universities in Australia and New Zealand. Results: This study has investigated the education environment as perceived by paramedicine students and found that generally, students were satisfied with the education environment at their institution. There were 630 student participants from Australia and 52 from New Zealand. Conclusions: The DREEM questionnaire has highlighted significant differences between universities, which is not surprising considering the various ways that universities structure their paramedicine programs. These findings can be used to inform universities and ambulance services about these differences and to guide strategic planning to ensure that there is a more consistent approach to paramedicine education in Australia and New Zealand.