■社区第一反应者是由救护车服务派遣的训练有素的志愿者,在最初的重要时刻为可能危及生命的紧急情况,例如心脏骤停提供护理,直到高技能的救护人员到达。首次推出社区急救计划,以支援乡村社区的救护服务,在那里获得院前急救护理更有可能被推迟。缺乏证据证明他们对农村医疗保健的贡献,如何提供护理以及如何改善护理。
■我们旨在描述社区第一反应者的活动,organization,提供护理的成本和结果,以及患者的看法和观点,public,社区第一反应者救护车服务人员和专员当前和未来的角色,包括农村卫生和护理劳动力的创新。
■我们使用了混合方法设计,使用实用主义和“演员”的镜头,“行为改变”和“因果途径”框架,以整合定量常规和定性(政策、指南和协议文件以及利益相关者访谈)来自10个英国救护车服务中的6个的数据。我们确定了社区第一响应者提供中的潜在创新,并使用改进的名义组技术对这些创新进行了优先排序。患者和公众参与整个研究。
■在2019年COVID-19大流行之前,来自六家英国地区救护车服务的450万起事件中,社区第一反应者首先参加农村地区的电话比例(几乎占4%)高于城市地区(约1.5%)。他们更有可能被召唤到农村(与城市)地区,并参加年龄较大的(与年轻),白色(vs.少数民族)更富裕的人(与剥夺)心肺和神经系统区域(vs.其他紧急情况)优先级较高的紧急情况或紧急情况(与第3、4或5类相比,第1类和第2类)呼叫,但也参加了较低类别的呼叫,例如跌倒。我们检查了七个救护车服务的10份文件。救护车政策和协议将社区第一响应者纳入救护车服务结构,以实现志愿者的安全有效运作。Costs,主要用于培训,设备和支持,差异很大,但并不总是清楚地描述。社区第一响应者实现了更快的院前响应时间。院外心脏骤停结果没有明显的益处。特定的社区第一响应者跌倒反应减少了救护车的出勤率,并可能节省成本。我们对从事社区第一响应者职能的47个不同利益相关者进行了半结构化访谈。这表明了成为社区第一反应者的轨迹,社区第一反应者的角色,治理和实践,以及利益相关者对社区第一反应者的积极看法,尽管公众对他们的角色缺乏了解。社区急救人员的实践范围因救护车服务而异,并已发展成为新领域。共识研讨会上优先考虑的创新是流程和结构的变化以及培训支持的扩大实践范围,其中包括咨询,同行支持,与控制室更好的沟通,导航和通信技术,以及针对社区急救人员的特定强制性和标准化培训。
■在一些利益相关者群体中缺少数据和少量访谈(患者,专员)是偏见的来源。
■未来的研究应包括对涉及社区第一反应者的创新进行强有力的评估。
■该试验注册为ClinicalTrials.gov,NCT04279262。
■该奖项由国家健康与护理研究所(NIHR)健康与社会护理提供研究计划(NIHR奖参考:NIHR127920)资助,并在健康与社会护理提供研究中全文发表。12号18.有关更多奖项信息,请参阅NIHR资助和奖励网站。
社区第一反应者是参加紧急情况的志愿者,特别是在农村地区,在救护车到来之前提供帮助.我们的目的是描述社区第一反应者的活动,成本和效果,并获得公众的意见,社区第一反应者救护人员和专员对社区第一响应者当前和未来的作用。我们的研究设计结合了不同的方法。我们检查了常规的救护车病人信息,审查救护车政策和指导方针,从采访中收集信息来理解我们的发现。通过采访,我们了解了社区第一反应人员的工作得到加强或可以改进的方式。在为期1天的研讨会上,一组非专业和专业专家,按有关涉及社区第一反应者的未来发展的重要思想排名。社区第一反应人员在救护车工作人员之前到达,农村地区的电话比例高于城市地区。他们接待了各种条件的人,包括呼吸困难,胸痛,中风,困倦,糖尿病和跌倒,通常是优先级最高的紧急情况,但也有优先级较低的呼叫。旨在确保社区第一反应者提供安全的政策,有效的护理。Costs,主要用于管理,培训和设备,有时是不完整或不准确的,并且在服务之间差异很大。社区第一反应者参加意味着对接受采访的患者和亲属的更快的反应和积极的体验。针对在家中摔倒的人的社区第一反应计划导致参加的救护车减少,并可能节省财务。当社区第一响应者提早到达时,由于心脏停止跳动而参加的人们的生存状况并没有好转。采访揭示了社区第一反应者为什么以及如何自愿接受培训,他们做了什么以及他们的感受。受访者对社区第一反应者持积极态度。建议的改进包括同事或顾问的支持,与救护车服务更好的沟通,通信和定位患者的技术,更好的训练。社区第一响应者在响应时间和患者护理方面都有好处。应该评估未来的改进。
UNASSIGNED: Community First Responders are trained
volunteers dispatched by ambulance services to potentially life-threatening emergencies such as cardiac arrest in the first vital minutes to provide care until highly skilled ambulance staff arrive. Community First Responder schemes were first introduced to support ambulance services in rural communities, where access to prehospital emergency care is more likely to be delayed. Evidence is lacking on their contribution to rural healthcare provision, how care is provided and how this might be improved.
UNASSIGNED: We aimed to describe Community First Responder activities, organisation, costs of provision and outcomes of care together with perceptions and views of patients, public, Community First Responders, ambulance service staff and commissioners of their current and future role including innovations in the rural health and care workforce.
UNASSIGNED: We used a mixed-methods design, using a lens of pragmatism and the \'actor\', \'behaviour change\' and \'causal pathway\' framework to integrate quantitative routine and qualitative (policy, guideline and protocol documents with stakeholder interview) data from 6 of 10 English ambulance services. We identified potential innovations in Community First Responder provision and prioritised these using a modified nominal group technique. Patients and public were involved throughout the study.
UNASSIGNED: In 4.5 million incidents from six English regional ambulance services during 2019, pre COVID-19 pandemic, Community First Responders attended first a higher proportion of calls in rural areas (almost 4% of calls) than in urban areas (around 1.5%). They were significantly more likely to be called out to rural (vs. urban) areas and to attend older (vs. younger), white (vs. minority ethnic) people in more affluent (vs. deprived) areas with cardiorespiratory and neurological (vs. other emergency) conditions for higher-priority emergency or urgent (category 1 and 2 compared with category 3, 4 or 5) calls but did also attend lower-category calls for conditions such as falls. We examined 10 documents from seven ambulance services. Ambulance policies and protocols integrated Community First Responders into ambulance service structures to achieve the safe and effective operation of
volunteers. Costs, mainly for training, equipment and support, varied widely but were not always clearly delineated. Community First Responders enabled a faster prehospital response time. There was no clear benefit in out-of-hospital cardiac arrest outcomes. A specific Community First Responder falls response reduced ambulance attendances and was potentially cost saving. We conducted semistructured interviews with 47 different stakeholders engaged in Community First Responder functions. This showed the trajectory of becoming a Community First Responder, the Community First Responder role, governance and practice, and the positive views of Community First Responders from stakeholders despite public lack of understanding of their role. Community First Responders\' scope of practice varied between ambulance services and had developed into new areas. Innovations prioritised at the consensus workshop were changes in processes and structures and an expanded scope of practice supported by training, which included counselling, peer support, better communication with the control room, navigation and communication technology, and specific mandatory and standardised training for Community First Responders.
UNASSIGNED: Missing data and small numbers of interviews in some stakeholder groups (patients, commissioners) are sources of bias.
UNASSIGNED: Future research should include a robust evaluation of innovations involving Community First Responders.
UNASSIGNED: This trial is registered as ClinicalTrials.gov, NCT04279262.
UNASSIGNED: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR127920) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 18. See the NIHR Funding and Awards website for further award information.
Community First Responders are
volunteers who attend emergencies, particularly in rural areas, and provide help until the ambulance arrives. We aimed to describe Community First Responder activities, costs and effects and get the views of the public, Community First Responders, ambulance staff and commissioners on the current and future role of Community First Responders. Our study design combined different approaches. We examined routine ambulance patient information, reviewed ambulance policies and guidelines, and gathered information from interviews to make sense of our findings. Through interviews we learned about ways that the work of Community First Responders had been enhanced or could be improved. In a 1-day workshop, a group of lay and professional experts ranked in order of importance ideas about future developments involving Community First Responders. Community First Responders arrived before ambulance staff for a higher proportion of calls in rural than in urban areas. They attended people with various conditions, including breathing problems, chest pain, stroke, drowsiness, diabetes and falls, and usually the highest-priority emergencies but also lower-priority calls. Policies aimed to ensure that Community First Responders provided safe, effective care. Costs, mainly used for management, training and equipment, were sometimes incomplete or inaccurate and varied widely between services. Community First Responders attending meant faster responses and positive experiences for those patients and relatives interviewed. A Community First Responder scheme responding to people who had fallen at home led to fewer ambulances attending and possible financial savings. Survival among people attended because their heart had stopped was no better when Community First Responders arrived early. Interviews revealed why and how Community First Responders volunteered and were trained, what they did and how they felt. Interviewees were largely positive about Community First Responders. Improvements suggested included support from colleagues or counsellors, better communication with ambulance services, technology for communication and locating patients, and better training. Community First Responders have benefits in terms of response times and patient care. Future improvements should be evaluated.