Introduction: Acute rheumatic fever (ARF) and its successive partner, rheumatic heart disease (RHD), pose a serious pediatric health problem worldwide. Alarmingly, New Zealand is one of the largest contributors and has the highest number of ARI cases recorded internationally (Jaine, Baker, & Venugopal, 2008). This essay will discuss the pathophysiology and epidemiology of ARF and RHD. It will focus on the impact of this disease on Māori and Pacific Island children in particular, as ARF is almost exclusive within these ethnic groups (Atatoa-Carr, Bell & Lennon, 2008; Sopoaga, Buckingham & Paul, 2010). Additionally, the role paramedics play in acute AKI cases will be discussed; with a focus on how paramedics and other healthcare professionals can reduce the burden ARF places on New Zealand society. Pathophysiology: ARF arises from an autoimmune response to a common bacterial infection; Group A Streptococcus (GAS) (Jaine, Baker, & Venugopal, 2011). A phenomenon called molecular mimicry occurs, in which antibodies against M proteins present on GAS molecules interact with glycoprotein antigens present in the connective tissue of the heart and joints (Porth and Matfin, 2009). This autoimmune response can continue for weeks after the GAS infection has cleared the body and lead to irreversible damage to the connective tissues of the heart. Although the likelihood of developing AKI following untreated GAS infection is relatively low, the incidence of developing AKI following recurrent GAS infection is much higher (Porth and Matfin , 2009). Although the pathogenesis of AKI is not fully understood, there is a proven correlation between GAS infection and the development of ARF (Lennon, 2004). Porth & Maftin (2009) state that the...... middle of article ......Eumatic fever 1. Diagnosis, management and secondary prevention. Auckland: Author. Porth, C. and Matfin, G. (2009). Pathophysiology: Concepts of Altered Health States (8th ed.). Philadelphia, PA: Lippincott Williams and Wilkins. Remenyi, B., Carapetis, J., Wyber, R., Taubert, K. and Mayosi, BM (2013). World Heart Federation position statement on the prevention and control of rheumatic heart disease. Nature Reviews Cardiology, (10), 284-292. doi:10.1038/nrcardio.2013.34Sopoaga, F., Buckingham, K., & Paul, C. (2010). Causes of excess hospitalizations among Pacific people in New Zealand: implications for primary care. Journal of Primary Health Care, 2(2), 105.Steer, AC and 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.2009.09.011