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Table 1 Summary of included studies

From: Community first responders and responder schemes in the United Kingdom: systematic scoping review

Study Aims and objectives Sample population Methods Results
Davies et al. (2008) [10] To investigate the psychological profile of first responders to gain insight into possible factors that might protect them against such reactions. First responders in a community scheme in Barry, South Wales. In depth semi-structured interviews with six subjects were analysed using Interpretive Phenomenological Analysis (IPA). CFRs were motivated by a sense of duty to their community. They found it rewarding when they contributed positively to a patient’s outcome. They felt it was important to understand their role and the limitations on it. CFRs described an emotionally detached state of mind, which helped them remain calm in these potentially stressful situations
Dennis et al. (2013) [14] To investigate which categories of Emotional Support messages could be used to support a CFR when they are experiencing different kinds of stress in the field. 20 participants from Amazon’s Mechanical Turk service. For this validation experiment (HIT), participants had to be based in the US and have an acceptance rate of 90% (90% of the work they do is accepted by other requesters had to be rated as good quality) and were paid $0.50 (US). As before, the validation experiment took the form of an online questionnaire administered on Mechanical Turk, with the same participation criteria. Participants were paid $0.50 and we received 40 responses. Participants were asked to indicate their gender, their age from a range and indicate if they were a health professional. 55% were female (45% male), 22.5% were aged 15-25, 45% 26-40, 27.5% 41-65 and 5% over 65. 5% of participants were healthcare professionals. Directed Action was the most popular category for Mental Demand (where the CFR needs to think), Temporal Demand (time pressure), Frustration, Distraction and Isolation. Reassurance was the most popular category for the remaining stressors – Physical Demand and Emotional Demand. Praise was also popular for Mental Demand, Physical Demand, Frustration, Distraction and Isolation. Emotional Advice appears to be much less popular, only used by few participants in Frustration, Distraction, Emotional Demand and Isolation. Emotional Reflection was only used for Frustration and Distraction.
Faddy and Garlick (2005) [16] This review aimed to determine whether 50% nitrous oxide was safe for use by first responders who are not trained as emergency medical technicians. From the electronic search of the Medline and EMBASE databases we identified 1,585 citations that matched the search criteria. These were screened for potentially relevant studies. A total of 158 abstracts were retrieved for more detailed evaluation, of which 33 described studies that were potentially relevant to this systematic review. These studies underwent critical appraisal. Twelve studies satisfied all subject and methodology criteria and were subsequently included in the review One reviewer performed all of the literature searches. The reviewer searched the Medline (1966–Oct 2001) and EMBASE (1985—Oct 2001) databases, using an optimally sensitive search strategy, for relevant studies comparing 50% nitrous oxide with placebo or other analgesic agents in the prehospital setting. Again, no studies in the prehospital setting were found.
Consequently, a broader search was performed to find randomised controlled trials from a wide range of clinical settings. Reference lists cited in original articles were examined for relevant studies not identified by the literature search.
Two studies assessed drowsiness in 135 patients treated with 50% nitrous oxide or placebo [16, 18]. The pooled result of these studies showed that 3% of patients treated with nitrous oxide analgesia and 4% of patients treated with placebo experienced drowsiness, indicating that drowsiness was probably unrelated to nitrous oxide inhalation (RD 21%, 95% CI 27% to 5%, p=0.8).
The incidence of hypotension in patients who were treated with nitrous oxide was lower than in patients treated with intravenous midazolam and pethidine (14%).
Farmer et al. (2015) [12] This article explored what happened, over the longer term, after a community participation exercise to design future rural service delivery models, and considered perceptions of why more follow-up actions did or did not happen. 22 citizens in three Scottish communities (healthcare practitioners, managers and policymakers) all of whom were involved in, or knew about, the original project. In-depth interviews to capture stakeholders' views. A semi-structured topic schedule was developed to ensure a similar approach across sites. All citizen participants of community C described the first responder scheme and its establishment during or just after Remote Service Futures, facilitated by training from the Scottish Ambulance Service. They said new volunteers were now needed. Two participants reported that, following the initial scheme establishment and training, there had been little follow-up by staff of any health-related service and that current first responders had not received ongoing training, leaving them feeling unsupported. Community members felt let down by state authorities and questioned whether volunteering should continue as it might be hindering provision of a statutory service.
Harrison-Paul et al. (2006) [15] To explore the experiences of lay people who have been trained to use automatic external defibrillators. The research questions were: (1) How can training courses help prepare people for dealing with real life situations? (2) Who is ultimately responsible for providing critical incident debriefing and how should this be organised? (3) What is the best process for providing feedback to those who have used an AED? 53 participants, some of whom had been given training to use defibrillators and others who delivered the training. Locations included airports, railway stations, private companies and first responder schemes. Geographically, the study covered Nottinghamshire, Lincolnshire, Yorkshire, Staffordshire, Essex and the West Midlands in the UK. Semi-structured, qualitative interviews. Most people believed scenarios based within their place of work were most useful in preparing for ‘real life’. Many people had not received critical incident debriefing after using an AED. There were a variety of systems in place to provide support after an incident, many of which were informal.
Kindness, et al. (2014) [1] To further understand the demands and stressors experienced by CFRs. An online survey using a modified NASA-TLX scoring system was sent to 535 Community First Responders in Scotland. CFRs were asked to gauge the demands and stressors experienced during a 'typical' and their 'most stressful' callout, what would be the biggest cause of stress if present and the most stressful time -period during callouts. 88 CFRs started the survey with 40 continuing to completion. Frustration that the CFR could not help the patient more was considered to be the biggest stressor for both a typical and a most stressful callout. Emotional demand was the most present demand in a typical callout and mental demand in the most stressful callout. If present, loneliness and isolation was deemed to be the biggest cause of stress for CFRs. Prior to arrival at scene was the most stressful time.
Roberts, et al. (2014) [4] To capture the CFR activity data at the same time as gathering in depth, robust qualitative material. Included were stakeholder interviews (e.g. with representatives of national and local government, health authority, health professionals, and community members), and focus groups with individual CFRs. Participants included purposively selected representatives from the Scottish Government (in the area of performance management for emergency medicine), Scottish Ambulance Service personnel, community engagement representatives from the Scottish Health Council, local after-hours service managers and General Practitioners (GPs). Study 1 (March 2009 – December 2010) evaluated the introduction of a CFR scheme in an isolated region with difficulties created by geography where the drive time to the nearest hospital with a major A & E department was more than 90 minutes. Study 2 (October 2010 – September 2011) investigated the contribution of six CFR schemes in urban, suburban and remote Scottish settings.
Data collection during both studies were mixed methods. Routine anonymised data provided by Scottish Ambulance Service about callouts were analysed. These were supplemented by face-to-face or telephone interviews, as well as CFR focus groups.
CFRs were enthusiastic about contributing to their community.
Supportive relationships amongst volunteers within their schemes and support from the wider ambulance service staff were reported.
SAS employees and CFRs agreed on the scope of practice of CFRs’ emergency response duties, but community members were confused about the CFRs role.
During the focus groups, CFRs were concerned that community members lacked knowledge about the response process, particularly CFRs only responding once an ambulance has been dispatched. CFRs perceived confusion in communities about reasons for introducing schemes.
All CFR volunteers in all schemes thought that more publicly available information describing the CFR role and “the point that the ambulance is on its way” would help community members understand why CFRs volunteer and this may impact upon acceptance.
A commonly raised theme among CFRs and ambulance personnel was that while volunteers must act professionally according to a formal code of conduct and protecting patient information, they do not have the same emergency professional qualification that their colleagues have.
CFRs felt that the lack of feedback about how patients fared was difficult to deal with. They were not formally informed about what happened to people after their first response assistance. This was challenging because they worked in the locality and may know the patient, their family or friends. Confidentiality prevented them from asking and yet they were often interested and concerned about fellow community members.
Seligman, et al. (2015) [13] The paper discusses the experience of launching the student first responder (SFR) scheme across three counties in the Thames Valley. Students participating in the SFR scheme in the Thames Valley region. The size of the SFR group as of August 2014 was 72. Data on the number of students participating in the SFR scheme were obtained from SCAS records. SCAS data were also obtained to determine the number and type of incidents to which SFRs were being dispatched.
An electronic survey was carried out in April–May 2015 of all Foundation Doctors who had been members of this SFR scheme during their time at medical school.
In the first 15 months of operation (June 2013– August 2014), SFRs were dispatched to 343 incidents. The Most common types of calls that they attended to were: other; respiratory emergencies; non-traumatic falls; and gastrointestinal emergencies.
Timmons and Vernon-Evans (2012) [11] To understand why people volunteer for, and continue to be active in CFR groups. CFR volunteers from one English region. Although, as a qualitative study, a statistically representative sample was not needed, the geographical region was intended to generate a mixture of CFR groups from urban, suburban and rural communities and being mixed in terms of socio-economic status. The different locations help to create a balanced sample. Given that the participants are volunteers who only meet infrequently as a group, focus groups were the most efficient and cost-effective way of collecting data. The most common route was finding out about CFRs through an advertisement in the local newspaper.
Many participants joined to ‘get involved’ or ‘get out in the community’, as each first responder group is a local charity and relies on volunteers and financial support from within the community.
A key factor in getting people to volunteer, but more importantly to stay, was the flexibility of the role and the nature of the role itself. Participants valued their role as an assistant to the paramedic.
The experiences with the ambulance service had not always been good. The flexible nature of the CFRs’ commitment may have played a part in this. CFR groups rely on money from the local community and they spend a lot of time raising funds at local events.
Participants highlighted the significance of the community supporting their local group, and how locals like to see good work being done that directly affects them and their community.