Title: Community First Responders' role in the current and future rural health and care workforce
Funder: Department of Health and Social Care

Abstract: Community First Responders (CFRs) are trained members of the public or off-duty health care staff who volunteer to provide first aid, helping ambulance services care for people with health emergencies, such as heart attacks, at home or in public places. CFRs are an important part of the care workforce, particularly in rural areas where it is more difficult to provide or get emergency care. CFRs are broadly perceived to be positive, but we need evidence on 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._x000D_ Patient and public involvement (PPI) members supported our previous research on CFRs and this proposal. The group will be expanded to include representatives from rural, including minority ethnic and migrant, communities. They will be involved throughout the research and its dissemination as steering group members, commenting on findings, helping to come up with recommendations, feeding into a final workshop and communicating findings to professionals and public. _x000D_ We will develop recommendations for rural CFRs, by exploring their contribution to care, evaluating their costs and effects, understanding experiences and views of patients, CFRs and other healthcare staff, and exploring the potential for CFRs to provide new services._x000D_ We will do this by: _x000D_ i. Describing how CFRs contribute to rural health care in numbers and timing of calls, and types of people and conditions attended._x000D_ ii. Evaluating the costs and consequences of having CFRs._x000D_ iii. Exploring local guidance and views of patients, relatives, ambulance staff, primary care, funders, CFRs and CFR scheme organisers on CFRs’ current role and potential for future developments and innovations. We will also ask about challenges and solutions to recruiting, training, retaining CFRs in rural areas and how to ensure accountability for safe, high quality care._x000D_ iv. Developing a list of recommendations for development in CFR services. _x000D_ v. Ranking recommendations in importance for future development of the rural CFR workforce._x000D_ We will achieve this using the following steps:_x000D_ 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 they attended and what happened to the patient when the ambulance arrived._x000D_ 2. Evaluate benefits and costs of CFRs attending rural emergencies._x000D_ 3. Interview patients/relatives, ambulance staff, GPs, funders, CFRs and CFR leads about their 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. _x000D_ 4. Combine this knowledge to develop recommendations for change, who will be involved and how services should change to solve the most pressing problems for rural communities they serve. _x000D_ 5. Present recommendations to a workshop of experts and public to agree priorities for future development._x000D_ We will feed back recommendations to each ambulance service and provide reports, articles, presentations, blogs, infographics and social media publicising findings to public and professional audiences._x000D_ We will conduct and complete the work during the 30 months of the project.

Lay abstract: RESEARCH QUESTIONS_x000D_ How are Community First Responders (CFRs) contributing to rural healthcare? Do they provide value for money? How are they perceived by patients and other providers? How can Community First Responder (CFR) schemes develop to support future rural health and care services?_x000D_ BACKGROUND_x000D_ Community First Responders (CFRs) are trained members of the public or off-duty health staff who volunteer to provide first aid, helping ambulance services care for people in emergencies, e.g. heart attacks or cardiac arrests. CFRs are important for the rural care workforce where providing or accessing emergency care is more difficult. CFRs are broadly perceived as positive by ambulance services, but we need evidence on how they contribute to rural services, how effective they are and at what cost, how they are perceived by patients and other health workers, and how they could be developed further. _x000D_ AIMS_x000D_ To work with patients, public and stakeholders to develop recommendations for future innovations in rural CFR provision by investigating current activity, costs of provision, and views of patients, public, CFR scheme and rural care providers._x000D_ OBJECTIVES_x000D_ Our objectives are to: _x000D_ i. Describe the contribution of CFRs to rural health care provision in terms of numbers/timing of calls attended, types of condition and characteristics of people attended._x000D_ ii. Evaluate costs, funding sources, and consequences of CFR schemes. _x000D_ iiia. Analyse CFR guidelines. _x000D_ iiib. Explore stakeholder (patients, relatives, ambulance staff, primary care, commissioners, CFRs and CFR scheme organisers) experiences and perceptions of CFRs’ current role and potential for future developments/innovations. We will also ask CFRs and CFR scheme organisers about challenges and solutions to recruiting, training, retaining CFRs in rural areas and how to ensure governance and accountability for safe, high quality care._x000D_ iv. Assimilate and integrate data from i-iii synthesising these using ABC (actor, behavioural change, causal pathway) theory to develop a list of recommendations for future innovations._x000D_ v. Prioritise recommendations for future developments/innovations in rural CFR provision through a consensus stakeholder workshop. _x000D_ METHODS_x000D_ Using mixed methods with five linked work packages (WP1-5) we will:_x000D_ WP1: Analyse data from six ambulance services to identify how many people and the proportion of ambulance calls CFRs attended, characteristics of people (age, sex, condition) attended, how quickly they attend, and what happens to patients when the ambulance arrives. _x000D_ WP2: Evaluate costs, funding sources and consequences of CFR schemes. _x000D_ WP3: Review guidance; interview patients/relatives, ambulance staff, GPs, commissioners, CFRs and CFR leads on their perspectives of the CFR role and potential for future development in rural areas. Interviews with CFRs and CFR leads exploring challenges and solutions to recruiting, training, retaining rural CFRs and ensuring governance and safe, high quality care._x000D_ WP4: Assimilate and integrate WP1-3 findings using the ABC framework to list recommendations/approaches for future developments/innovations. _x000D_ WP5: Present recommendations to stakeholder consensus workshop to agree future development priorities for rural CFRs._x000D_ TIMELINES_x000D_ The study will take place over 30 months (M). Ethics: Months (M) 0-3. WP1:M3-21; WP2:M12-23; WP3:M3-23; WP4:M21-24; WP5:M25-26; dissemination M27-30; final report M30._x000D_ IMPACT/DISSEMINATION_x000D_ We will report to services, the funder, and through peer reviewed articles, presentations, and social media, publicising findings to lay/professional audiences. We anticipate the study will stimulate practice change in ambulance and independent CFR schemes.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE