Community First Responders' Role in the Current and Future Rural Health and Care Workforce

Community First Responders (CFRs) are trained members of the public, lay people or off-duty healthcare staff who volunteer to provide first aid. CFRs help ambulance services to provide care for people having health emergencies, from falls to road accidents to heart attacks, at home or in public places. CFRs are particularly important in rural areas where it is more difficult to provide or access emergency care, and where they are an important part of the care workforce. CFRs are broadly perceived to be positive, however evidence is needed about how they contribute to rural health services, which patients/conditions they attend, what care they provide, how effective they are and at what cost, how they are perceived by patients and other health workers, and how they could be developed to improve care for rural communities.

The investigators aim to develop recommendations for rural CFRs, by exploring their contribution to rural care, evaluating their value for money, understanding experiences and views of patients, CFRs and other healthcare staff, and exploring the potential for CFRs to provide new services.

Study Overview

• Status: Completed
• Conditions: Emergency Medical Services
• Intervention / Treatment: Other: attendance by community first responders for medical emergencies

Detailed Description

The project will involve the following steps:

1. Analyse records from six ambulance services to see: how many people CFRs attended; the proportion of ambulance calls attended; age, sex and conditions of people attended; how quickly CFRs attended and what happened to the patient(s) when the ambulance arrived.
2. Evaluate benefits and costs of CFRs attending rural emergencies.
3. Interview patients/relatives, ambulance staff, GPs, funders, CFRs and CFR leads to obtain views on rural CFR current and potential future roles. Interviews will also explore with CFRs and CFR leads, challenges and solutions to recruiting, training, retaining rural CFRs and ensuring safe, high quality care.
4. Combine this knowledge (gained in steps1-3 above) to develop recommendations for change; who will be involved and how services should change to solve the most pressing problems for the rural communities served.
5. Present recommendations to a workshop of experts and public to agree priorities for future development.

• Study Type: Observational
• Enrollment (Actual): 83995

Contacts and Locations

Study Locations

• United Kingdom
  • Lincolnshire
    • Lincoln, Lincolnshire, United Kingdom, LN5 7AY
      • Community and Health Research Unit, University of Lincoln

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

For the interview studies the investigators will purposively sample patients, relatives, and ambulance staff identified from records of patients who have been attended by a CFR in a rural location in the previous six months. Where possible the investigators will interview patients, relatives, CFRs and ambulance staff attending the same event. GPs will be purposively sampled from rural areas of the ambulance services involved. The investigators will recruit a maximum variation sample of patients (according to age, sex, condition, and ethnicity), ambulance staff (sex, experience, ethnicity and role), CFR (sex, ethnicity, length of experience, skill level) and CFR scheme leads (independent charity and ambulance trust overseen schemes).

Description

Inclusion Criteria:

• Adults capable of giving informed consent. The investigators will recruit a maximum variation sample of patients (according to age, sex, condition, and ethnicity), ambulance staff (sex, experience, ethnicity and role), CFR (sex, ethnicity, length of experience, skill level) and CFR scheme leads (independent charity and ambulance trust overseen schemes).

Exclusion Criteria:

• The investigators will exclude children and adults who are unable to give informed consent from this study.

London Ambulance Service NHS Trust is not included as it is mainly urban; East of England Ambulance Service and North East Ambulance Service are not included because of lack of electronic data.

Study Plan

How is the study designed?

Number of groups / cohorts

5

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Anonymised records from 6 ambulance services; The total available sample for analysis for this cohort is estimated to be at least 50,000 incidents across 6 ambulance trusts. The investigators will describe the epidemiology of CFR provision to rural health areas using an anonymised dataset.	Other: attendance by community first responders for medical emergencies; The investigators will purposively sample patients, relatives, and ambulance staff identified from records of patients who have been attended by a CFR in a rural location in the previous six months. Where possible the investigators will interview patients, relatives, CFRs and ambulance staff attending the same event. GPs will be purposively sampled from rural areas of the ambulance services involved. Investigators will recruit a maximum variation sample of patients (according to age, sex, condition, and ethnicity), ambulance staff (sex, experience, ethnicity and role), CFR (sex, ethnicity, length of experience, skill level) and CFR scheme leads (independent charity and ambulance trust overseen schemes).
Interviews with patients (and/or relatives); The investigators will interview about 15-20 patients (and/or relatives) who have been attended by CFRs.	Other: attendance by community first responders for medical emergencies; The investigators will purposively sample patients, relatives, and ambulance staff identified from records of patients who have been attended by a CFR in a rural location in the previous six months. Where possible the investigators will interview patients, relatives, CFRs and ambulance staff attending the same event. GPs will be purposively sampled from rural areas of the ambulance services involved. Investigators will recruit a maximum variation sample of patients (according to age, sex, condition, and ethnicity), ambulance staff (sex, experience, ethnicity and role), CFR (sex, ethnicity, length of experience, skill level) and CFR scheme leads (independent charity and ambulance trust overseen schemes).
Interviews with CFRs; The investigators will interview about 15-20 CFRs/ CFR scheme leaders.
Interviews with Ambulance staff; The investigators will interview about 15-20 ambulance staff who have experience of working with CFRs.
Interviews with GPs and commisioners; The investigators will interview about 10-15 GPs and ambulance service commissioners.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of ambulance calls that CFRs attend in one year	We will establish how many people CFRs attended and work out the proportion of ambulance calls attended.	we will evaluate all emergency attendances during one year
The type of cases treated by CFRs	characteristics of people (age, sex, condition) attended	we will evaluate all emergency attendances during one year
How quickly cases are dealt with	how quickly they attend	we will evaluate all emergency attendances during one year
Treatments given and transfer to hospital	we will evaluate the treatments provided and the number of cases transferred to hospital	we will evaluate all emergency attendances during one year
Locations	We will describe rurality and location (eg. at home or elsewhere) where CFRs give treatment.	we will evaluate all emergency attendances during one year

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Perceptions of CFR schemes	We will interview different stakeholders (patients, CFRs, GPs, ambulance staff, CFR leads)	participants will have been involved in a CFR attendance in the previous 6 months

Collaborators and Investigators

• Sponsor: University of Lincoln
• Investigators: Principal Investigator: Niro Siriwardena, University of Lincoln, UK

Study record dates

Study Major Dates

• Study Start (Actual): June 1, 2020
• Primary Completion (Actual): May 1, 2022
• Study Completion (Actual): December 3, 2022

Study Registration Dates

• First Submitted: January 23, 2020
• First Submitted That Met QC Criteria: February 19, 2020
• First Posted (Actual): February 21, 2020

Study Record Updates

• Last Update Posted (Actual): November 29, 2023
• Last Update Submitted That Met QC Criteria: November 28, 2023
• Last Verified: May 1, 2022

More Information

Terms related to this study

• Keywords: Rural health; Community first responder; Ambulance service
• Additional Relevant MeSH Terms: Pathologic Processes; Disease Attributes; Emergencies
• Other Study ID Numbers: 20002

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No