Barriers and facilitators while implementing community first responder systems in a western setting: mixed-methods expert consensus.
International Journal of Emergency Medicine · 2026-05-08 · Qualitative study
Abstract
BACKGROUND: Early cardiopulmonary resuscitation and timely defibrillation are key determinants of out-of-hospital cardiac arrest survival. Community first responder (CFR) networks improve early response, yet adoption varies internationally. This study summarizes current key factors affecting CFR-system implementation through an international expert consensus process. METHODS: A mixed-methods design explored barriers and facilitators to CFR system development. Data were collected during an expert consensus workshop in April 2024 Hinterzarten, Germany (46 experts, 14 countries) and an online survey. Experts were invited based on previous authorship regarding CFR systems. Thematic content analysis and descriptive statistics identified recurrent themes and areas of agreement. RESULTS: Experts agreed on core needs for effective CFR systems with high consensus regarding locally adapted dispatch algorithms, clear privacy rules for CFR activation, sufficient CFR training, structured debriefing and psychological support. Congruence was weaker regarding funding, legal or governance frameworks, reflecting variation in responsibilities, liability, and automated external defibrillator- (AED-) registry organisation. Findings were structured around a previously developed roadmap outlining four stages of CFR-system maturation. In the exploration phase, unrecognition of delays in Basic Life Support initiation impedes translation of practice gaps into action. Installation is challenged by recruitment, funding, and coordination among stakeholders. Implementation requires outcome evaluation. Moreover, sustainability is threatened by volunteer attrition and reliance on government budgets. Supportive legal frameworks, centralised AED registries, and integration into national health initiatives facilitate both establishment and long-term stability. CONCLUSION: This exploratory expert consensus process on CFR system implementation highlights the need for stable funding, coherent governance, aligned legal frameworks, comprehensive and exhaustive AED registration, data-driven feedback from practice to system optimisation and targeted training of CFR.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
Alerted volunteer responders · Implementation · Interagency collaboration
Related articles
- Emergency medical services infrastructure development and operations in low- and middle-income countries: Community first responder-driven (Tier-1) emergency medical services systems. (Surgery, 2024)
- Ten years of the community-based emergency first aid responder (EFAR) system in the Western Cape of South Africa: What has happened, what has changed, and what has been learned. (Afr J Emerg Med, 2022)
- Evaluation of a Rural Emergency Medical Service Project in Germany: Protocol for a Multimethod and Multiperspective Longitudinal Analysis. (JMIR Res Protoc, 2020)
- Addressing Challenges of Implementing Community First Responder Models based on National and International Experiences: A Systematic Scoping Review. (Iran J Public Health, 2024)
- [Registration procedures in smartphone-based first responder alerting systems in Germany : A nationwide secondary data analysis with a local implementation example]. (Med Klin Intensivmed Notfmed, 2026)
- Needs assessment and Acceptability of a Community First Aid Responder programme to increase Out-of-hospital capacity in Kinshasa, Democratic Republic of Congo: A qualitative study. (Afr J Emerg Med, 2025)