Background/Objectives: Disaster medicine is frequently constrained by shortages of highly qualified medical personnel. Telemedicine may extend advanced expertise to less-qualified responders, but previous disaster telemedicine models have predominantly relied on physicians as remote consultants. This study compared patient care outcomes under telemedical support provided by experienced Paramedics with tele-physician support, conventional on-site physician care, and EMT-only care. Methods: A prospective, simulation-based, controlled quasi-experimental study was conducted during a 7.5-h mass casualty exercise in Hamburg, Germany. Seven treatment tents were assigned to four groups: on-site physician (CONT), EMT-only care (IV 1), tele-physician support (IV 2), and tele-Paramedic support (IV 3). Outcomes comprised time to first treatment order, indicated treatments addressed, analgesia management, and patient contact frequency by the most highly qualified team member. Results: A total of 151 simulated patients were included. Time to first treatment order did not differ significantly between groups (p = 0.09). The proportion of indicated treatments addressed differed significantly (p < 0.001), with rates of 56% in CONT, 8% in IV 1, 57% in IV 2, and 51% in IV 3. Analgesia was addressed in 68%, 7%, 59%, and 60% of patients with an indication, respectively (p < 0.001). Increasing pain intensity significantly increased the likelihood of analgesia in CONT, IV 2, and IV 3 but not in IV 1. Recorded patient contact frequencies were descriptively higher in the telemedicine groups, although contacts were operationally defined differently between telemedicine and non-telemedicine models. Conclusions: Tele-physician and tele-Paramedic support showed similar observed performance across selected outcomes to conventional physician-led care and substantially better rates of indicated treatments addressed and analgesia provision than EMT-only care. The findings indicate that experienced Paramedics may represent a valuable additional resource for telemedical disaster response. Larger studies are needed to confirm these results, define the appropriate scope of practice, and evaluate tiered consultation models in which tele-Paramedics provide first-line support and tele-physicians remain available for escalation of complex cases.