STRENGTHS AND LIMITATIONS OF THIS STUDY
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This review will follow a well-established methodological framework, with a thorough search and screening procedure.
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By following the inclusion and exclusion criteria outlined in the protocol, we aim to reduce bias.
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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.14–16 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.21–23 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:
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What are the key dimensions and components of CFR models worldwide?
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What are the specific measures and interventions employed to enhance the efficacy of CFR models?
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What is the global landscape of CFR initiatives, and how do different countries approach the integration of CFR into their EMS systems?
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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.
Search strategy
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).
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.26–28 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.
Ethics statements
Patient consent for publication
Acknowledgments
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.
This post was originally published on https://bmjopen.bmj.com