Jordan James Fineanganofo did not attend Parramatta Bail Court on Saturday where his lawyer, Javid Faiz, did not apply for bail and it was formally refused.
Steven Tougher, a 29-year-old father of one, was stabbed outside Campbelltown McDonald's while he and a workmate took a break towards the end of their night shift about 5.30am on Friday.
The colleague activated a duress alarm, sparking a police response in which a man wielding a knife was tasered and arrested.
Homicide detectives later charged Fineanganofo with murder.
Outside court Mr Faiz told reporters his client had mental health issues and was in the hospital at Long Bay jail, but he understood the charges.
"I've explained the offences and he is fully aware of the gravity," Mr Faiz said.
"Police are currently at his bedside due to his mental health issues."
Fineanganofo is due to reappear in court on June 28.
Mr Tougher, who had been working for the ambulance service for about a year, was helped by witnesses at the scene but died shortly after arriving at Liverpool Hospital.
"The surgeons ... worked valiantly, albeit futile in this instance, to support our colleague," NSW Ambulance Commissioner Dominic Morgan said.
The slain man's father said his son had always wanted to be a paramedic and had just been posted to southwest Sydney, Dr Morgan said.
"I've met with the family and as you can imagine personally, it's very difficult to process."
A GoFundMe page set up on Friday afternoon sought support for the paramedic's partner Madison who is expecting a second child.
"Madison is due to have her second child in a few short weeks," the page description read.
It is understood the couple intended raising their family in southwestern Sydney after he recently landed a posting in the area.
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