Knowledge, Attitudes, and Availability of Romanian Firefighter Paramedics to Adopt the Role of Community First Responders in Out-of-Hospital Cardiac Arrest.
Journal of clinical medicine · 2026-07-15 · Observational study
Abstract
Background: Out-of-hospital cardiac arrest (OHCA) remains a major public health challenge in Romania. Although trained first-responder systems have improved prehospital response in other European settings, Romania lacks a structured national framework. This study assessed the knowledge, attitudes, perceived preparedness, and willingness of Inspectorate for Emergency Situations (ISU) personnel to participate as community first responders outside working hours. Methods: A national cross-sectional survey was conducted using a structured online questionnaire distributed to operational ISU personnel. The final sample included 1537 participants from five professional categories: firefighter officers with paramedic training, firefighter sub-officers with paramedic training, firefighter officers, firefighter sub-officers, and other personnel. Multivariable binary logistic regression was used to identify factors associated with high enthusiasm and desire for additional training. Results: More than 70% of respondents supported the integration of firefighter-paramedics into a community first-responder system, and over 75% expressed willingness to participate. Significant differences were observed between professional categories in demographic, professional, and first responder-related variables. In multivariable analysis, firefighter officers with and without paramedic training, as well as other personnel, had higher odds of high enthusiasm compared with firefighter sub-officers without paramedic training. Desire for additional training was independently associated with female sex and firefighter officer status, with or without paramedic training. Conclusions: Romanian ISU personnel showed favorable self-reported attitudes and high willingness to participate in a structured OHCA first-responder system. However, these findings reflect perceived motivation rather than operational feasibility, competence, or improved patient outcomes. Implementation would require standardized training, legal clarification, dispatch integration, adequate AED access, supervision, audit systems, and prospective evaluation using patient-level OHCA outcomes.