Ambulance Victoria is a "boys' club" where white, able-bodied men are favoured for senior roles, an independent review has found.
The Victorian Equal Opportunity and Human Rights Commission on Thursday released the second part of its review into workplace equality within the organisation.
The first review released in November found bullying and harassment deeply entwined in Ambulance Victoria's culture, with employees being raped and driven to self harm.
According to the latest volume, ongoing structural and attitude barriers are impeding access to promotion and progression for female and diverse workers.
Ambulance Victoria stereotyped paramedic job applicants as "white, male, of able-body and mind, confident, stoic, and the family breadwinner" in recruitment processes, limiting opportunities for those who did not fit that mould.
It has accepted the commission's 19 latest recommendations including advancing equal pay, disrupting stereotypes, removing career advancement barriers and embedding flexibility into long-term workforce planning.
The report revealed some job openings, including senior roles, were not required to be advertised and some staff were instead tapped on the shoulder to fill those vacancies.
"It's very much a boys' club," a review participant said.
"You'll probably hear lots of stories over the next few weeks around nepotism and people getting promoted because they're mates with the guy who's in charge."
Sick leave patterns were also considered alongside performance for employees wanting to advance.
Another review interviewee said a good resume meant nothing when it came to promoting staff.
"They'll pick who they want, it's notoriously corrupt," they said.
Acting Ambulance Victoria CEO Libby Murphy said the corruption assessment was worrying.
"It concerns me that people think that way," she told reporters, conceding the service had likely lost staff because the poor internal behaviour.
The commission called on Ambulance Victoria to proactively increase diversity and the number of women in senior roles, although no specific targets have been set.
"You can't be what you can't see. It's important to have diversity at all levels," Victorian Equal Opportunity and Human Rights Commissioner Ro Allen said.
Operational staff found pervasive and negative attitudes toward flexible work applications, while others reported no comprehensive strategy for transition to retirement.
Ms Allen noted women had only worked within Ambulance Victoria for the past 35 years and said a major structural overhaul would not be a quick fix.
"The structure has been set up for a different time and for men," she said.
"It's not about band-aiding and sticking on things to the structure ... it's about pulling down the structure and starting again so that Ambulance Victoria is exclusive for everybody."
The first part of the VEOHRC report made 24 recommendations for change after it found more than half of 2163 survey respondents were bullied and 47 per cent discriminated against.
