IoT-Enabled Volunteer Practitioner Framework for Pre-Hospital Emergency Response: Extended TAM-Based Adoption Analysis and Simulation-Based Performance Evaluation in Riyadh

Delays in pre-hospital care continue to undermine the effectiveness of emergency response, particularly in settings where conventional ambulance services cannot reach patients within critical intervention windows. This paper presents an IoT-enabled framework that integrates a mobile application, a smartwatch, and a network of volunteer healthcare practitioners to enable rapid on-site first aid intervention that may enhance pre-hospital emergency response. The system was developed using an Agile methodology with continuous stakeholder engagement to ensure alignment between system requirements and real-world emergency response needs. The framework was evaluated in Riyadh, Saudi Arabia, through two complementary phases. The first phase assessed user-centered aspects among 420 participants, examining usability via the System Usability Scale (SUS) and technology acceptance via an extended Technology Acceptance Model incorporating constructs from Institutional Theory and performance expectancy. The second phase evaluated operational performance using 25 controlled emergency simulation scenarios, measuring emergency alert latency and response time. Results showed a mean SUS score of 78.25, exceeding the commonly accepted benchmark of 68, indicating high perceived usability. Linear regression analyses showed that perceived usefulness, performance expectancy, and coercive and normative pressures were each significantly associated with behavioral intention to adopt the proposed system. Operational evaluation indicated a mean emergency alert latency of 5.40±3.76 s and an 18.45% reduction in mean response time relative to estimated ambulance dispatch, both under controlled simulation conditions. These findings suggest that the proposed framework may facilitate earlier initiation of pre-hospital interventions and could serve as a complementary mechanism to existing emergency response systems.