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Background GL can be defined as literature published outside the normal domain of commercial publishing. A study has quantified GL in nursing citations at c10.4% and veterinary science 6-10%. GL, guidelines, reports, policy briefs and unpublished research, provide current and practical insights not available in peer-reviewed journals. GL bridges gaps in traditional academic publishing by including voices and data that are otherwise excluded. Integrating GL into academic discourse creates an inclusive evidence base supporting patient care, offering context-specific information for researchers/practitioners ensuring research remains relevant, responsive, and grounded in the realities of healthcare practice.In this project we 1) identify a benchmark percentage of citations in paramedicine that are GL, for comparison wih other subject areas in healthcare and related areas; 2) create a richer picture of the forms of GL used in paramedic research and 3) frame conclusions around using GL informed by this research for researchers, editors and peer reviewers.Methods We analysed citations from substantive research articles, excluding commentaries, editorial and case studies, published in the British Paramedic Journal (Ingenta/College of Paramedics), Prehospital Emergency Care (Taylor & Francis) and Paramedicine (Sage). We sampled Issue 1 of each volume from 2019 to 2025, identifying and categorising citations to grey literature.Results We identified 233 journal articles with 6802 citations. 844 were identified as GL or 12.41%. There was variation in the %’s of GL, Paramedicine (SAGE) 11%, Prehospital Emergency Care (T&F) 12% and British Paramedic Journal (COP/Ingenta) 17%. Most popular GL forms are: 1) reports, 2) websites, 3) guidelines, / standards, 4) statistical compilations. Least popular are: 1) theses, 2) conference papers, 3) preprints, 4) posters. The results point to:variations in % use of specific GL types e.g. Paramedicine has a higher use of theses, Prehospital Emergency Care has a higher use of Statistical Compilations;rich sources of unpublished research, theses (4.7%), conference papers (3.1%), preprints (1.2%) and conference posters (0.5%) are largely ignored;evidence that articles on COVID19 used higher GL is mixed. Paramedicine 11% for COVID19 and 11% for other subjects. Prehospital Emergency Care 28% for COVID19 and 12% for other subjects;evidence indicating fluctuations in the use of GL 2019-2025 with a peak in 2022 but no general increase over time.Conclusion Rich sources of unpublished research are largely ignored. Awareness of the value of unpublished research and education/training on finding it may be required. Trends in the citation of GL in Paramedicine are broadly consistent with the Nursing (10%) and Veterinary Science (6% - 10%). There are variations according to journal title which possibly reflect the topics covered or editorial policy. There is mixed evidence for the impact of COVID19 on citation trends in GL, although some effect is indicated.