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This is a plain English summary of original publications from a research project. The views expressed are those of the author(s) and reviewer(s) at the time of publication.

This study describes the role of community first responders in England: their activities, organisation, cost and impact on care outcomes. It found that responders:

  • arrive ahead of ambulances in 1 in 11 of the most serious calls
  • provide reassurance to people waiting for an ambulance
  • help ambulance services to meet their response time targets for the most urgent calls.

Rules and policies relating to community first responders vary between ambulance services. The researchers are working with policy teams to standardise responders’ responsibilities and training, and to improve recruitment and retention.

Further information is available on the website of the Association of Ambulance Chief Executives.

What do community first responders do?

More than 12,000 people in the UK volunteer as community first responders. They include members of the public and off-duty healthcare professionals; they are all trained to administer life-saving skills. Ambulance services send responders to people who have called 999; their goal is to arrive ahead of the ambulance crew and can provide emergency care, for example, to someone whose heart has stopped beating (cardiac arrest).

Responders are an increasingly important part of emergency services. They were first introduced to help ambulance services in rural areas, where access to emergency care might be delayed. But evidence is lacking on their contribution to medical outcomes, what care they provide, how it could be improved, and how much the role costs.

What’s new?

Researchers examined routine electronic records covering 4.5 million incidents in 2019 from 6 ambulance services in England. They reviewed policies and guidelines from 7 ambulance services. The researchers interviewed 47 people (including responders, commissioners, ambulance staff, patients and their relatives).

The study found that responders typically took on 1 shift per week (on-call for 7 hours). They attended calls for many health issues, including breathing difficulties, choking and seizures. They shared information such as blood pressure and temperature with ambulance crews on arrival.

Overall, community first responders arrived before ambulance crews in 2% (86,880) of all calls made. They were most likely to arrive first:

  • in rural areas (4%) compared with urban areas (1.5%)
  • for the most serious calls (9%) and for slightly less serious calls (5%)
  • for neurological conditions including stroke and endocrine problems such as low blood sugar (6.5%)
  • for heart and breathing problems (almost 6%).

Responders are assigned to calls according to their location when the call is made. The study suggested that wealthier, less diverse areas were best served by community first responders. Callers who were less likely to be seen by a community first responder ahead of an ambulance were:

  • from minority ethnic backgrounds (0.07% calls compared with 2.0% calls made by white people)
  • from lower income areas (0.8% calls compared with 1.1% calls in high-income areas).

The impact of the service was mixed. Community first responders:

The data did not show a direct impact on survival rates in cardiac arrest. This is because the arrival of community first responders is only one among many factors that influence survival.

The research team found that rules, standards and procedures (to ensure the safety of responders, patients and the public) varied between services. The numbers of responders across ambulance services, and the training, varied widely. Costs were incompletely recorded and reported but estimates ranged from £40,000 to over £800,000 per service per year.

In interviews, responders said they had made a proactive and positive decision to take on the role. Some were motivated by the first aid training. Patients and the public were often unaware of the responder role. Despite this, the arrival of a responder provided reassurance as well as assistance.

Why is this important?

The study highlights the value of community first responders to emergency medical services and the people they care for. Responders help ambulance services meet their target response time. They sometimes reach people faster than ambulances (particularly in rural settings) and provide emergency care before paramedics arrive.

When the role was introduced, responders were only called out to people whose hearts had stopped outside of hospital. They are now called for a range of emergencies, and the role is expanding (to attend people who have long-term conditions, or who have fallen at home, for example).

The study raised concerns about the accuracy of ambulance services’ records of costs, including training for responders and out of pocket expenses such as fuel. The incomplete nature of the records partly explains the large cost differences in services’ estimates; better record-keeping is needed to establish whether first responders are cost-effective.

What’s next?

In collaboration with policymakers, the researchers are developing recommendations to develop the responder role. Recommendations include standardisation of training and of the responsibilities of the role.

At meetings with people from 8 ambulance services (regional and national), they called for ambulance services to standardise training and responsibilities. Stakeholders suggested a nationally recognised certificate for all responders. These discussions informed the future National Ambulance Volunteering Strategy.

Some ambulance services are trialling falls programmes for community first responders, in which emergency calls are fielded to responders instead of ambulance crews. Using responders for potentially non-urgent call-outs could reduce ambulance call-outs, save ambulance crews’ time and reduce NHS spending.

You may be interested to read

This is a summary of a research project. All outputs are on the project web page:

Papers include:

Botan V, and others. Community first responders’ contribution to emergency medical service provision in the United Kingdom. Annals of Emergency Medicine 2023; 81: 176 – 183.

Patel G, and others. “It's like a swan, all nice and serene on top, and paddling like hell underneath”: community first responders’ practices in attending patients and contributions to rapid emergency response in rural England, United Kingdom—a qualitative interview study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2023; 31: 7.

Hosseini SMP, and others. PP47 Effectiveness of falls response partnership in emergency medical services in Lincolnshire, UK: an economic evaluation

Patel G, and others. Common hierarchies, varied rules – the problem of governing community first responders in prehospital care for quality standards: documentary discourse analysis. BMC Health Services Research 2023; 23: 38.

An article published on the Lincoln Policy Hub about this research: Policy engagement towards informing the current and future role of Community First Responders’ in the United Kingdom. January 2024.

If you are interested in volunteering for the ambulance service, as a community first responder or in another role, visit the Association of Ambulance Chief Executives website.

Funding: This study was funded by the NIHR Health and Social Care Delivery Research programme.

Conflicts of Interest: No relevant conflicts were declared. Full disclosures are available on the original papers.

Disclaimer: Summaries on NIHR Evidence are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that the views expressed are those of the author(s) and reviewer(s) at the time of publication. They do not necessarily reflect the views of the NHS, the NIHR or the Department of Health and Social Care.

NIHR Evidence is covered by the creative commons, CC-BY licence. Written content may be freely reproduced provided that suitable acknowledgement is made. Note, this license excludes comments made by third parties, audiovisual content, and linked content on other websites.

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