Digital Adoption in Paramedicine: A Scoping Review Protocol

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However, a paradox exists between studies demonstrating the many benefits of Digital Systems in Healthcare and the volume of literature detailing end-user clinician acceptance issues. The problems encountered when designing, developing, and operating complex technologies are not limited to technical or engineering issues. Technology implemented in organizations does not stand alone but is part of a broader socio-technical system, spanning divergent groups of people, each with their own cultural dynamics and distinct ways of working. Paramedics have personality traits that may be advantageous in their career, but research is needed to determine how these affect their ability to accept new technologies. Methods This scoping review will be conducted according to Joanna Briggs Institute (JBI) guidelines has been registered with the Open Science Foundation (OSF). Electronic searches for relevant publications will be conducted in MEDLINE, PubMed, Scopus, CINHAL, IEEE, ACM, PsycINFO, Web of Science. Global English language literature related to digital acceptance in Emergency Medical Services after 2004 will be included. Results The process of extraction, analysis, and presentation will be conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Conclusions This scoping review will collect meta-data on Behavioural, Cognitive, and Environmental factors common to the dominant prevailing digital acceptance theories to determine if any would be effective in explaining the experience of implementing technology with Paramedics and Emergency Medical Technicians (EMTs) working in Emergency Medical Services. 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HRB Open Res 2025, 8 :96 ( https://doi.org/10.12688/hrbopenres.14229.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Study Protocol Digital Adoption in Paramedicine: A Scoping Review Protocol [version 1; peer review: 1 approved, 3 approved with reservations] Brian McKeon https://orcid.org/0009-0007-2240-5526 1,2 , Dr. Eoin Coughlan 1 , Dr. Siobhan Masterson https://orcid.org/0000-0002-3003-4792 1-3 , Dr. Karen Neville 4 , Prof. Conor Deasy 1,5 Brian McKeon https://orcid.org/0009-0007-2240-5526 1,2 , Dr. Eoin Coughlan 1 , [...] Dr. Siobhan Masterson https://orcid.org/0000-0002-3003-4792 1-3 , Dr. Karen Neville 4 , Prof. Conor Deasy 1,5 PUBLISHED 28 Aug 2025 Author details Author details 1 Department of Emergency Medicine and Pre-Hospital Care, University College Cork School of Medicine, Brookfield, College Road,, University College Cork, T12 AK54, Ireland 2 National Ambulance Service of Ireland, Rivers Building, Tallaght, Dublin, D24 XNP2, Ireland 3 School of Medicine, University of Galway, Clinical Science Institute, Discipline of General Practice, University of Galway, H91 TK33, Ireland 4 Cork University Business School, Business Information Systems, University College Cork, O'Rahilly Building, College Road., Cork, Ireland 5 Department of Emergency Medicine, Cork University Hospital, Wilton, Cork, T12 DFK4, Ireland Brian McKeon Roles: Conceptualization, Investigation, Methodology, Project Administration, Writing – Original Draft Preparation, Writing – Review & Editing Dr. Eoin Coughlan Roles: Methodology, Supervision, Writing – Review & Editing Dr. Siobhan Masterson Roles: Methodology, Supervision, Writing – Review & Editing Dr. Karen Neville Roles: Methodology, Supervision, Writing – Review & Editing Prof. Conor Deasy Roles: Methodology, Supervision, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS Abstract Background Since the late 1980s there’s been a growing body of knowledge that applies behavioural and cognitive theories to understanding how people accept new technologies. However, a paradox exists between studies demonstrating the many benefits of Digital Systems in Healthcare and the volume of literature detailing end-user clinician acceptance issues. The problems encountered when designing, developing, and operating complex technologies are not limited to technical or engineering issues. Technology implemented in organizations does not stand alone but is part of a broader socio-technical system, spanning divergent groups of people, each with their own cultural dynamics and distinct ways of working. Paramedics have personality traits that may be advantageous in their career, but research is needed to determine how these affect their ability to accept new technologies. Methods This scoping review will be conducted according to Joanna Briggs Institute (JBI) guidelines has been registered with the Open Science Foundation (OSF). Electronic searches for relevant publications will be conducted in MEDLINE, PubMed, Scopus, CINHAL, IEEE, ACM, PsycINFO, Web of Science. Global English language literature related to digital acceptance in Emergency Medical Services after 2004 will be included. Results The process of extraction, analysis, and presentation will be conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Conclusions This scoping review will collect meta-data on Behavioural, Cognitive, and Environmental factors common to the dominant prevailing digital acceptance theories to determine if any would be effective in explaining the experience of implementing technology with Paramedics and Emergency Medical Technicians (EMTs) working in Emergency Medical Services. READ ALL READ LESS Keywords Paramedicine, Paramedic, Emergency Medical Technician, EMT, Emergency Medical Services, Digital Acceptance, Digital Adoption, Technology Corresponding Author(s) Brian McKeon ( [email protected] ) Close Corresponding author: Brian McKeon Competing interests: Brian McKeon is currently employed by the National Ambulance Service of Ireland. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2025 McKeon B et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: McKeon B, Coughlan DE, Masterson DS et al. Digital Adoption in Paramedicine: A Scoping Review Protocol [version 1; peer review: 1 approved, 3 approved with reservations] . HRB Open Res 2025, 8 :96 ( https://doi.org/10.12688/hrbopenres.14229.1 ) First published: 28 Aug 2025, 8 :96 ( https://doi.org/10.12688/hrbopenres.14229.1 ) Latest published: 28 Aug 2025, 8 :96 ( https://doi.org/10.12688/hrbopenres.14229.1 ) Introduction Digital acceptance in paramedicine Since the late 1980s there’s been a growing body of knowledge that applies behavioural and cognitive theories to understanding how people accept new technologies. Models were developed, and have been applied to healthcare in general, but an initial search would indicate that there is limited research into the socio-technical, cognitive, and behavioural factors that determine how Paramedics accept new technologies. The goal of the proposed scoping review is to analyse the current literature on digital acceptance in Paramedicine to determine if any prevalent models are appropriate to form the basis for future research. Impact of new technologies in healthcare There are many benefits to the implementation of technology in commercial organizations, including productivity growth, organizational expansion, efficiency, effectiveness, competitiveness etc. 1 . In healthcare organizations, the implementation of technology leads to quantitative benefits through increased revenue or averted costs. It can also lead to many qualitative benefits including improved quality of care, patient safety, and improved coordination of care 2 . Despite an abundance of literature pertaining to the benefits of technology in healthcare, there are also many studies that describe difficult implementations. Topaz et al . (2017) surveyed 469 nurses from 45 countries and found that two thirds of participants reported their current recording systems are not suitable for nursing clinical practice 3 , 4 . Software systems have been linked to physician burnout 5 and Doctors describe how these technologies have created a ”...monster of incomprehensibility” 6 . Design and features fail to cross cultural boundaries and there is a limited number of major international companies that dominate competitive processes 7 . A paradox exists between studies demonstrating the many benefits of Digital Systems in Healthcare 1 , 2 and the volume of literature detailing end-user clinician acceptance issues 3 – 6 . Socio-technical systems in healthcare The problems encountered when designing, developing, and operating complex technologies are not limited to technical or engineering issues. Technology implemented in organizations does not stand alone but is part of a broader socio-technical system, spanning divergent groups of people, each with their own cultural dynamics and distinct ways of working 8 , 9 . For improved acceptance, systems engineering and technology implementation may benefit from an understanding of this broader socio-technical perspective. Healthcare work is highly complex and takes place across primary, secondary and tertiary care sectors, in private or public settings. Users are from diverse professional groups and services, some in patient contact (including doctors, nurses, and allied health professionals) and others are indirectly involved (including health administrators, epidemiologists, health economists) 10 . It is unsurprising that large-scale technology implementations (such as Electronic Health Records) which look to encompass broad aspects of healthcare encounter issues with end-user acceptance. To better understand individuals or groups behaviour, and the factors that impact successful technology implementations, researchers have created digital acceptance models. An Overview of Digital Acceptance Modelling . Since the “Cognitive Revolution” 11 between the 1950s and 1970s, with the shift in focus to internal mental processes and developments in the understanding of information processing, cognitive theories have been the bedrock of the development of technology acceptance models. Fishbein & Ajzen’s Theory of Reasoned Action (1975) and Bandura’s Social Cognitive Theory (1977) became the foundation for the development of the first technology acceptance models 12 , 13 . In the 1980s there was limited empirical insight into users' involvement in the design and implementation of information systems. In 1989 Davis embarked on the development of a Technology Acceptance Model (TAM) by framing the processes mediating the relationship between information system characteristics and actual system use 14 . According to TAM, acceptance is a three-stage process, whereby external factors (system design features) trigger cognitive responses (”Perceived Ease of Use” and ”Perceived Usefulness”), which in turn form an affective response (attitude toward using technology/intention), influencing Use Behaviour 14 , 15 . Further work by Venkatesh and Davis in 2000, determined that ”Perceived Usefulness” was the strongest predictor of intention to use. They investigated the key antecedents of ”Perceived Usefulness” and created TAM2 which incorporated new constructs and moderators: subjective norm, image, job relevance, output quality, result demonstrability, experience, and voluntariness 16 . Subsequent to this Venkatesh identified a number of limitations with TAM, TAM2 and its variants. He analysed all the dominant technology models and created the Unified Theory of Acceptance and Use of Technology (UTAUT). This unified model suggested that the actual use of technology is determined by behavioural intention. The perceived likelihood of adopting the technology is dependent on the direct effect of four key constructs: Performance Expectancy, Effort Expectancy, Social Influence, and Facilitating Conditions 17 . Venkatesh continued to refine and develop UTAUT in response to critiques or in the course of pursuing new research opportunities. The limited external validity of the model drove further research to add additional determinants of behaviour, such as trust, self-efficacy, computer self-efficacy, innovativeness, perceived threats, and perceived risk 18 , 19 . The model was also extended by introducing new moderating effects, such as income, location, culture, and technology readiness 20 , 21 . TAM, UTAUT, and their variants are some of the most established models in literature 22 . The models and variants evolved from theories with common antecedent cognitive, behavioral, and environmental factors. Therefore, to determine if one of these models significantly explains the experience implementing technologies for Paramedics in EMS organizations, it is proposed to collect meta-data on factors common to all models, including their positive or negative impact on digital acceptance. Understanding paramedic behavioural and cognitive traits When researching how digital acceptance models apply to Paramedicine, it’s not only important to understand the constructs and moderating factors of the models, but also particular behavioural or cogitative traits specific to Paramedics. Globally, EMS have a broad range of clinicians who provide pre-hospital treatment to stabilize and transport patients to appropriate secondary or tertiary healthcare facilities. In Ireland, the vast majority of EMS services are Paramedic-provided, with a small proportion of EMTs also providing direct patient care. Paramedics have been shown to “display the ability to problem solve, critically analyse, perform complex reasoning, and work closely with the patient as well as in a group. They are adept at rapidly forming clinical impressions in the critically ill with minimal information, and are able to modulate their interventions accordingly, while simultaneously continuing to gather data as they perform life-saving measures” 23 . Using a modified version of the Hamburg Personality Inventory (HPI), Pajonk et al . (2010) found that Paramedics score high in Contentiousness, Sensation Seeking, Resiliency, and Empathy. They have also been shown to score low in Extroversion, and Neuroticism (important in mitigating burnout) 24 , 25 . These personality traits may be advantageous in their career, but further research is needed to examine how they affect the ability to accept new technologies, which may require different skills and expertise from their core profession. Aims and objectives It is proposed to conduct a scoping review of literature related to the implementation of Technology in EMS. The primary goal of the review is: To determine if any of the current models of Digital Acceptance would be effective for Paramedics or EMTs working in Emergency Medical Services. The rationale for conducting a scoping review Scoping Reviews are conducted when it may be difficult to produce a critically appraised and synthesized answer to the question 26 . Preliminary searches have found a paucity of literature related to Digital Acceptance in Paramedicine. Scoping Reviews are also used to identify common characteristics or concepts within the literature 27 . Analysing the literature using the key concepts underpinning the Behavioural, Cognitive, and Environmental roots of mainstream Digital Acceptance Models may elicit a general compatibility with existing models or alternatively allow us to understand where current models are deficient with the domain of paramedicine. Rationale for limiting population to paramedics and EMTs In Europe, and globally, there is a wide variety in the clinical specialities in an Emergency Ambulance who respond to calls 28 . The aim of the proposed scoping review is to determine if a digital acceptance model can be found that could be researched in the National Ambulance Service of Ireland. As Ireland is predominantly a Paramedic and EMT based service, we will limit the search to sources that describe technology implementation for those specialities. Pajonk et al . found that ”the personality types of emergency physicians and paramedics are not homogeneous” 25 . A scoping review conducted by Mason et al ., 2020, discovered conflicting results when attempting to ascertain if Nurses (including Emergency Nurses) and Paramedics had similar dominant personality types 29 . Therefore, this scoping review will be limited to Paramedics and EMTs to remove any confounding data introduced by other professions. Methods This scoping review will be conducted according to Joanna Briggs Institute (JBI) guidelines 27 has been registered with the Open Science Foundation (OSF). Eligibility criteria The PCC Framework (population, concept, and context) is “recommended by JBI as a guide to construct clear and meaningful objectives and eligibility criteria” 30 . - Population: ○ Paramedics and EMTs - Concept: ○ Studies that describe or evaluate Technology implementations (not proposed or theoretical) that affect clinical practice, experience, or perception of Technology that is used in relation to patient care. - Context: ○ Paramedics and EMTs in Emergency, Community Paramedicine, or Pre-Hospital Care Services, in any country, run by an Emergency Medicine Service Search method Electronic searches for relevant publications will be conducted in MEDLINE, PubMed, Scopus, CINHAL, IEEE, ACM, PsycINFO, Web of Science. The databases and search strings were designed with the assistance of an expert librarian (see Table 1 ). Table 1. Search Strategy. Population (Paramedic or Paramedicine or Paramed* or EMT or “Emergency Medical Technician”) Concept (“Emergency Medical Service” or EMS or Ambulance or Helicopter or "Critical Care" or Retrieval or "Rapid Response" or "Alternative Pathway") AND (Digital or Adoption or Computer or Technology or Telemetry or Device or App* or Software or Hardware) AND (Adoption or Change or Transition or Upgrade or Implementation or Project) Context Year > 2004 English Language Screening All references will be imported into reviewing software and duplicates removed. The primary reviewer will screen the title and abstract in accordance with the eligibility criteria. Independent screening will be carried out by the second reviewer, with any disagreements discussed and resolved by the third reviewer. Grey literature (conference abstracts, government reports, private company reports, web articles etc.) will not be included in the review. The aim of the scoping review is to determine common characteristics or concepts in the literature, so there is a significant risk that the effect of publication (and other) bias from grey literature would confound the data 31 . There is a large variance in the number and structure of EMS organizations in different countries. EMS may be public or private, national or regional, and have different protocols and standards 28 . As each organization generally serves a large population, there are a limited number of EMS globally, therefore English language papers from any country will be included in the scoping review. Data extraction The process of extraction, analysis, and presentation will be conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) 30 . Data will be extracted from all sources by the primary reviewer. The second reviewer will perform an audit of 10% of the sources. The third reviewer will perform an audit of 10% of the sources (excluding the second reviewers’ sources). Data synthesis Data will be populated using the following metadata fields: Year Country Population in Study ○ Staff Type ▪ Paramedic ▪ Advanced/Specialist Paramedic ▪ Emergency Medical Technician ▪ Combination of staff types ○ Number of staff studied Technology Type (Software, Device, Hardware, All) The following headings will be analysed in terms of their positive (+) or negative (-) impact on Technology Acceptance. Constructs: ○ Performance Expectancy (+/-) ▪ Including: Perceived Usefulness, Extrinsic Motivation, Job-Fit, Relative Advantage, Outcome Expectations ○ Effort Expectancy (+/-) ▪ Including: Perceived Ease of Use, Complexity, Ease of Use ○ Social Influence (+/-) ▪ Including: Subjective Norm, Social Factors, Image ○ Facilitating Conditions (+/-) ▪ Including: Perceived Behavioural Control, Facilitating Conditions, Compatibility ○ Organisational Environment (+/-) ▪ Including: Macro Organisational Change, National Policy, Industrial Relations Environment ○ Paramedic Traits (+/-) ▪ Including: High: Contentiousness, Sensation Seeking, Resiliency, Empathy. Low: Extroversion and Neuroticism Moderators: ○ Gender ○ Age ○ Experience ○ Voluntariness of Use Protocol registration This protocol has been registered with the Open Science Framework (OSF) Study status The current status of the review is that formal screening of search results against the eligibility criteria is ongoing. Data (and Software) availability No data is associated with this article. Reporting guidelines (if applicable) Not applicable Faculty Opinions recommended References 1. Tarutė A, Gatautis R: ICT impact on SMEs performance. Procedia Soc Behav Sci. 2014; 110 : 1218–1225. Publisher Full Text 2. Menachemi N, Brooks RG: Reviewing the benefits and costs of electronic health records and associated patient safety technologies. J Med Syst. 2006; 30 (3): 159–168. PubMed Abstract | Publisher Full Text 3. Topaz M, Ronquillo C, Peltonen LM, et al. : Nurse informaticians report low satisfaction and multi-level concerns with electronic health records: results from an international survey. AMIA Annu Symp Proc. 2017; 2016 : 2016–2025. PubMed Abstract | Free Full Text 4. Staggers N, Elias BL, Makar E, et al. : The imperative of solving nurses’ usability problems with health information technology. J Nurs Adm. 2018; 48 (4): 191–196. PubMed Abstract | Publisher Full Text 5. Collier R: Rethinking EHR interfaces to reduce click fatigue and physician burnout. CMAJ. 2018; 190 (33): E994–E995. PubMed Abstract | Publisher Full Text | Free Full Text 6. Gawande A: Why doctors hate their computers. The New Yorker. New York, November 05, 2018; Accessed: March 24, 2025. Reference Source 7. Allen A: Lost in translation: epic goes to Denmark. Politico. Copenhagen, September 06, 2019; Accessed: March 24, 2025. Reference Source 8. Hofstede G: Dimensionalizing cultures: the hofstede model in context. Online Readings in Psychology and Culture. 2011; 2 (1). Publisher Full Text 9. Baxter G: Socio-technical systems engineering handbook. University of St Andrews, Accessed: March 31, 2025. Reference Source 10. Fitzpatrick G, Ellingsen G: A review of 25 years of CSCW research in healthcare: contributions, challenges and future agendas. Comput Supported Coop Work. 2013; 22 (4–6): 609–665. Publisher Full Text 11. Gotlib IH: Information processing and psychopathology. International Encyclopedia of the Social & Behavioral Sciences. 2001; 7456–7460. Publisher Full Text 12. Bandura A: Social learning theory. Prentice-Hall, 1971. Reference Source 13. Fishbein M, Ajzen I: Belief, attitude, intention, and behavior: an introduction to theory and research. Reading, Mass: Addison-Wesley Pub. Co., 1975. 14. Davis FD: Perceived usefulness, perceived ease of use and user acceptance of information technology. MIS Q. 1989; 13 (3): 319–340. Publisher Full Text 15. Davis FD: User acceptance of information technology: system characteristics, user perceptions and behavioral impacts. Int J Man Mach Stud. 1993; 38 (3): 475–487. Publisher Full Text 16. Venkatesh V, Davis FD: A theoretical extension of the technology acceptance model: four longitudinal field studies. Manage Sci. 2000; 46 (2): 186–204. Publisher Full Text 17. Venkatesh V, Morris MG, Davis GB, et al. : User acceptance of information technology: toward a unified view. MIS Q. 2003; 27 (3): 425–478. Publisher Full Text 18. Martins C, Oliveira T, Popovič A: Understanding the Internet banking adoption: a unified theory of acceptance and use of technology and perceived risk application. Int J Inf Manage. 2014; 34 (1): 1–13. Publisher Full Text 19. Slade E, Williams M, Dwivedi Y, et al. : Exploring consumer adoption of proximity mobile payments. J Strat Mark. 2015; 23 (3): 209–223. Publisher Full Text 20. Im Il, Hong S, Kang MS: An international comparison of technology adoption: testing the UTAUT model. Inform Manage. 2011; 48 (1): 1–8. Publisher Full Text 21. Borrero JD, Yousafzai SY, Javed U, et al. : Perceived value of Social Networking Sites (SNS) in students’ expressive participation in social movements. J Res Interact Mark. 2014; 8 (1): 56–78. Publisher Full Text 22. Marikyan D, Papagiannidis S, Stewart G: Technology acceptance research: meta-analysis. J Inf Sci. 2023. Publisher Full Text 23. Perona M, Rahman MA, O’Meara P: Paramedic judgement, decision-making and cognitive processing: a review of the literature. Australas J Paramed. 2019; 16 : 1–12. Publisher Full Text 24. Mason R, Roodenburg J, Williams B: Personality and vocational interest typologies associated with better coping and resilience in paramedicine: a review of two models. Paramedicine. 2024; 21 (1): 36–44. Publisher Full Text 25. Pajonk FG, Andresen B, Schneider-Axmann T, et al. : Personality traits of emergency physicians and paramedics. Emerg Med J. 2011; 28 (2): 141–146. PubMed Abstract | Publisher Full Text 26. Munn Z, Peters MDJ, Stern C, et al. : Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Med Res Methodol. 2018; 18 (1): 143. PubMed Abstract | Publisher Full Text | Free Full Text 27. Peters MDJ, Godfrey CM, Khalil H, et al. : Guidance for conducting systematic scoping reviews. Int J Evid Based Healthc. 2015; 13 (3): 141–146. PubMed Abstract | Publisher Full Text 28. Bos N, Krol M, Veenvliet C, et al. : Ambulance care in Europe: organization and practices of ambulance services in 14 European countries. Accessed: Apr. 06, 2025. Reference Source 29. Mason R, Roodenburg J, Williams B: What personality types dominate among nurses and paramedics: a scoping review? Australas Emerg Care. 2020; 23 (4): 281–290. PubMed Abstract | Publisher Full Text 30. Pollock D, Peters MDJ, Khalil H, et al. : Recommendations for the extraction, analysis, and presentation of results in scoping reviews. JBI Evid Synth. 2023; 21 (3): 520–532. PubMed Abstract | Publisher Full Text 31. Rothstein HR, Sutton AJ, Borenstein M: Publication bias in meta-analysis: prevention, assessment and adjustments. 2006; 1–356. Publisher Full Text Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 28 Aug 2025 ADD YOUR COMMENT Comment Author details Author details 1 Department of Emergency Medicine and Pre-Hospital Care, University College Cork School of Medicine, Brookfield, College Road,, University College Cork, T12 AK54, Ireland 2 National Ambulance Service of Ireland, Rivers Building, Tallaght, Dublin, D24 XNP2, Ireland 3 School of Medicine, University of Galway, Clinical Science Institute, Discipline of General Practice, University of Galway, H91 TK33, Ireland 4 Cork University Business School, Business Information Systems, University College Cork, O'Rahilly Building, College Road., Cork, Ireland 5 Department of Emergency Medicine, Cork University Hospital, Wilton, Cork, T12 DFK4, Ireland Brian McKeon Roles: Conceptualization, Investigation, Methodology, Project Administration, Writing – Original Draft Preparation, Writing – Review & Editing Dr. Eoin Coughlan Roles: Methodology, Supervision, Writing – Review & Editing Dr. Siobhan Masterson Roles: Methodology, Supervision, Writing – Review & Editing Dr. Karen Neville Roles: Methodology, Supervision, Writing – Review & Editing Prof. Conor Deasy Roles: Methodology, Supervision, Writing – Review & Editing Competing interests Brian McKeon is currently employed by the National Ambulance Service of Ireland. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (1) version 1 Published: 28 Aug 2025, 8:96 https://doi.org/10.12688/hrbopenres.14229.1 Copyright © 2025 McKeon B et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics VIEWS $counts.viewCount downloads Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article McKeon B, Coughlan DE, Masterson DS et al. Digital Adoption in Paramedicine: A Scoping Review Protocol [version 1; peer review: 1 approved, 3 approved with reservations] . HRB Open Res 2025, 8 :96 ( https://doi.org/10.12688/hrbopenres.14229.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 28 Aug 2025 Views 0 Cite How to cite this report: Davis K. Reviewer Report For: Digital Adoption in Paramedicine: A Scoping Review Protocol [version 1; peer review: 1 approved, 3 approved with reservations] . HRB Open Res 2025, 8 :96 ( https://doi.org/10.21956/hrbopenres.15650.r52429 ) The direct URL for this report is: https://hrbopenresearch.org/articles/8-96/v1#referee-response-52429 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 16 Jan 2026 Kimberley Davis , NSW Ambulance, New South Wales, Australia Approved with Reservations VIEWS 0 https://doi.org/10.21956/hrbopenres.15650.r52429 Given the rapidly-evolving digital health environment, this represents an important body of work which may inform jurisdictional ambulance service implementation of new technologies amongst their workforce. Introduction The technology being discussed is not really defined. ... Continue reading READ ALL Given the rapidly-evolving digital health environment, this represents an important body of work which may inform jurisdictional ambulance service implementation of new technologies amongst their workforce. Introduction The technology being discussed is not really defined. What kinds of things are the authors talking about? The main one it seems is eMR. EMT is provided as an acronym by not defined in-text. Obvious to those in the field but not elsewhere. Same with EMS. Have the authors defined the environment? Prehospital, critical care, or other relevant retrieval terminology is not used. Please expand. Methods Overall Methods are sound; limiting to paramedics/EMTs rather than other clinician types is appropriate as the authors outline. Why after 2004? Presumably not including 2004? Population – what about community or volunteer paramedics? Are road only paramedics/services being evaluated, what about aeromedical retrieval? Is the rationale for, and objectives of, the study clearly described? Partly Is the study design appropriate for the research question? Yes Are sufficient details of the methods provided to allow replication by others? Yes Are the datasets clearly presented in a useable and accessible format? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Prehospital care, Ambulance service, health service research I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Davis K. Reviewer Report For: Digital Adoption in Paramedicine: A Scoping Review Protocol [version 1; peer review: 1 approved, 3 approved with reservations] . HRB Open Res 2025, 8 :96 ( https://doi.org/10.21956/hrbopenres.15650.r52429 ) The direct URL for this report is: https://hrbopenresearch.org/articles/8-96/v1#referee-response-52429 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Nudell N. Reviewer Report For: Digital Adoption in Paramedicine: A Scoping Review Protocol [version 1; peer review: 1 approved, 3 approved with reservations] . HRB Open Res 2025, 8 :96 ( https://doi.org/10.21956/hrbopenres.15650.r51780 ) The direct URL for this report is: https://hrbopenresearch.org/articles/8-96/v1#referee-response-51780 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 06 Jan 2026 Nikiah Nudell , The Paramedic Foundation, Duluth, USA Approved with Reservations VIEWS 0 https://doi.org/10.21956/hrbopenres.15650.r51780 This is an interesting question that should yield results that are of interest. The authors should consider including an additional metadata field to capture the domain of practice (it does not appear that the organizational environment is intended for this ... Continue reading READ ALL This is an interesting question that should yield results that are of interest. The authors should consider including an additional metadata field to capture the domain of practice (it does not appear that the organizational environment is intended for this purpose). Technology used in daily life (e.g., mobile phones) may have different implications than clinical equipment that is highly regulated (e.g., defibrillators), which may then differ from technology used for operations or decision-making. Is the rationale for, and objectives of, the study clearly described? Yes Is the study design appropriate for the research question? Partly Are sufficient details of the methods provided to allow replication by others? Yes Are the datasets clearly presented in a useable and accessible format? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: paramedicine, machine learning, public policy I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Nudell N. Reviewer Report For: Digital Adoption in Paramedicine: A Scoping Review Protocol [version 1; peer review: 1 approved, 3 approved with reservations] . HRB Open Res 2025, 8 :96 ( https://doi.org/10.21956/hrbopenres.15650.r51780 ) The direct URL for this report is: https://hrbopenresearch.org/articles/8-96/v1#referee-response-51780 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Mordaunt DA. Reviewer Report For: Digital Adoption in Paramedicine: A Scoping Review Protocol [version 1; peer review: 1 approved, 3 approved with reservations] . HRB Open Res 2025, 8 :96 ( https://doi.org/10.21956/hrbopenres.15650.r52430 ) The direct URL for this report is: https://hrbopenresearch.org/articles/8-96/v1#referee-response-52430 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 06 Jan 2026 Dylan A Mordaunt , Victoria University of Wellington, Wellington, New Zealand Approved with Reservations VIEWS 0 https://doi.org/10.21956/hrbopenres.15650.r52430 This protocol outlines a scoping review of studies on technology implementation in EMS involving paramedics and EMTs, aiming to assess whether existing technology acceptance models adequately explain acceptance in paramedicine and to identify common constructs and moderators reported in the ... Continue reading READ ALL This protocol outlines a scoping review of studies on technology implementation in EMS involving paramedics and EMTs, aiming to assess whether existing technology acceptance models adequately explain acceptance in paramedicine and to identify common constructs and moderators reported in the literature. Strengths - Clear aim and justification, including rationale for focusing on paramedics/EMTs. - Methods broadly align with JBI scoping guidance and include duplicate screening with arbitration. - Intention to report using PRISMA-ScR is stated. Major - The eligibility section says “Year > 2004” but doesn’t specify the earliest included year in plain terms. - Table 1 provides the concept structure, but replication requires full strings per database (fields, subject headings, limits). - Consider adding “prehospital/pre-hospital/out-of-hospital” terms** (or justify exclusion). This is a credible sensitivity issue for capture. It would be worth referencing any reported hedges. - Fix minor indexing/clarity issues (e.g., “CINHAL” should be “CINAHL”). - It's worth considering PRESS for peer review of the search strategy. - Using PRISMA-P adds to quality and reproducibility. Is the rationale for, and objectives of, the study clearly described? Yes Is the study design appropriate for the research question? Yes Are sufficient details of the methods provided to allow replication by others? Partly Are the datasets clearly presented in a useable and accessible format? Not applicable Competing Interests: No competing interests were disclosed. Reviewer Expertise: Health economics, digital health, out-of-hospital, health services I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Mordaunt DA. Reviewer Report For: Digital Adoption in Paramedicine: A Scoping Review Protocol [version 1; peer review: 1 approved, 3 approved with reservations] . HRB Open Res 2025, 8 :96 ( https://doi.org/10.21956/hrbopenres.15650.r52430 ) The direct URL for this report is: https://hrbopenresearch.org/articles/8-96/v1#referee-response-52430 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Todd VF. Reviewer Report For: Digital Adoption in Paramedicine: A Scoping Review Protocol [version 1; peer review: 1 approved, 3 approved with reservations] . HRB Open Res 2025, 8 :96 ( https://doi.org/10.21956/hrbopenres.15650.r50091 ) The direct URL for this report is: https://hrbopenresearch.org/articles/8-96/v1#referee-response-50091 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 25 Nov 2025 Verity F Todd , Auckland University of Technology, Auckland, Auckland, New Zealand Approved VIEWS 0 https://doi.org/10.21956/hrbopenres.15650.r50091 Title: Digital Adoption in Paramedicine: A Scoping Review Protocol General comments: This protocol is of a high standard, with comprehensive referencing and meticulous attention to detail. The protocol is appropriately supported by established frameworks (PRISMA) and the ... Continue reading READ ALL Title: Digital Adoption in Paramedicine: A Scoping Review Protocol General comments: This protocol is of a high standard, with comprehensive referencing and meticulous attention to detail. The protocol is appropriately supported by established frameworks (PRISMA) and the review has been registered with the Open Science Framework, demonstrating commitment to transparent and reproducible research practices. The aim of this study is to conduct a scoping review to determine whether current digital acceptance models are suitable for application to paramedics in emergency medical services. Is the rationale for, and objectives of, the study clearly described? Yes. The authors have clearly articulated gaps in the existing literature and provided strong justification for this review. The background section effectively addresses two key aspects: current and emerging technologies in healthcare delivery, and the specific characteristics of paramedic practice that may influence technology adoption. This dual focus appropriately contextualises the research question. Is the study design appropriate for the research question? The scoping review methodology is well-suited to mapping the breadth of literature on digital acceptance models in paramedicine. The PCC (Population, Concept, Context) framework is appropriately applied to this review question. The search strategy appears comprehensive; however, I note that the search term "prehospital" (or "pre-hospital") does not appear to be included. Was this intentional? Given that much paramedicine literature uses prehospital care terminology, this may be worth considering to ensure comprehensive capture of relevant studies. I have verified that the OSF registration matches the details included in this protocol. Are sufficient details of the methods provided to allow replication by others? Yes. The methods are well-presented and contain sufficient detail to enable future replication. However, one detail requires clarification: What is the earliest year that will be included in the search? Specifying the temporal scope of the review would strengthen the reproducibility of the search strategy. Are the datasets clearly presented in a useable and accessible format? The data synthesis section is clearly presented, with comprehensive descriptions of the technology acceptance themes that will be reported, including specific terms of interest. The planned approach to data extraction and charting is appropriate for a scoping review of this nature. Recommendation: This is a well-designed protocol that requires only minor clarification regarding: 1. The temporal scope of the search (earliest year to be included) 2. Consideration of whether "prehospital"/"pre-hospital" terminology should be included in the search strategy Is the rationale for, and objectives of, the study clearly described? Yes Is the study design appropriate for the research question? Yes Are sufficient details of the methods provided to allow replication by others? Yes Are the datasets clearly presented in a useable and accessible format? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: prehospital I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Todd VF. Reviewer Report For: Digital Adoption in Paramedicine: A Scoping Review Protocol [version 1; peer review: 1 approved, 3 approved with reservations] . HRB Open Res 2025, 8 :96 ( https://doi.org/10.21956/hrbopenres.15650.r50091 ) The direct URL for this report is: https://hrbopenresearch.org/articles/8-96/v1#referee-response-50091 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 28 Aug 2025 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 3 4 Version 1 28 Aug 25 read read read read Verity F Todd , Auckland University of Technology, Auckland, New Zealand Dylan A Mordaunt , Victoria University of Wellington, Wellington, New Zealand Nikiah Nudell , The Paramedic Foundation, Duluth, USA Kimberley Davis , NSW Ambulance, New South Wales, Australia Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Davis K. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 16 Jan 2026 | for Version 1 Kimberley Davis , NSW Ambulance, New South Wales, Australia 0 Views copyright © 2026 Davis K. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Given the rapidly-evolving digital health environment, this represents an important body of work which may inform jurisdictional ambulance service implementation of new technologies amongst their workforce. Introduction The technology being discussed is not really defined. What kinds of things are the authors talking about? The main one it seems is eMR. EMT is provided as an acronym by not defined in-text. Obvious to those in the field but not elsewhere. Same with EMS. Have the authors defined the environment? Prehospital, critical care, or other relevant retrieval terminology is not used. Please expand. Methods Overall Methods are sound; limiting to paramedics/EMTs rather than other clinician types is appropriate as the authors outline. Why after 2004? Presumably not including 2004? Population – what about community or volunteer paramedics? Are road only paramedics/services being evaluated, what about aeromedical retrieval? Is the rationale for, and objectives of, the study clearly described? Partly Is the study design appropriate for the research question? Yes Are sufficient details of the methods provided to allow replication by others? Yes Are the datasets clearly presented in a useable and accessible format? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Prehospital care, Ambulance service, health service research I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Davis K. Peer Review Report For: Digital Adoption in Paramedicine: A Scoping Review Protocol [version 1; peer review: 1 approved, 3 approved with reservations] . HRB Open Res 2025, 8 :96 ( https://doi.org/10.21956/hrbopenres.15650.r52429) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://hrbopenresearch.org/articles/8-96/v1#referee-response-52429 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Nudell N. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 06 Jan 2026 | for Version 1 Nikiah Nudell , The Paramedic Foundation, Duluth, USA 0 Views copyright © 2026 Nudell N. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions This is an interesting question that should yield results that are of interest. The authors should consider including an additional metadata field to capture the domain of practice (it does not appear that the organizational environment is intended for this purpose). Technology used in daily life (e.g., mobile phones) may have different implications than clinical equipment that is highly regulated (e.g., defibrillators), which may then differ from technology used for operations or decision-making. Is the rationale for, and objectives of, the study clearly described? Yes Is the study design appropriate for the research question? Partly Are sufficient details of the methods provided to allow replication by others? Yes Are the datasets clearly presented in a useable and accessible format? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise paramedicine, machine learning, public policy I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Nudell N. Peer Review Report For: Digital Adoption in Paramedicine: A Scoping Review Protocol [version 1; peer review: 1 approved, 3 approved with reservations] . HRB Open Res 2025, 8 :96 ( https://doi.org/10.21956/hrbopenres.15650.r51780) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://hrbopenresearch.org/articles/8-96/v1#referee-response-51780 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Mordaunt D. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 06 Jan 2026 | for Version 1 Dylan A Mordaunt , Victoria University of Wellington, Wellington, New Zealand 0 Views copyright © 2026 Mordaunt D. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions This protocol outlines a scoping review of studies on technology implementation in EMS involving paramedics and EMTs, aiming to assess whether existing technology acceptance models adequately explain acceptance in paramedicine and to identify common constructs and moderators reported in the literature. Strengths - Clear aim and justification, including rationale for focusing on paramedics/EMTs. - Methods broadly align with JBI scoping guidance and include duplicate screening with arbitration. - Intention to report using PRISMA-ScR is stated. Major - The eligibility section says “Year > 2004” but doesn’t specify the earliest included year in plain terms. - Table 1 provides the concept structure, but replication requires full strings per database (fields, subject headings, limits). - Consider adding “prehospital/pre-hospital/out-of-hospital” terms** (or justify exclusion). This is a credible sensitivity issue for capture. It would be worth referencing any reported hedges. - Fix minor indexing/clarity issues (e.g., “CINHAL” should be “CINAHL”). - It's worth considering PRESS for peer review of the search strategy. - Using PRISMA-P adds to quality and reproducibility. Is the rationale for, and objectives of, the study clearly described? Yes Is the study design appropriate for the research question? Yes Are sufficient details of the methods provided to allow replication by others? Partly Are the datasets clearly presented in a useable and accessible format? Not applicable Competing Interests No competing interests were disclosed. Reviewer Expertise Health economics, digital health, out-of-hospital, health services I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Mordaunt DA. Peer Review Report For: Digital Adoption in Paramedicine: A Scoping Review Protocol [version 1; peer review: 1 approved, 3 approved with reservations] . HRB Open Res 2025, 8 :96 ( https://doi.org/10.21956/hrbopenres.15650.r52430) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://hrbopenresearch.org/articles/8-96/v1#referee-response-52430 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Todd V. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 25 Nov 2025 | for Version 1 Verity F Todd , Auckland University of Technology, Auckland, Auckland, New Zealand 0 Views copyright © 2025 Todd V. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Title: Digital Adoption in Paramedicine: A Scoping Review Protocol General comments: This protocol is of a high standard, with comprehensive referencing and meticulous attention to detail. The protocol is appropriately supported by established frameworks (PRISMA) and the review has been registered with the Open Science Framework, demonstrating commitment to transparent and reproducible research practices. The aim of this study is to conduct a scoping review to determine whether current digital acceptance models are suitable for application to paramedics in emergency medical services. Is the rationale for, and objectives of, the study clearly described? Yes. The authors have clearly articulated gaps in the existing literature and provided strong justification for this review. The background section effectively addresses two key aspects: current and emerging technologies in healthcare delivery, and the specific characteristics of paramedic practice that may influence technology adoption. This dual focus appropriately contextualises the research question. Is the study design appropriate for the research question? The scoping review methodology is well-suited to mapping the breadth of literature on digital acceptance models in paramedicine. The PCC (Population, Concept, Context) framework is appropriately applied to this review question. The search strategy appears comprehensive; however, I note that the search term "prehospital" (or "pre-hospital") does not appear to be included. Was this intentional? Given that much paramedicine literature uses prehospital care terminology, this may be worth considering to ensure comprehensive capture of relevant studies. I have verified that the OSF registration matches the details included in this protocol. Are sufficient details of the methods provided to allow replication by others? Yes. The methods are well-presented and contain sufficient detail to enable future replication. However, one detail requires clarification: What is the earliest year that will be included in the search? Specifying the temporal scope of the review would strengthen the reproducibility of the search strategy. Are the datasets clearly presented in a useable and accessible format? The data synthesis section is clearly presented, with comprehensive descriptions of the technology acceptance themes that will be reported, including specific terms of interest. The planned approach to data extraction and charting is appropriate for a scoping review of this nature. Recommendation: This is a well-designed protocol that requires only minor clarification regarding: 1. The temporal scope of the search (earliest year to be included) 2. Consideration of whether "prehospital"/"pre-hospital" terminology should be included in the search strategy Is the rationale for, and objectives of, the study clearly described? Yes Is the study design appropriate for the research question? Yes Are sufficient details of the methods provided to allow replication by others? Yes Are the datasets clearly presented in a useable and accessible format? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise prehospital I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Todd VF. Peer Review Report For: Digital Adoption in Paramedicine: A Scoping Review Protocol [version 1; peer review: 1 approved, 3 approved with reservations] . HRB Open Res 2025, 8 :96 ( https://doi.org/10.21956/hrbopenres.15650.r50091) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. 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