This case study investigated how experienced paramedics learn to navigate ethical decision-making in the field. This research is aligned with workplace experiential learning and with evolving international discussions of the changing roles, professional identity, and educational and policy needs of paramedics. Twenty-five experienced paramedics were interviewed, and the data analysis applied situational mapping and thematic and guided framework coding techniques. The findings indicate that during emergent situations, paramedics do not rely on formal educational knowledge to develop judgment in navigating ethical dilemmas beyond applying and honing technical skills. Instead, they rely on a combination of workplace experience, self-directed learning including personal reflection, and their immediate environmental context. Participants conveyed the importance of supervisors and trusted partners in maintaining an alternative to consult or debrief during emergent situations or shortly after ethical dilemmas occur. Participants discussed the use of integrated principles of empathy, beneficence, and accountability. Those participants who maintained an open awareness related to stress and trauma and toward integrating reflection and intentional practice into their work exhibited more nuanced expertise in handling ethical dilemmas and in their commitment to the professional growth.