Acute rheumatic fever (ARF) is defined by Mosby (2010) as a systemic inflammatory disease that can develop with inadequate treatment of upper respiratory tract infections group A beta-hemolytic streptococcus. Repeated episodes of ARF can cause autoimmune reactions within 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 have been found to predominantly affect people living in developing countries. Steer and Carapetis (2009), linked this problem to worsening socioeconomic conditions, crowded households, inadequate healthcare and poor hygiene. By comparison, both ARF and RHD have been virtually eliminated in industrialized countries (Steer & Carapetis, 2009). It is therefore of considerable concern that the indigenous people of New Zealand are still heavily affected by ARF and RHD, potentially affecting 1 in 3 Māori and Pacific children with significant morbidity and mortality among young adults (The National Heart Foundation of New Zealand, 2007). Along with this statistic, this essay will review the pathophysiology and epidemiology of ARF and RHD in New Zealand. Additionally, the role of paramedics and the contributions paramedics could make to reduce the burden of ARF and RHD on New Zealand society will be brought up for discussion. Group A streptococcal pharyngitis (GAS) 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 polysaccharide structure of the cell wall. GAS is again classified based on the M type, which defines the virulence of the particular bacterium. The M protein was researched... halfway through the article...sician, 41(1-2), 31-35Steer, AC, & Carapetis, JR (2009). Acute rheumatic fever and rheumatic heart disease in indigenous populations. The 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.The 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., & 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