Certified first responder

A portion of the accident scene for Ansbach, Germany incident response exercise for U.S. and German emergency responders, October 2007.

A certified first responder is a person who has completed a course and received certification in providing pre-hospital care for medical emergencies. They have more skill than someone who is trained in basic first aid but they are not a substitute for advanced medical care rendered by emergency medical technicians (EMTs), emergency physicians, nurses, or paramedics. First responder courses cover cardiopulmonary resuscitation (CPR), automated external defibrillator usage, spinal and bone fracture immobilization, oxygen and, in some cases, emergency childbirth as well as advanced first aid. The term "certified first responder" is not to be confused with "first responder", which is a generic term referring to the first medically trained responder to arrive on scene (police, fire, EMS). Most police officers and all professional firefighters in the US and Canada, and many other countries, are certified first responders. This is the required level of training. Some police officers and firefighters take more training to become EMTs or paramedics.

Certified First Responders in Canada

Many options are available in order to become a certified First Responder in Canada. Courses are offered by many sources including the Canadian Red Cross, and St. John Ambulance, and the Department of National Defence. Certified First Responder courses in Canada are separated into either "First Responder" or "Emergency Medical Responder" level courses. "First Responder" level courses are usually 40 hours in length and is considered the minimum level of training for crews providing medical standby at events, as well as for employment with some private stable transport companies that provide inter-hospital transfer for patients in need of a bed, but are stable and do not require advanced medical care. "Emergency Medical Responder" level courses meet the Paramedic Association of Canada's National Occupational Competency Profile, and those who receive certification at this level can work for Emergency Medical Services in some provinces.^[1]

First Responders from St. John Ambulance and fire departments assist paramedics during an exercise outside Thunder Bay, Ontario, Canada

Examples

The Canadian Ski Patrol System, St. John Ambulance Patient Care Divisions, Volunteer Fire Departments, Campus Response Teams, and the Canadian Coast Guard all provide Certified First Responder level emergency medical care, in some cases as a support to existing services, and in others as the primary emergency response organization.

Limitations on Certified First Responders

While all Certified First Responders in Canada are covered under Good Samaritan laws^[2] in jurisdictions where they are enacted, in some cases they have a Duty to Act. Certified First Responders who are providing medical coverage to events (such as St. John Ambulance's Patient Care Divisions at community events), as well as those who are employed by Volunteer Fire Departments, Campus Response Teams, and others who are required to perform Emergency Medical Response as part of their duties all have a Duty to Act.^[3] While Certified First Responders in general are not required to render aid to injured/ill persons, those who work in the aforementioned areas can be accused of and prosecuted for negligence if they fail to respond when notified of a medical emergency, if their care does not meet the standard to which they were trained, or their care exceeds their scope of practice and causes harm to the patient.^[4] As with all medically trained and certified persons, Certified First Responders are immune to successful prosecution if assistance was given in good faith up to, and not beyond, the limits of certification and training.

First responders in France

Main article: Certified First Responder in France

In France, the pre-hospital care is either performed by first responders from the fire department (sapeurs-pompiers, most emergency situations) or from a private ambulance company (relative emergency at home), or by a medical team that includes a physician, a nurse and an ambulance technician (called "SMUR"). The intermediate scale, the firefighter nurse (infirmier sapeur-pompier, ISP), is only a recent evolution and is performed by nurses specially trained acting with emergency protocols; these nurses are the French equivalent of paramedics. The first responders are thus the most frequent answer to emergency calls. In addition, in France there exists a network of first responder associations, as French red cross (croix rouge française), civil protection (protection civile) or others. These CFR volunteers are allowed to supervise massive outside meetings, student fests, etcetera. These volunteers have followed the same special rescuer training as firefighters (PSE 1 & PSE 2, at all 70 hours of training).

First responders in the United Kingdom

In the United Kingdom, most statutory NHS ambulance services deploy paid first responders who drive dedicated "Rapid Response Vehicles" (RRVs). These are typically estate cars, MPVs or 4x4s, are liveried with high-visibility ambulance markings, and fitted with blue flashing lights and sirens. These vehicles are generally single-crewed, by a Paramedic. This differs from most ambulances in the UK, which usually have two crew members.

Community First Responder Schemes

Main article: Community First Responder

Scottish Ambulance Service "First Responder" vehicle

A Community First Responder Scheme is made up of groups of volunteers who, within the community in which they live or work, have been trained to attend emergency calls received by the NHS (National Health Service) Ambulance Service, providing potentially life-saving treatment and first aid until an emergency ambulance arrives.

The Welsh Ambulance Services NHS Trust, when looking at the locations for Responder Groups, take the following into consideration:

• Towns or villages where it is challenging for an emergency ambulance to arrive at scene within 8 minutes – this is usually in the more rural areas of the county.

• The total number of calls received within these locations must be significant enough for training to take place, ensuring motivation of the group members and that their contribution would have a valued, significant effect on patients.

• Responders are members of the community who are trained to use Automated external defibrillator, Oxygen and other lifesaving equipment to assist ambulance crews, and maintain patient stability whilst professional crews are in attendance. Responders have no special dispensation to break the rules of the road whilst attending calls. Under the Road Traffic Act and various other UK traffic law, correct and permitted use of Blue Lights on a vehicle does not allow the driver to cross solid white lines to overtake, but does allow the driver to treat a red light as a 'Give Way' sign. Out of all the Ambulance trusts in the UK, a handful have CFR schemes with dedicated cars, and these are not given blue lights as CFR's do not undergo blue light training.

First responders in the United States

History

The U.S. Department of Transportation (D.O.T.) recognized a gap between the typical eight hours training required for providing advanced first aid (as taught by the Red Cross) and the 180 hours typical of an EMT-Basic program. Also, some rural communities could not afford the comprehensive training and highly experienced instructors required for a full EMT-Basic course. The First Responder training program began in 1979 as an outgrowth of the "Crash Injury Management" course.

In 1995 the D.O.T. issued a manual for an intermediate level of training called "First Responder." This training can be completed in forty to sixty hours. Importantly, this training can be conducted by an EMT-Basic with some field experience—which is a resource available "in-house" for many volunteer fire departments who do not have the resources for full EMT training. The first responder training is intended to fill the gap between First Aid and EMT-Basic.

The American Red Cross conducts a course titled "Emergency Response" that fits this definition.

In the US the term "Emergency Medical Responder" will largely replace the term "Certified First Responder" beginning 2012.^[5]

Scope of practice

Emergency responders are tested during a training exercise.

First Responders in the US can either provide emergency care first on the scene (police/fire department/park rangers) or support Emergency Medical Technicians and Paramedics, provide basic first aid, CPR, Automated external defibrillator use, spinal immobilization, oxygen, and assist in emergency childbirth (in some areas they are trained in the use of suction and airway adjuncts. CFRs can also assist with providing glucose, aspirin,and epi-pens. They are also trained in packaging, moving and transporting patients.^[6]

First responder skills and limitations

First responder training differs per state or country. Lifesaving skills in the first responder course include recognizing unsafe scenarios and hazardous materials emergencies, protection from blood borne pathogens, controlling bleeding, applying splints, conducting a primary life-saving patient assessment, in-line spinal stabilization and transport,CPR,and calling for more advanced medical help.Some areas give more training in other life-saving techniques and equipment (see below).

Emergency medical oxygen is a common supplementary skill that may be added in accordance with the 1995 DOT First Responder:National Standard Curriculum guidelines^[7] or under the authority of EMS agencies or training providers such as the American Red Cross. Other supplementary skills at this level can include the taking of vital signs including manual blood pressures, advanced splinting and the use of the Automated External Defibrillator (AED), suction, and airway adjuncts.^[8]

First Responders can serve as secondary providers with some volunteer EMS services. A certified first responder can be seen either as an advanced first aid provider, or as a limited provider of emergency medical care when more advanced providers are not yet on scene or available.

Rescue

The National Fire Protection Association regulations 1006^[9] and 1670^[10] state that all "rescuers" must have medical training to perform any technical rescue operation, including cutting the vehicle itself during an extrication. Therefore, in most all rescue environments, whether it is an EMS Department or Fire Department that runs the rescue, the actual rescuers who cut the vehicle and run the extrication scene or perform any rescue such as rope rescues, etc., are Medical First Responders, Emergency Medical Technicians, or Paramedics, as most every rescue has a patient involved.

Traditional first responders

The first responder training is considered a bare minimum for emergency service workers who may be sent out in response to a call for help and is almost always required for professional firefighters, such as the FDNY, who require valid CFR-D (Certified First Responder-Defibrillation) certification for all firefighters. The first responder level of emergency medical training is also often required for police officers.

Non-traditional first responders

Many people who do not fall into the earlier mentioned categories seek out or receive Certified First Responder training through their employment because they are likely to be first on the scene of a medical emergency, or because they work far from medical help.

Some of these non-traditional first responders include:

• Park rangers
• Taxi Drivers
• Utility workers
• Teachers, childcare workers, and school bus drivers
• Designated industrial workers in a large facility (industrial plant) or at a remote site (fish-packing plant, commercial vessel, oil rig)
• Security Officers
• Bodyguards
• General aviation pilots and commercial flight attendants
• Sports coaches and Athletic trainers
• Hunting and fishing guides
• Search and rescue personnel
• Campus Responders and campus police
• Lifeguards/Ski Patrollers
• Camp counsellors
• Boy Scouts and Girl Scouts and leaders
• Community Emergency Response Team (CERT) members (varies by jurisdiction)
• Airport ground personnel

See also

• Combat Lifesaver
• Extrication
• National First Responders Organization (USA)
• Outdoor Emergency Care
• Rescue squad
• Triage

External links

• National Registry Of Emergency Medical Technicians. This US organization also certifies Certified First Responders, who will soon be known as Emergency Medical Responders.
• UK First Responder Scheme

References

1. ^ Association of Canada's National Occupational Competency Profile
2. ^ "1". Emergency Care Manual. The Canadian Red Cross Society (1 ed.). Guelph, ON: The StayWell Health Company. 2008. pp. 9. ISBN 978-1-59490-404-8. 
3. ^ "1". Emergency Care Manual. The Canadian Red Cross Society (1 ed.). 2 Quebec St, Suite 107, Guelph, ON: The StayWell Health Company. 2008. pp. 7. ISBN 978-1-58480-404-8. 
4. ^ "1". Emergency Care Manual. The Canadian Red Cross Society (1 ed.). Guelph, ON: The StayWell Health Company. 2008. pp. 9. ISBN 978-1-58480-404-8. 
5. ^ "NREMT News", National Registry of Emergency Medical Technicians, Columbus, Ohio, 2011 Retrieved 2011-10-09.
6. ^ Certified First Responder (CFR) Original Course Curriculum, Dept of Health, New York State. Retrieved 2011-10-04.
7. ^ "First Responder: National Standard Curriculum". United States Department of Transportation: National Highway Transportation Safety Administration. 1995. pp. xiv. http://www.nhtsa.dot.gov/people/injury/ems/pub/frnsc.pdf. Retrieved 2009-11-19. 
8. ^ "Emergency Response Training". American Red Cross Silicon Valley Chapter. 2009. Archived from the original on 2011-01-06. http://web.archive.org/web/20110106170731/http://www.siliconvalley-redcross.org/index.php?option=com_content&view=article&id=158:emergency-response-training-hspro103&catid=75:professional-responder-courses-&Itemid=164. Retrieved 2011-10-04. 
9. ^ NFPA 1006 Standards for Technical Rescuer Professional Qualifications. National Fire Protection Association (2008 ed.). Quincy, MA: National Fire Protection Association. 2007. pp. 1006-13 through 1006-15. http://www.nfpa.org/aboutthecodes/AboutTheCodes.asp?DocNum=1006. Retrieved 2009-11-18. 
10. ^ NFPA 1670 Standard on Operations and Training for Technical Search and Rescue Incidents. National Fire Protection Association (2009 ed.). National Fire Protection Association. 2008. pp. 1670-12. http://www.nfpa.org/aboutthecodes/AboutTheCodes.asp?DocNum=1670. Retrieved 2009-11-18.