References
History and experience of a volunteer ambulance first responder scheme in London
Abstract
Emergency responders (ERs) are volunteers who attend category 1 (immediately life-threatening) and category 2 (emergency) 999 calls on behalf of the London Ambulance Service NHS Trust (LAS). ERs aim to arrive first on scene to these incidents to provide essential life-saving interventions prior to the arrival of further ambulance resources. ERs come from a wide range of backgrounds and undergo a thorough selection, training and mentorship process before advancing to working in a two-person ER crew. Compared to most traditional volunteer first responder schemes, the LAS ER scheme, which was set up in 2008, involves an enhanced skillset, dispatch to medical and traumatic emergencies in addition to cardiac arrest, and the use of blue-light vehicles to reduce response times. Over a period of 13 years, the scheme has grown in scope and size, and now operates with more than 120 volunteers based at seven ambulance stations across London.
Out-of-hospital cardiac arrest is a major cause of morbidity and mortality in the UK (Hawkes et al, 2017). In 2019, ambulance services in England resuscitated 31 024 patients in cardiac arrest. Of those, 30.1% sustained return of spontaneous circulation to hospital and, overall, 9.3% survived to discharge (NHS England, 2020).
Survival following out-of-hospital cardiac arrest depends on a swift ‘chain of survival’ (Nolan et al, 2006), which begins with early cardiopulmonary resuscitation (CPR) and defibrillation. High-quality CPR and early defibrillation are simple skills but remain the most important interventions for these patients (Rainer et al, 1997). Survival rates increase when patients receive early bystander CPR and public access defibrillation (Hawkes et al, 2017).
Many UK ambulance service trusts are supported by volunteer community first responders (CFRs) (Perkins et al, 2016). Often responding to emergencies in their local areas, CFRs initiate life-saving interventions before an ambulance resource arrives. The dispatch of CFRs has been shown to increase the rate of defibrillation and survival to admission (Barry et al, 2019).
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