Community first responder
Encyclopedia
A Community First Responder (CFR), is a person available to be dispatched by an ambulance
control centre to attend medical emergencies in their local area. They can be members of the public, who have received basic training in life saving interventions such as defibrillation
, off duty ambulance staff, or professionals from a non-medical discipline who may be nearby or attending emergencies, such as firefighters or security guards. Community first responders are found in the emergency healthcare systems of the United Kingdom
, the USA, and Australia
.
in cardiac arrest patients until a fully equipped ambulance
arrives. The schemes were originally envisaged for rural areas where emergency medical services
response is likely to be delayed beyond the approximate 8-10 minutes during which a cardiac arrest is likely to become irreversible. The schemes have since expanded to more populous areas, where the benefit of early intervention can still prove life saving, and the volume of people available to ambulance control assists them with meeting response time targets such as ORCON
.
Examples of first responders include "co-responders" (police or fire service), members of staff of a shopping mall or other public place, members of a first aid organisation, lifeguards, community first responders, and others who have been trained to act in this capacity. Employees of the statutory ambulance services may also act as first responders whilst off-duty.
Schemes vary in the UK and are mostly managed by the local ambulance service, although some schemes are run externally (such as by St John Ambulance or by commercial entities such as Alton Towers
) in association with the ambulance service. The majority of responders are volunteers and take no payment (although in some areas, payments are made for each call, particularly to staff responders) and use their own cars with no mileage recompense. In most schemes, they are expected to drive under normal road traffic laws, and are not permitted to claim exemptions or use blue lights and sirens. There are a small number of schemes which have dedicated response cars and responders, who have been fully trained in response driving, respond on blue lights and sirens. In most cases funding for these schemes is from charitable donations from local communities.
and oxygen therapy
. Most schemes also use some further extended skills adjuncts, not normally taught on public first aid courses, such as suction
and placement of oropharyngeal airway
s.
There is no agreed national standard for first responders, with some schemes using the nationally recognised First Person on Scene (FPOS) Basic or Intermediate courses, run by the Institute of Healthcare Development (IHCD), a branch of exam body Edexcel
which also qualifies ambulance staff, and others opting for internal training standards. West Midlands Ambulance Servise now trains all its responders to FPOS intermediate level with some "advanced" responders completing additional modules and continued professional development to FPOS enhanced level. In most cases the training takes place over several evenings and/or weekends and there may be a period of supervision for new responders including ambulance observation shifts before they are deemed competent to respond on their own.
Ambulance
An ambulance is a vehicle for transportation of sick or injured people to, from or between places of treatment for an illness or injury, and in some instances will also provide out of hospital medical care to the patient...
control centre to attend medical emergencies in their local area. They can be members of the public, who have received basic training in life saving interventions such as defibrillation
Defibrillation
Defibrillation is a common treatment for life-threatening cardiac arrhythmias, ventricular fibrillation and pulseless ventricular tachycardia. Defibrillation consists of delivering a therapeutic dose of electrical energy to the affected heart with a device called a defibrillator...
, off duty ambulance staff, or professionals from a non-medical discipline who may be nearby or attending emergencies, such as firefighters or security guards. Community first responders are found in the emergency healthcare systems of the United Kingdom
United Kingdom
The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...
, the USA, and Australia
Australia
Australia , officially the Commonwealth of Australia, is a country in the Southern Hemisphere comprising the mainland of the Australian continent, the island of Tasmania, and numerous smaller islands in the Indian and Pacific Oceans. It is the world's sixth-largest country by total area...
.
Role
Community first responders are there to provide assistance to those with a medical emergency, and most importantly to start and maintain the chain of survivalChain of survival
The chain of survival refers to a series of actions that, when put into motion, reduce the mortality associated with cardiac arrest. Like any chain, the chain of survival is only as strong as its weakest link...
in cardiac arrest patients until a fully equipped ambulance
Ambulance
An ambulance is a vehicle for transportation of sick or injured people to, from or between places of treatment for an illness or injury, and in some instances will also provide out of hospital medical care to the patient...
arrives. The schemes were originally envisaged for rural areas where emergency medical services
Emergency medical services
Emergency medical services are a type of emergency service dedicated to providing out-of-hospital acute medical care and/or transport to definitive care, to patients with illnesses and injuries which the patient, or the medical practitioner, believes constitutes a medical emergency...
response is likely to be delayed beyond the approximate 8-10 minutes during which a cardiac arrest is likely to become irreversible. The schemes have since expanded to more populous areas, where the benefit of early intervention can still prove life saving, and the volume of people available to ambulance control assists them with meeting response time targets such as ORCON
Operational Research CONsultancy
ORCON was developed by a UK consultancy company in 1974 as a standard for monitoring ambulance service performance....
.
Examples of first responders include "co-responders" (police or fire service), members of staff of a shopping mall or other public place, members of a first aid organisation, lifeguards, community first responders, and others who have been trained to act in this capacity. Employees of the statutory ambulance services may also act as first responders whilst off-duty.
Operations
In general First Responders are sent to immediately life threatening situations such as cardiac arrest. Some ambulance services restrict the type of calls which responders can attend, either through blanket prohibition or by more detailed call screening by the emergency dispatch centre. This is because responders do not necessarily have the levels of training or equipment available to full time staff, and may arrive on their own, increasing risks. Types of call which responders may not be asked to attend (or be stood down if already en-route) include drugs related problems, domestic violence and abusive patients as well as dangerous scenes such as traffic collisions or building sites. In some areas, responders are also not dispatched to paediatric cases, although other areas have this as a main part of their role.Schemes vary in the UK and are mostly managed by the local ambulance service, although some schemes are run externally (such as by St John Ambulance or by commercial entities such as Alton Towers
Alton Towers
Alton Towers is a theme park and resort located in Staffordshire, England. It attracts around 2.7 million visitors per year making it the most visited theme park in the United Kingdom. Alton Towers is also the 9th most visited theme park in Europe...
) in association with the ambulance service. The majority of responders are volunteers and take no payment (although in some areas, payments are made for each call, particularly to staff responders) and use their own cars with no mileage recompense. In most schemes, they are expected to drive under normal road traffic laws, and are not permitted to claim exemptions or use blue lights and sirens. There are a small number of schemes which have dedicated response cars and responders, who have been fully trained in response driving, respond on blue lights and sirens. In most cases funding for these schemes is from charitable donations from local communities.
Training
The training is generally first aid-based and at its core includes extended first aid skills such as defibrillationDefibrillation
Defibrillation is a common treatment for life-threatening cardiac arrhythmias, ventricular fibrillation and pulseless ventricular tachycardia. Defibrillation consists of delivering a therapeutic dose of electrical energy to the affected heart with a device called a defibrillator...
and oxygen therapy
Oxygen therapy
Oxygen therapy is the administration of oxygen as a medical intervention, which can be for a variety of purposes in both chronic and acute patient care...
. Most schemes also use some further extended skills adjuncts, not normally taught on public first aid courses, such as suction
Suction (medicine)
In medicine, devices are sometimes necessary to create suction. Suction may be used to clear the airway of blood, saliva, vomit, or other secretions so that a patient may breathe. Suctioning can prevent pulmonary aspiration, which can lead to lung infections...
and placement of oropharyngeal airway
Oropharyngeal airway
An oropharyngeal airway is a medical device called an airway adjunct used to maintain a patent airway. It does this by preventing the tongue from covering the epiglottis, which could prevent the person from breathing...
s.
There is no agreed national standard for first responders, with some schemes using the nationally recognised First Person on Scene (FPOS) Basic or Intermediate courses, run by the Institute of Healthcare Development (IHCD), a branch of exam body Edexcel
Edexcel
Edexcel, a UK company, is one of England, Wales and Northern Ireland's five main examination boards, and is wholly owned by the private-sector Pearson PLC, a UK-based media and publishing conglomerate. Its name is a portmanteau word derived from the words "educational" and "excellence"...
which also qualifies ambulance staff, and others opting for internal training standards. West Midlands Ambulance Servise now trains all its responders to FPOS intermediate level with some "advanced" responders completing additional modules and continued professional development to FPOS enhanced level. In most cases the training takes place over several evenings and/or weekends and there may be a period of supervision for new responders including ambulance observation shifts before they are deemed competent to respond on their own.