What is the contribution of Community First Responders to rural Emergency Medical Service provision in the UK?

Conference:

SAPC ASM 2022 - UCLan

Talk Code:

4E.6

Presenter:

Vanessa Botan

Co-authors:

Zahid Asghar, Elise Rowan, Murray D. Smith, Gupteswar Patel, Viet-Hai Phung, Ian Trueman, Robert Spaight, Amanda Brewster, Pauline Mountain, Roderick Orner, A. Niroshan Siriwardena

Author institutions:

University of Lincoln, East Midlands Ambulance Service NHS Trust

Problem

Community First Responders (CFRs) are volunteers dispatched by Emergency Medical Services (EMS) to potentially life-threatening emergencies to provide care until the ambulance staff arrive. Previous qualitative research described CFRs’ role, perceptions, and motivations, but quantitative evidence on their contribution to rural healthcare provision is lacking. We aimed to investigate the number, rate, types and location of calls and characteristics of patients attended.

Approach

We used a retrospective observational design analysing routine data from electronic clinical records from six of ten ambulance services in England during 2019 calendar year. Descriptive statistics were used to compare CFR first attendances in rural or urban areas with those of ambulance staff. A multivariable logistic regression model was used to identify the main predictors of CFR attendance whilst accounting for confounding effects.

Findings

The data included 4.5 million incidents over one year. CFRs attended first in a significantly higher proportion of incidents located in rural areas rather than urban areas (3.90% vs 1.48 %, p<0.05). The main predictors of CFR presence were the rural location of the incident (Odds Ratio [OR] 2.05, 95% Confidence Interval [CI] 1.99-2.11, p<0.001), conditions including cardiorespiratory (OR 9.20, 95%CI 5.08-16.64, p<0,001) or neurological/endocrine (OR 9.26, 95%CI 5.12-16.77, p<0.001) and call categories 1 (OR 5.19, 95%CI 3.86-6.99, p<0.001) and 2 (OR 4.44, 95%CI 3.31-5.96 p<0.001). Patients attended first by CFRs were less likely to be from minority ethnic backgrounds, from more deprived areas, or younger than 39 years.

Consequences

CFRs contribute to EMS delivery particularly in rural areas and especially for more urgent calls. These findings demonstrate the important role that CFRs play in rural communities, where access to emergency care services is more difficult. Although CFRs attend more urgent calls, they also attend a variety of conditions indicating that the work of CFRs has expanded from its original purpose to attend life-threatening, out-of-hospital cardiac arrest. This has implications for the future development of CFR schemes which should prioritise training for a range of conditions, and access to more deprived and ethnically diverse areas.

Submitted by:

Vanessa Botan

Funding acknowledgement:

This report presents independent research commissioned by the National Institute for Health Research (NIHR) Research for Patient Benefit Programme. The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NIHR.