
==== Front
BMJ Open
BMJ Open
bmjopen
bmjopen
BMJ Open
2044-6055
BMJ Publishing Group BMA House, Tavistock Square, London, WC1H 9JR

39214657
10.1136/bmjopen-2024-085071
bmjopen-2024-085071
Protocol
Emergency Medicine
1691
1506
Exploring national and international experiences with community first responder models: protocol for a scoping review
http://orcid.org/0000-0002-5100-8024
Naboureh Abbas 1naboureh1355@gmail.com

http://orcid.org/0000-0003-0550-5641
Farrokhi Mehrdad 1me.farrokhi@uswr.ac.ir

Saatchi Mohammad 2m.saatchi65@gmail.com

Ahmadi Shokoufeh 1ahmadi.shokoufeh@gmail.com

Layeghi Fereydon 3layeghi@yahoo.com

http://orcid.org/0000-0002-9532-5646
Khankeh Hamidreza 14hrkhankeh@gmail.com

QUEST Center for Responsible Research
1 Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Science, Tehran, Tehran, Iran (the Islamic Republic of)
2 Department of Epidemiology & Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
3 Department of Clinical Sciences, University of Social Welfare and Rehabilitation Science, Tehran, Tehran, Iran (the Islamic Republic of)
4 Department of Clinical Science and Education Södersjukhuset, Karolinska Institute, Stockholm, Stockholm, Sweden
Professor; hrkhankeh@gmail.com
None declared.

2024
30 8 2024
14 8 e08507105 2 2024
04 7 2024
Copyright © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
2024
https://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

ABSTRACT

Introduction

Timely arrival of emergency medical services (EMS) is pivotal for effective prehospital care, and efforts by EMS leaders and policymakers to reduce response times, especially in cardiac arrests responsible for 70%–80% of coronary heart disease-related deaths, underscore the global urgency. With approximately 55 out-of-hospital cardiac arrests per 100 000 people annually, survival rates hinge on timely cardiopulmonary resuscitation, emphasising its initiation within a 4–6 min window. Trauma, causing 6 million deaths and nearly 40 million injuries a year, further underscores the need for prompt prehospital care. Acknowledging these challenges, health systems have incorporated community first responder (CFR) models, where trained community members provide initial aid, aiming to bridge the crucial gap until professional help arrives. This scoping review intends to explore the experiences of various countries with CFR models, including their conceptual and theoretical frameworks, recognising CFR as a critical solution for reducing response times in prehospital emergency care.

Methods and analysis

Arksey and O'Malley’s approach will be followed in this scoping review. Our protocol was drafted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols extension for Scoping Reviews. The study objective is to comprehensively understand and map current knowledge about CFR model characteristics and identify effective components and indicators. The review will encompass available articles indexed in PubMed, Scopus and Web of Science without restrictions on date of publication. Additional searches will explore grey literature on Google Scholar and reliable websites in the field of EMS. Articles published in languages other than English and those inaccessible in full text will not be considered for inclusion.

Ethics and dissemination

Since the study data are accessible from publicly accessible secondary sources, no ethical approval is necessary. Peer-reviewed publications will be used to report the study findings.

Emergency Departments
ACCIDENT & EMERGENCY MEDICINE
Health Services
==== Body
pmcSTRENGTHS AND LIMITATIONS OF THIS STUDY

This review will follow a well-established methodological framework, with a thorough search and screening procedure.

By following the inclusion and exclusion criteria outlined in the protocol, we aim to reduce bias.

We will only include English-language publications, so may miss relevant reports in other languages.

Introduction

The timely arrival of emergency medical services (EMS) is a crucial factor in ensuring the effectiveness of prehospital care, and as such, it must be carefully managed to enhance the prospects of survival.1 Consequently, those in charge of EMS and healthcare policymakers are actively working to address the issue of reducing response times through a range of measures.2

Trauma and cardiac arrest are among the most common time-sensitive emergencies. A highly time-critical emergency is when a cardiac arrest occurs outside hospitals, which is responsible for 70%–80% of coronary heart disease-related deaths.3 4 Globally, approximately 55 out-of-hospital cardiac arrests (OHCAs) occur per 100 000 people each year.5 Survival rates for these cases range from 5% to 38%, with the variance attributed to how prehospital care and services are provided.6 Cardiopulmonary resuscitation (CPR) is the primary and most vital response to cardiac arrest, with a critical window of 4–6 min for initiation. Delaying CPR by just 1 min reduces a patient’s chances of survival by 7%–10%.7 Starting CPR before the arrival of prehospital emergency teams substantially improves the odds of survival, increasing those twofold to threefold.5 8

Trauma is another serious, time-sensitive emergency that significantly contributes to fatalities.7 9 Globally, trauma causes around 6 million deaths and nearly 40 million injuries every year.10 11 As per the most recent prehospital trauma critical care guidelines, the foremost priority in evaluating trauma patients is the control of bleeding.12 Bleeding is frequently cited as the primary cause of preventable death in the aftermath of trauma. In certain trauma cases, just 5 min of uncontrolled bleeding can result in the victim’s death.13

Health systems worldwide, in addition to improving and modernising EMS, aim to decrease response times in emergencies and attain better outcomes for patients and injured individuals through initiatives such as community first responder (CFR) programmes.1416 In several nations, including the USA, Australia, the UK and Canada, CFR has emerged in response to evolving healthcare situations and requirements.17 A CFR is a trained member of the community who voluntarily offers initial aid when accidents or emergencies occur near their home or workplace, bridging the gap until professional ambulance assistance arrives.18

Our objective is to undertake a scoping review to investigate and map the current body of literature on CFR globally. The goal is to identify existing knowledge, pinpoint gaps in understanding, and formulate recommendations for future research in the field of CFR.

Study rationale

The increasing global ageing population and urbanisation contribute to longer response times and delays in healthcare delivery.19 20 However, studies indicate that improving the standard of early prehospital treatment can significantly lower the frequency of health-related problems and improve patient outcomes.2123 CFR schemes address this gap by mobilising local resources, reducing response times and improving patient prognoses.

Study objectives

This study aims to explore the experiences of various countries with CFR models, including their conceptual and theoretical frameworks, and to investigate the reported impacts of CFR programmes on reducing response times in prehospital emergencies, particularly focusing on cardiac arrests and trauma. The goal is to identify successful CFR models and frameworks for potential implementation on a broader scale. We will conduct a thorough examination of the existing literature on ongoing CFR models worldwide, aiming to identify areas necessitating further investigation.

Methods and analysis

We will use a comprehensive scoping review approach to analyse published research about CFR initiatives, covering interventions, comparisons and outcomes. The objective is to comprehensively assess, outline and synthesise the breadth of published literature, regardless of its quality.24 We will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for Scoping Reviews to ensure a rigorous and systematic reporting process.

Step 1: Identifying the research questions

Arksey and O'Malley suggest an iterative process of formulating research questions, emphasising repeated attempts to enhance familiarity with the existing literature.24 Our study questions were generated and modified through consultations held by the research team to establish the possibility of adopting CFR models internationally. There are four research questions in this review:

What are the key dimensions and components of CFR models worldwide?

What are the specific measures and interventions employed to enhance the efficacy of CFR models?

What is the global landscape of CFR initiatives, and how do different countries approach the integration of CFR into their EMS systems?

How can the identified key dimensions of CFR schemes guide the design and implementation of suitable models tailored to the specific needs and capacities of different regions?

Step 2: Identifying pertinent studies using search terms and inclusion/exclusion standards

To identify pertinent studies, searches will be conducted through electronic databases: Web of Science Core Collection, PubMed and Scopus. Additional searches will explore grey literature on Google Scholar and reliable websites in the field of EMS. Before conducting a database search, the MeSH terms will be used to extract the keywords and synonyms related to the term ‘community first responder’ as well as additional keywords such as: ‘emergency responders’, ‘lay responders’, ‘immediate responders’, ‘volunteer first responders’, and ‘medical first responders’. Databases will be searched as outlined in table 1. There are no restrictions on the date of publication.

Table 1 Search strategy

Database	Formula	Result	
PubMed	(“emergency responder*“(Mesh Terms] OR “emergency responder*“(tiab] OR “lay responder*“(tiab))) OR “immediate responder*“(tiab] OR “volunteer first responder*“(tiab))) OR “community first responder*“(tiab] OR “first person on scene*” OR “medical first responder*"(tiab))) OR community [tiab] AND first [tiab] AND responder [tiab)).	N =?	
Web of Science	((TS=(“emergency responder” OR “lay responder” OR “immediate responder” OR “first person on scene” OR " community first responder*” OR “community responder*” OR “first responder*” OR " volunteer first respond*” OR “medical first responder*” OR community)) AND TS=(first)) AND TS=(responder*)	N =?	
Scopus	(TITLE-ABS-KEY (“emergency responder*”) OR TITLE-ABS-KEY (“lay responder*”) OR TITLE-ABS-KEY (“first person on scene”) OR TITLE-ABS-KEY (“community first respon*”) OR TITLE-ABS-KEY (“community respon*”) OR TITLE-ABS-KEY (“first respon*”) OR TITLE-ABS-KEY (“first-respon*”) OR TITLE-ABS-KEY (“medical first respon*”) OR TITLE-ABS-KEY (“citizen first person*”) OR TITLE-ABS-KEY (“volunteer first person*”) OR TITLE-ABS-KEY (“community”) AND TITLE-ABS-KEY (“first”) AND TITLE-ABS-KEY (“responder”))AND TITLE−ABS−KEY (first) AND TITLE−ABS−KEY (responder*)	N =?	

Step 3: Selection process

After conducting a comprehensive search across all databases, the chosen studies will be imported into EndNote, and duplicate entries will be removed. Next, the titles and abstracts of these studies will be reviewed to identify their relevance. Subsequently, the full texts of the relevant studies will be independently assessed by two knowledgeable reviewers with expertise in the field. Any discrepancies between the reviewers will be resolved through group discussion and consensus. In cases where disagreements persist, a third reviewer will be consulted for assistance. In addition, references to the ultimately selected articles will be examined to discover any potentially pertinent publications. Furthermore, expert opinions in the field will be used to manually review specialised journals related to this domain, with the search extending up without time limits for relevant papers. The selection of studies will be reported in a PRISMA flow diagram (figure 1).

Figure 1 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram.

In our research criteria, we concentrate on papers and documents specifically addressing the design, execution or enhancement of CFR models. We will identify studies containing keywords associated with CFR in their titles, abstracts or keyword sections. In addition, we will review official documents, books or scholarly works relevant to this area of interest. Articles published in languages other than English and those inaccessible in full text will not be considered in this study.

Step 4: Charting the data

The charting of the data from the chosen articles is the fourth step in the Arksey and O'Malley scoping review technique.24 Following the completion of the literature search, data will be extracted through a full-text evaluation of the publications that were ultimately chosen. Based on a premade form, each individual will independently extract the original data. Specific information about the following research factors must be extracted:1 the study’s country of origin;2 the study’s purpose;3 the study’s methodology;4 and the study’s key conclusions regarding the elements and aspects of CFR models, patterns and frameworks. Furthermore, additional information will be taken from the chosen article based on the consensus of the reviewers.

Step 5: Data analysis and synthesis

This study investigates CFR models, patterns and frameworks worldwide. Because of the diverse range of study types and methodologies in the existing literature, quantitative meta-analysis is not feasible for data analysis. Consequently, we will employ thematic content analysis to analyse the gathered data.

Discussion

Various studies have examined the advantages of the CFR models, including their prompt arrival at the patient’s location ahead of ambulance staff, the timely initiation of essential measures, improved patient survival rates and hospital discharges with favourable neurological outcomes.19 20 25 In addition, research has explored the motivations behind joining CFR groups, the required qualifications to become a CFR, their interaction with ambulance staff, and more.2628 However, significant variations exist among CFR groups worldwide and even within a single country. These differences encompass the types of missions CFRs are called for and the necessary training and qualifications that individuals must possess.

Although a scoping review has been conducted on CFR patterns in the UK,29 and certain systematic studies have addressed specific aspects, such as outcomes for patients with OHCA,8 there remains a notable gap in the literature. This study aims to fill this gap by conducting a comprehensive, systematic, scoping review of the available literature in this field.

It will explore the essential dimensions and components of CFR models, patterns and frameworks on a global scale. However, our study has some limitations. Only English-language publications are considered for inclusion, so any relevant publications in other languages will be missed. Synthesising diverse methodologies may pose challenges, and variability in CFR programmes across regions may affect the generalisability of findings. Furthermore, interpreting the results of the scoping review may be difficult given that evaluation of the quality of the included studies will not be done.

Acknowledgements

The authors thank the Health Department of the University of Social Welfare and Rehabilitation Sciences in the Emergency and Disaster Research Centre for their guidance and assistance with this research.

Review Process File
30 08 2024

Funding: This research is a component of a PhD thesis funded by the Rehabilitation Sciences and Social Welfare University.

Prepublication history for this paper is available online. To view these files, please visit the journal online (https://doi.org/10.1136/bmjopen-2024-085071).

Patient consent for publication: Not applicable.

Provenance and peer review: Not commissioned; externally peer reviewed.

Patient and public involvement: Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
==== Refs
References

1 Lawner BJ Hirshon JM Comer AC et al The impact of a freestanding ED on a regional emergency medical services system Am J Emerg Med 2016 34 1342 6 10.1016/j.ajem.2015.11.042 26686934
2 Khalemsky M Schwartz DG Herbst R et al Motivation of emergency medical services volunteers: a study of organized Good Samaritans Isr J Health Policy Res 2020 9 11 10.1186/s13584-020-00370-9 32482170
3 Niu Y Chen R Liu C et al The association between ambient temperature and out-of-hospital cardiac arrest in Guangzhou, China Sci Total Environ 2016 572 114 8 10.1016/j.scitotenv.2016.07.205 27497032
4 Tobaldini E Iodice S Bonora R et al Out-of-hospital cardiac arrests in a large metropolitan area: synergistic effect of exposure to air particulates and high temperature Eur J Prev Cardiol 2020 27 513 9 10.1177/2047487319862063 31311316
5 Berdowski J Berg RA Tijssen JGP et al Global incidences of out-of-hospital cardiac arrest and survival rates: systematic review of 67 prospective studies Resuscitation 2010 81 1479 87 10.1016/j.resuscitation.2010.08.006 20828914
6 Rzońca P Gałązkowski R Panczyk M et al Polish Helicopter Emergency Medical Service (HEMS) Response to Out-of-Hospital Cardiac Arrest (OHCA): a Retrospective Study Med Sci Monit 2018 24 6053 8 10.12659/MSM.908962 30166502
7 Mokdad AH Forouzanfar MH Daoud F et al Global burden of diseases, injuries, and risk factors for young people’s health during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013 The Lancet 2016 387 2383 401 10.1016/S0140-6736(16)00648-6
8 Scquizzato T Pallanch O Belletti A et al Enhancing citizens response to out-of-hospital cardiac arrest: a systematic review of mobile-phone systems to alert citizens as first responders Resuscitation 2020 152 16 25 10.1016/j.resuscitation.2020.05.006 32437783
9 Rhee P Joseph B Pandit V et al Increasing trauma deaths in the United States Ann Surg 2014 260 13 21 10.1097/SLA.0000000000000600 24651132
10 Organization WHO Preventing injuries and violence: a guide for ministries of health 2007
11 Wesson HKH Boikhutso N Bachani AM et al The cost of injury and trauma care in low- and middle-income countries: a review of economic evidence Health Policy Plan 2014 29 795 808 10.1093/heapol/czt064 24097794
12 Broughton W Gowens P Prehospital trauma life support Jones & Bartlett Learning 2019
13 Latour J McDonough E Medical Reserve Corps: increasing Community Resilience in Mass Casualties Through Active Bystander Training Health Secur 2019 17 507 11 10.1089/hs.2019.0106 31794676
14 Murad MK Husum H Trained lay first responders reduce trauma mortality: a controlled study of rural trauma in Iraq Prehosp Disaster Med 2010 25 533 9 10.1017/s1049023x00008724 21181688
15 Sarkisian L Mickley H Schakow H et al Global positioning system alerted volunteer first responders arrive before emergency medical services in more than four out of five emergency calls Resuscitation 2020 152 170 6 10.1016/j.resuscitation.2019.12.010 31923531
16 Stroop R Kerner T Strickmann B et al Mobile phone-based alerting of CPR-trained volunteers simultaneously with the ambulance can reduce the resuscitation-free interval and improve outcome after out-of-hospital cardiac arrest: a German, population-based cohort study Resuscitation 2020 147 57 64 10.1016/j.resuscitation.2019.12.012 31887366
17 O’Meara P Stirling C Ruest M et al Community paramedicine model of care: an observational, ethnographic case study BMC Health Serv Res 2016 16 39 10.1186/s12913-016-1282-0 26842850
18 Barry T Doheny MC Masterson S et al Community first responders for out-of-hospital cardiac arrest in adults and children Cochrane Database Syst Rev 2019 7 10.1002/14651858.CD012764.pub2
19 Campbell A Ellington M Reducing Time to First on Scene: an Ambulance-Community First Responder Scheme Emerg Med Int 2016 2016 1915895 10.1155/2016/1915895 27119024
20 Roberts A Nimegeer A Farmer J et al The experience of community first responders in co-producing rural health care: in the liminal gap between citizen and professional BMC Health Serv Res 2014 14 460 10.1186/1472-6963-14-460 25326796
21 Mehmood A Rowther AA Kobusingye O et al Assessment of pre-hospital emergency medical services in low-income settings using a health systems approach Int J Emerg Med 2018 11 53 10.1186/s12245-018-0207-6 31179939
22 Lin CB Peterson ED Smith EE et al Emergency medical service hospital prenotification is associated with improved evaluation and treatment of acute ischemic stroke Circ Cardiovasc Qual Outcomes 2012 5 514 22 10.1161/CIRCOUTCOMES.112.965210 22787065
23 Rogers FB Rittenhouse KJ Gross B The golden hour in trauma: dogma or medical folklore? Injury 2015 46 525 7 10.1016/j.injury.2014.08.043 25262329
24 Arksey H O’Malley L Scoping studies: towards a methodological framework Int J Soc Res Methodol 2005 8 19 32 10.1080/1364557032000119616
25 Barry T Headon M Quinn M et al General practice and cardiac arrest community first response in Ireland Resusc Plus 2021 6 100127 10.1016/j.resplu.2021.100127 34223384
26 Barry T González A Conroy N et al Mapping the potential of community first responders to increase cardiac arrest survival Open Heart 2018 5 e000912 10.1136/openhrt-2018-000912 30402259
27 Högstedt A Thuccani M Carlström E et al Characteristics and motivational factors for joining a lay responder system dispatch to out-of-hospital cardiac arrests Scand J Trauma Resusc Emerg Med 2022 30 22 10.1186/s13049-022-01009-1 35331311
28 Seligman WH Ganatra S England D et al Initial experience in setting up a medical student first responder scheme in South Central England Emerg Med J 2016 33 155 8 10.1136/emermed-2015-204638 26253147
29 Phung V-H Trueman I Togher F et al Community first responders and responder schemes in the United Kingdom: systematic scoping review Scand J Trauma Resusc Emerg Med 2017 25 58 10.1186/s13049-017-0403-z 28629382
