Community First Responders’ role in the current and future rural health and care workforce: a mixed-methods study

 Background: Community First Responders are trained volunteers dispatched by ambulance services to  potentially life-threatening emergencies such as cardiac arrest in the first vital minutes to provide care  until highly skilled ambulance staff arrive. Community First Responder schemes were first introduced to  support ambulance services in rural communities, where access to prehospital emergency care is more  likely to be delayed. Evidence is lacking on their contribution to rural healthcare provision, how care is  provided and how this might be improved. Objectives: We aimed to describe Community First Responder activities, organisation, costs of  provision and outcomes of care together with perceptions and views of patients, public, Community  First Responders, ambulance service staff and commissioners of their current and future role including  innovations in the rural health and care workforce. Design: We used a mixed-methods design, using a lens of pragmatism and the ‘actor’, ‘behaviour  change’ and ‘causal pathway’ framework to integrate quantitative routine and qualitative (policy,  guideline and protocol documents with stakeholder interview) data from 6 of 10 English ambulance  services. We identified potential innovations in Community First Responder provision and prioritised  these using a modified nominal group technique. Patients and public were involved throughout  the study. Results: In 4.5 million incidents from six English regional ambulance services during 2019, pre COVID?19 pandemic, Community First Responders attended first a higher proportion of calls in rural areas  (almost 4% of calls) than in urban areas (around 1.5%). They were significantly more likely to be called  out to rural (vs. urban) areas and to attend older (vs. younger), white (vs. minority ethnic) people in more  affluent (vs. deprived) areas with cardiorespiratory and neurological (vs. other emergency) conditions for  higher-priority emergency or urgent (category 1 and 2 compared with category 3, 4 or 5) calls but did  also attend lower-category calls for conditions such as falls. We examined 10 documents from seven  ambulance services. Ambulance policies and protocols integrated Community First Responders into  ambulance service structures to achieve the safe and effective operation of volunteers. Costs, mainly for  training, equipment and support, varied widely but were not always clearly delineated. Community First  Responders enabled a faster prehospital response time. There was no clear benefit in out-of-hospital  cardiac arrest outcomes. A specific Community First Responder falls response reduced ambulance attendances and was potentially cost saving. We conducted semistructured interviews with 47 different  stakeholders engaged in Community First Responder functions. This showed the trajectory of becoming  a Community First Responder, the Community First Responder role, governance and practice, and the  positive views of Community First Responders from stakeholders despite public lack of understanding of  their role. Community First Responders’ scope of practice varied between ambulance services and had  developed into new areas. Innovations prioritised at the consensus workshop were changes in processes  and structures and an expanded scope of practice supported by training, which included counselling,  peer support, better communication with the control room, navigation and communication technology,  and specific mandatory and standardised training for Community First Responders.