Investigating the impact of community first responders on out-of-hospital cardiac arrest outcomes in the North East of England: a retrospective cohort study.
British paramedic journal · 2026-09-01 · Registry study
Abstract
INTRODUCTION: Community first responders (CFRs) are integrated within UK ambulance services to deliver early life-saving interventions prior to the arrival of emergency medical services (EMS). Although CFR attendance is associated with earlier cardiopulmonary resuscitation (CPR) and defibrillation, evidence regarding their independent impact on survival following out-of-hospital cardiac arrest (OHCA) remains mixed, and regional data from North East England are limited. The aim of this study was to evaluate the association between CFR attendance and survival outcomes following OHCA attended by a single NHS ambulance service. METHODS: A retrospective cohort study was conducted using anonymised adult OHCA data from the North East Ambulance Service NHS Foundation Trust for the period between November 2020 and October 2025. The analytic cohort included all cases receiving advanced life support and basic life support - only cases that achieved return of spontaneous circulation represented viable resuscitation attempts. Cases were categorised by CFR attendance. The primary outcome was survival to hospital discharge. Secondary outcomes included OHCA characteristics, bystander interventions and EMS treatments. Multivariable logistic regression was used to adjust for established Utstein predictors and system-level factors. RESULTS: A total of 7916 OHCA cases were included, of which 177 (2.2%) involved CFR attendance. CFR-attended cases were more likely to occur in rural locations and were associated with longer ambulance response times. Public-access defibrillation was more frequent in CFR-attended cases (20.3% vs 12.2%, p = 0.001), while bystander CPR rates were similar between groups. Survival to hospital discharge did not differ significantly between CFR and non-CFR cases (9.6% vs 10.2%, p = 0.797). After adjustment, CFR attendance was not independently associated with survival to hospital discharge (adjusted OR 1.15, 95% CI 0.51-2.61). CONCLUSION: CFR attendance was associated with improved early resuscitation processes but not with increased survival to hospital discharge after adjustment. These findings suggest that CFRs strengthen the early links of the chain of survival, while longer-term outcomes remain influenced by downstream system and clinical factors. Further research incorporating more granular CFR-specific data is required to better characterise their contribution to OHCA outcomes.
Tags
Bystanders & volunteers · Mortality & survival · Rural & remote