What are First Responders?
Why are First Responders Needed?
Where should First Responder Schemes be established?
Who will be running each First Responder Scheme?
What types of incidents are First Responders asked to attend?
Do First Responders drive like emergency services?

First Responder Schemes are made up from volunteers who live or work within a community or village and have been trained to attend certain 999 calls in support of the Northern Ireland Ambulance Service (NIAS). Their purpose is to provide first aid including oxygen therapy and Cardiac defibrillation if required, until an ambulance arrives.

Even though an ambulance is already on its way, First Responders can make a potentially life-saving contribution.

Volunteers can be from a number of sources, typically:

• Lay members of the public;
• Ambulance staff (off-duty);
• Other emergency services staff;
• Nurses;
• Doctors.

Previous experience of first aid training or medical knowledge is not essential, as standardised training is undertaken prior to any group of First Responders being utilised by the NIAS.

The Northern Ireland Ambulance Service is not the employer of First Responders.

What are First Responders?

First Responders are members of community based teams, to attend certain 999 calls and provide emergency life support until an ambulance arrives.

Why Are First Responders Needed?

Most people can survive cardiac arrest when a particular sequence of events occurs as rapidly as possible. This sequence is:

• Recognition of early warning signs;
• Activation of the emergency medical system;
• Basic Cardiopulmonary Resuscitation (CPR);
• Defibrillation;
• Intubation, and;
• Intravenous administration of medicines

This 'life support chain' was first identified by Peter Safar in 1998 and is often simplified into the following:

The Chain of Survival

• Early access;
• Early CPR;
• Early Defibrillation;
• Early Advanced Care.

First Responders are expected to impact on the first three links of the 'chain of survival' and in doing so it has been shown that survival rates for out of hospital cardiac arrests can increase 2 or 3 fold. This is the primary purpose of First Responder Schemes.

First Responders actions can result in improvement and reassurance for patients suffering from other conditions as well as providing valuable assistance and information for attending ambulance crews.

Where should First Responder Schemes be established?

Selection criteria for such schemes would include, frequency of emergency calls, existing ambulance resource bases, numbers of people gathered at a particular location, availability of volunteers.

Typical locations would include isolated communities where it is challenging for the ambulance service to arrive at the scene within the critical 8 minutes. These would be the more rural parts of Northern Ireland.

There needs to be some history of emergency calls occurring in a particular location for interest in the scheme to be sustained.

There are over 46 ambulance stations/deployment points in Northern Ireland and there would be limited requirement for First Responder Schemes close to such stations.

First Responder Schemes require a significant commitment on the part of the volunteers. This should not be underestimated - member(s) of the scheme will have to be on duty either at all times or at times specified in agreement with the NIAS. Consequently any proposed First Responder Scheme should have enough volunteers to maintain cover without over-burdening individuals.

Considering the main purpose of these schemes the NIAS will, in co-operation with the volunteers, identify the geographical area to be covered using the 8 minute response time as a guide to the outer boundary. The NIAS may review historical data to identify areas that need a scheme.

Who will be running each First Responder Scheme?

Each group of people who come together to provide First Response will do so out of a desire to provide a service and improve conditions for their local area, community, or colleagues. Such motivation often results in some people becoming organisers and others wishing to undertake additional duties in regard to committee roles and fund-raising etc.

It is worth reinforcing that these schemes are 'voluntary' -NIAS does not fund them.

There is generally a requirement for a lead person, champion, chairperson, or co-ordinator who will hold the group together and give direction. This person will typically provide the main liaison with the NIAS. Other roles required by any adopted constitution or voluntary group affiliation will be undertaken by individual Responders.

'Constitution or voluntary group affiliation'? Most First Responder Schemes are set up as charities or trusts. Many are affiliated to other voluntary services - an example of this is the St John Ambulance Neighbourhood First Responder Schemes. There are advantages to such an affiliation in terms of support for organisation, infrastructure, equipment procurement etc.

What types of incidents are First Responders asked to attend?

Ambulance Emergency Calls can be categorised into Immediately Life-threatening calls (Category A), Not Life-Threatening but Serious calls (Category B), and Neither Life-Threatening or Serious calls (Category C).

This categorisation is important for identifying those calls suitable for First Response in a particular area.

Examples of calls considered suitable would be:

• Patients suffering from chest pain believed to be of cardiac origin, and who are at risk of cardiac arrest;
• Patients who are in cardiac arrest;
• Patients who are unconscious from unknown origin;
• Patients who are choking;
• Patients who are unconscious or collapsed following immersion.

Calls such as those above are considered to be 'medical emergencies' and would make up the majority of activity considered suitable for a First Responder Scheme.

First Responders are not deployed to attend trauma calls eg road traffic collisions or any known violent or other dangerous situations.

Do First Responders drive like emergency services?

First Responders are asked to attend serious medical incidents within their community, but are not to break the speed limit and must drive safely and comply with all Road Traffic Act regulations. There are no exceptions and failure to follow the regulations may lead to prosecution. Under no circumstances are First Responders authorised to use blue or green flashing lights.

Other Information

Interested - For details of your local group or other information, please contact the Northern Ireland Ambulance Service First Responder Co-ordinator.

Mr John Wright, RRV Manager, Northern Ireland Ambulance Service, Ambulance Headquarters, Site 30, Knockbracken Healthcare Park, Saintfield Road, Belfast, BT8 8SG

Telephone No: (028) 90400 999 or Email: John.Wright@nias.hscni.net