Report Calls For National Guidance For Emergency Ambulance Volunteers, UK

Main Category: Public Health
Article Date: 27 Dec 2007 - 0:00 PDT

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First ever survey of community first responders (emergency ambulance volunteers) shows ambulance trusts value schemes but standard management approach needed

The Healthcare Commission called for national guidelines to be developed to enable ambulance trusts to manage and govern their community first responder (CFR) schemes consistently.

Community first responders are volunteers that help respond to immediate life threatening calls, such as heart attacks, in their local community. They are used in addition to, not instead of, ambulance services.

They were set up across England in 1999 after the Government encouraged ambulance services in rural areas to use them to help achieve Government targets (on Category A calls) requiring services to reach life threatening emergencies within eight minutes of a 999 call being made.

Community first responders are commonplace in ambulance services. The Commission's survey has found there are 1,331 CFR schemes and 10,158 CFRs working throughout ambulance trusts in England.

Over time the role and function of CFR schemes have expanded but there have been no national guidelines available to ambulance services for their development. The Commission believes the development of this service requires the NHS to ensure the schemes are properly managed, supported and audited by ambulance services.

Ambulance services value the support of CFR schemes. When asked in the survey about the benefits of CFR schemes the response from ambulance trusts was generally very positive, with the main benefit being the contribution CFRs made to trusts achieving their government target of responding to category A (life or death) 999 calls within 8 minutes.

Twelve out of the 13 NHS ambulance trusts in England took part in the survey (one trust did not take part in the survey because it is based in a highly urban area and therefore does not run a community first responder scheme). The survey sought to present a national picture of the role and the management of community first responder schemes, and focus on important areas such as training.

The Healthcare Commission carried out the survey after it began an investigation into Staffordshire Ambulance NHS Trust which included an assessment of the management of community first responders within that trust. The Commission found there was no national information on the role and management of community first responders to provide a context for this investigation, so carried out the survey to provide this information.The findings of the investigation into Staffordshire Ambulance NHS Trust will be published early next year.

Healthcare Commission Head of Investigations Nigel Ellis said: "Community first responders are recognised as providing a valuable service to their local communities.

"Our survey shows that ambulance trusts value the contribution that CFRs make, especially in helping them to reach patients in rural areas as quickly as possible.

"What needs to happen now is for these schemes to receive a consistent level of support, no matter what part of the country they are operating in. We believe that national guidelines are necessary to achieve this. These guidelines need to cover the management and governance of these schemes, as well as the level of training provided to volunteers."

For the purpose of the survey the results have been presented in relation to 26 "localities" across England.

Key findings:

- The number of emergency calls that CFRs attend is relatively low in comparison to the number of calls attended by ambulance staff. In 2006/2007 the 12 ambulance services that took part in the survey received and responded to five million 999 calls. Of these, CFRs were sent to 92,928 which is 1.8% of the total calls.

- In most cases the line of accountability for CFR schemes lies with the director of operations in an ambulance trust. In other cases accountability lies with the locality director, the director of human resources, the director of production, the director of governance or the director of corporate development.

- All CFRs are trained to provide Basic Life Support, but the type of training that CFRs receive varies between localities. Eleven localities use the Institute of Healthcare Development's "First Person on Scene" course. The other localities use in-house courses, that in some cases are based on the "First Person on Scene" qualification although they do not register with the Institute of Healthcare Development.

- For the majority of localities (19) oxygen is the only drug that CFRs are approved to administer. However, seven localities have additional approved medications for CFRs to administer including entonox (pain relief), intramuscular injection for anaphylaxis (severe allergic reaction) and glucose for diabetic comas.

- Three localities allow specific CFRs to repond to calls using blue lights and sirens.These CFRs need to have already completed advanced driver training through their full-time occupation (e.g. as a GP.)

- One locality reported that each CFR scheme has a designated vehicle that is adapted by the ambulance service to include blue lights and a siren. Guidance is provided to ensure that CFRs comply with Road Traffic Act and do not exceed speed limits or pass red lights.

The Healthcare Commission will share the findings of this survey with all ambulance trusts. Early next year it will publish the findings of its investigation into Staffordshire Ambulance NHS Trust.

More information on the role and management of community first responders

Information on the Healthcare Commission

The Healthcare Commission is the health watchdog in England. It keeps check on health services to ensure that they are meeting standards in a range of areas. The Commission also promotes improvements in the quality of healthcare and public health in England through independent, authoritative, patient-centred assessments of those who provide services.

Responsibility for inspection and investigation of NHS bodies and the independent sector in Wales rests with Healthcare Inspectorate Wales (HIW). The Healthcare Commission has certain statutory functions in Wales which include producing an annual report on the state of healthcare in England and Wales, national improvement reviews in England and Wales, and working with HIW to ensure that relevant cross-border issues are managed effectively.

The Healthcare Commission does not cover Scotland as it has its own body, NHS Quality Improvement Scotland. The Regulation and Quality Improvement Authority (RQIA) undertakes regular reviews of the quality of services in Northern Ireland.

Healthcare Commission