Background
Methods
Study design and setting
Participants
Data collection and analysis
Results
Category | Frequency (per cent) |
---|---|
Sex | |
Male | 12 (75) |
Female | 4 (25) |
Age range | |
18–24 years | 1 (6) |
25–34 years | 1 (6) |
35–44 years | 1 (6) |
45–54 years | 3 (19) |
55–64 years | 7 (44) |
65–74 years | 3 (19) |
Level of expertise | |
Level 2 | 3 (19) |
Level 3 | 9 (56) |
Level 4 | 4 (25) |
Motivation and ongoing commitment
Paths to volunteering
When I realised it was a community first responding scheme, I became a little bit interested. I spoke to my two friends about it, who strongly recommended it and invited me to a meeting. I came along to one of the meetings and spoke to a few members. They explained what they did and how things work and my interest piqued really. I said I was available and joined up. Male, 18-24 years.
The value of being a CFR
The best bit about it, and it really is the best bit, is when you realise you’ve made a difference, you’ve done something good. Male, 55-64 years.
A key motivation was to make a difference to patients. While CFRs received anecdotal feedback from family or friends of patients that they had attended, the absence of formal feedback mechanisms meant that there was no means of recognising their contribution, which participants agreed should be addressed.We’ve got a student nurse and a lad who is soon to start who works in an ambulance service, he’s a student paramedic, and myself – we’re all going into the healthcare profession at some point. Male, 18-24 years.
To be honest with you, because you’re in the local village, you may bump into people that you’ve treated – which any doctor does or anything – and it’s patient confidentiality, that’s fine. And they will inevitably say, “Thank you very much.” But we don’t get any phone calls or anything like that, as a general rule. Male, 45-54 years.
No, but I think you can ask for it [feedback], but you’d only get it if they’d offered it to head office, because it’s all data protection. Female, 55-64 years.
Balancing volunteering with personal life
So, if I know for example that I’ve got six hours free, then I can log on for that six hours, and when I need to go, I just tell them that I need to go and that’s the end of it. There’s no rota; there’s no set period of time that you have to be logged on for, so it fits perfectly. It’s basically I can do it when I want. Male, 18-24 years.
Learning to be a CFR
Training preferences
Very real, because they are highly experienced training officers that see those incidents every single day, so they know how to play role (sic) it, if you know what I mean. And a lot of the… I don’t know what you’d call it. They’ve got things up at head office: like there’s a smashed-up vehicle. Male, 25-34 years.
While they valued the realism of scenario-based training, participants spoke also of needing other practical training that dealt with specific skills that their role required, such as handing over care to ambulance staff.You don’t know what you’re going to get when you log on duty, but in real life – especially in my area, because it’s very rural, it’s very quiet, you don’t get many assaults or drug abuse. They will be more age related problems, so what you might get on a scenario day isn’t necessarily a true reflection of real life where you live. Male, 65-74 years.
Handover-wise, I think if we were trained to give handovers that would be very, very useful, because we are not actually training on how to do a handover. So we don’t know the order that the paramedics want the statistics or anything like that. We don’t actually get told how to do that; it is something that you learn. Male, 55-64 years.
Progressing as a CFR
Level 4 is a lot more advanced. Again, it’s three days of actual training but you have to go through a far, far higher level of diagnostic training. You also have to be able to give certain drugs. They’re able to give Entonox, which is a pain relieving gas – the old gas and air. They can also give salbutamol for asthma as well as glucagon for someone who is hypoglycaemic… Male, 45-54 years.
Most of the guiding lights, if you like, of LIVES have been clinical professionals, massively experienced in their fields, massively competent, magnificent at their job as clinical professionals. But their mind-set, if you like, is onwards and upwards. If you’re Level 2, you must be striving to Level 3 and Level 3 should be striving to Level 4, constantly getting more skills, more knowledge and progressing onwards and upwards. Female, 55-64 years.
…some members of staff think it is a cheap ambulance service and some don’t agree with the principle. Male, 25-34 years.
The training needs to be more about keeping them competent in the basics so that they can build on if they want to, rather than always give them extra to build on, build on, build on. Male, 55-64 years.
Suggestions for improving training
I think they are under the impression that it’s something that you either have or don’t have and that’s where it ends. They very much focus on the clinical side of things. I think even just half a day with patient communication would be beneficial. Male, 65-74 years.
Some training on how to deal with, not irate but upset family members or concerned family members would be something that I would be interested in even if it was just something to touch on for an hour or so in a training day. Male, 45-54 years.
The reality of being a CFR
Being first on-scene and alone
I’m the first one on scene then I’ll be doing what I can for the patient and when they come in the door behind me, it’s my job, it’s my responsibility to the patient, to them and to LIVES, if you like, to give a handover to the ambulance service and say, “This is what I’ve got. This is what I found when I got here. This is what I’ve been doing since and this is the state they’re in now.” Male, 55-64 years.
Preparing for and attending incidents
It’s not something you can prepare for emotionally, I don’t think, because you don’t know what you’re going to come across – is the best I can answer it. You don’t know what you’re going to see, you don’t know what you’re going to have to do, so to try and prepare emotionally for it would actually have a detrimental effect. Male, 18-24 years.
Emotional support
As I have said from the outset, there are numerous members of staff at HQ who have all said, “This is our phone number. I don’t care what time of day it is; if you have a call and you need to talk about it, ring me and I’ll answer the phone.” Female, 55-64 years.
Fundraising
Because you’ve got to add fundraising on to top up the LIVES fees, so the commitment is quite a lot. Male, 45-54 years.
Relationships with statutory ambulance services and the public
When CFRs and ambulance staff complement each other
You know, you give them as much statistical information as you can. So it’s: pulse rate, respiratory rate – all that kind of information. Then they know, straight away, a lot of vital information for their assessment, so that they haven’t got to do the tests immediately. If they have certain information, they know what route to go down probably quicker than if they’d just turned up and have to start doing everything themselves. Female, 55-64 years.
It’s quite nice actually. It makes a change because if you register a tiny bit of interest, they will explain everything. It’s a good learning curve. Male, 18-24 years.
Sometimes other crews will say why don’t you stay and you can learn this or you can help us do that and actually involve the responder and that actually builds up the responders confidence up and they think 'Oh' I actually helped a bit extra and I have done something above my skills set I’ve been supported by a paramedic or they might say if it’s a poorly patient can you travel to hospital with us in case we need your help on the way and actually it builds up the CFR and they think I was asked to go to hospital and that was really good and they felt confident in me asking to go and support them on a job. Male, 25-34 years.
I’ve always regarded myself as just being the trained amateur and once they come in the door, I’ll tell them what I’ve found, I’ll tell them what I’ve done, I’ll tell them what I’ve got and then I’ll defer to them straightaway because they’re professionals, they've got the registration, they’ve got all the practice and all the kit. At that point, I just become whatever they want me to be. Male, 55-64 years.
Conflict between CFRs and the ambulance staff
The very, very first call I had, I got there, the ambulance was already there – and when an ambulance is there you make contact with the crew, basically, “Do you need any help?” Nine times out of ten they’ll say, “No, we’re fine,” occasionally, “Yes please, come in.” On this occasion, “No, we don’t need any help,” so I turn around and I drove home and I couldn’t get out of the car, I was absolutely shaking. Male, 65-74 years.
I think what would help us is if the ambulance service acknowledged us a little bit more. When they do their press conferences saying, “We met this statistic and that statistic,” I think that would help a big deal, because if we are acknowledged by them… However, I think that is in the pipework and I think it is something that won’t happen overnight. Male, 18-24 years.
Relationship between CFRs and patients
Once the treatment from you has stopped personally, then you start reflecting on it and thinking “Hang on a sec, they’re my friend. Is there anything that I could have done differently?” But the treatment level between a friend and somebody that you have never met before does not change. It doesn’t matter that it’s a friend. Male, 55-64 years.
Lack of public recognition of CFRs
Well I tend to wear my green polo shirt and black trousers or something similar. Roughly, they dial 999 and five minutes later, I turn up in my car and walk through the door. They often say “the doctor’s here” or “the paramedic’s here” and I reply, “no, I’m a LIVES responder”. But they don’t care at that point. There’s somebody here. They don’t care who it is. Male, 45-54 years.
The way forward for CFRs and the scheme
The evolving role of the CFR
First off decide what LIVES is about. It started off as doctors and medics, healthcare professionals using their skills in their off duty time. Then it became community first responders as well. The community first responders idea keeps on changing and varying. That, I think, is where, if there’s a problem, that’s probably where it lies, is what do we want from the community first responders? What are we actually asking them to be able to do? Female, 55-64 years.
It’s a tricky one because for us to improve any further, we would be taking it away from the realms of it being in your spare time as a community first responder. I think if we were trying to improve or trying to do any more, we would start having to change the qualification levels. It would start becoming far too formal. I think it would be too close to becoming an ambulance service than a community responding charity. Male, 18-24 years.
Complementary but distinct
I’m from the South West. The RNLI is down there, everybody knows about the sea and the Lifeboat Institution is revered. They’re all volunteers, they’re all charity funded, they do a wonderful thing. But they’re the only people in the field doing it. There is no statutory provided organisation which they work around. LIVES is like the RNLI. Ours should be a bonus to the system, not a fundamental part of it. Male, 45-54 years.
Volunteer support [subheading] [next line] Participants expressed the need for greater support, for example through the role of First Responder Development Officers (FRDO).I think we could do with more information. Sometimes the two-way bit is hard to fathom. There’s also this feeling, sometimes, that people forget that the responders are all volunteers. I suppose, in a sense, that’s a bit of a backhanded compliment because it means they think of them as professionals. Male, 55-64 years.
I think for the FRDOs who have so many groups as well, they are too far out, they’ve got too many groups to do. We need somebody a little bit more localised, it’s that stepping stone between us and head office. And a more localised holding point for equipment, so that we’re not travelling 45 minutes an hour to pick up essential stuff. We keep a little bit, we do keep a little bit in our own homes, but I’m talking about oxygen – stuff like that. Female, 55-64 years.
Publicising the work of the CFR scheme
The two main things I would like to see improved are the awareness and recruitment. Male, 45-54 years.
I think probably most people only know about LIVES if you’ve had a LIVES responder out to your friends or family, or if, you know, you know somebody personally. But, I mean, a lot of people don’t really know what LIVES is or what LIVES means. Do you know what LIVES stands for? Female, 55-64 years.
Future funding arrangements
Redeveloping the brand and merchandise and just marketing the whole… you know, getting the message out to everybody. And the way it’s… the fundraising: that’s all going to be changed because, at the moment, we all do our own fundraising for our own group. Female, 55-64 years.
And so if people view us as part of the ambulance service, then they view us as centrally funded and therefore, we don’t, in their eyes, don’t look the same as the air ambulance. Everybody knows it’s not centrally funded and needs lots of money to keep the gents in the air. Male, 45-54 years.
I’ve got one coming up this Saturday, there’s a drive sale where they raise thousands and thousands of pounds for air ambulance, not a single person would have put in for LIVES. But this year I’ve got a table. Female, 55-64 years.