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      The experience of community first responders in co-producing rural health care: in the liminal gap between citizen and professional

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          Abstract

          Background

          The involvement of community first responders (CFRs) in medical emergencies in Scotland, and particularly in remote and rural areas, has expanded rapidly in recent years in response to geographical and organisational challenges of emergency medical service access. In 2013 there were over 120 active or developing schemes in a wide variety of settings. Community first responders are volunteers trained in First Person on the Scene (FPOS) first aid, administered prior to the arrival of an ambulance. Although there is limited literature which describes the role of first response, little academic literature has been published about the complexities of their specific role in both the community and organisational contexts.

          Methods

          Here we reflect on data from two mixed-methods studies into the role of CFRs in Scotland.

          Results

          We highlight findings that explore the liminal and complex role of the first responder as both ‘practitioner’ and community member, and how this contributes to a sense of communitas within the study areas. The rural context encompasses additional complexity in relation to the role of emergency care volunteer, having the highest levels of volunteering and this paper questions assumptions that rural areas, are more accepting of volunteerism.

          Conclusions

          Complexities arising from the experience of blurred voluntary/practitioner boundaries emerge as a key feature of voluntary participation in medical emergencies in this setting.

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          Most cited references42

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          Public-access defibrillation and survival after out-of-hospital cardiac arrest.

          The rate of survival after out-of-hospital cardiac arrest is low. It is not known whether this rate will increase if laypersons are trained to attempt defibrillation with the use of automated external defibrillators (AEDs). We conducted a prospective, community-based, multicenter clinical trial in which we randomly assigned community units (e.g., shopping malls and apartment complexes) to a structured and monitored emergency-response system involving lay volunteers trained in cardiopulmonary resuscitation (CPR) alone or in CPR and the use of AEDs. The primary outcome was survival to hospital discharge. More than 19,000 volunteer responders from 993 community units in 24 North American regions participated. The two study groups had similar unit and volunteer characteristics. Patients with treated out-of-hospital cardiac arrest in the two groups were similar in age (mean, 69.8 years), proportion of men (67 percent), rate of cardiac arrest in a public location (70 percent), and rate of witnessed cardiac arrest (72 percent). No inappropriate shocks were delivered. There were more survivors to hospital discharge in the units assigned to have volunteers trained in CPR plus the use of AEDs (30 survivors among 128 arrests) than there were in the units assigned to have volunteers trained only in CPR (15 among 107; P=0.03; relative risk, 2.0; 95 percent confidence interval, 1.07 to 3.77); there were only 2 survivors in residential complexes. Functional status at hospital discharge did not differ between the two groups. Training and equipping volunteers to attempt early defibrillation within a structured response system can increase the number of survivors to hospital discharge after out-of-hospital cardiac arrest in public locations. Trained laypersons can use AEDs safely and effectively. Copyright 2004 Massachusetts Medical Society
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            Case study research, design and methods

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              The ritual process: structure and anti-structure

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                Author and article information

                Contributors
                a.roberts@abdn.ac.uk
                Amy.Nimegeer@glasgow.ac.uk
                j.farmer@latrobe.edu.au
                d.heaney@abdn.ac.uk
                Journal
                BMC Health Serv Res
                BMC Health Serv Res
                BMC Health Services Research
                BioMed Central (London )
                1472-6963
                18 October 2014
                2014
                : 14
                : 1
                : 460
                Affiliations
                [ ]The Centre for Rural Health, Centre for Health Science, University of Aberdeen, Inverness, IV2 3JH Aberdeen, UK
                [ ]Institute of Health & Wellbeing, University of Glasgow, Glasgow, Scotland
                [ ]Faculty of Health Sciences, La Trobe University, Melbourne, Australia
                Article
                3565
                10.1186/1472-6963-14-460
                4283089
                25326796
                1984c78f-ceda-405d-964f-5b61e7d5f698
                © Roberts et al.; licensee BioMed Central Ltd. 2014

                This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 29 October 2013
                : 15 September 2014
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2014

                Health & Social care
                emergency medicine,volunteering,rural health,community first response
                Health & Social care
                emergency medicine, volunteering, rural health, community first response

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