Certified first responder

A certified first responder is a person who has completed forty to sixty hours of training in providing care for medical emergencies. They have more skill than someone who is trained in first aid but are not emergency medical technicians. The term "certified first responder" is not to be confused with a typical "first responder", which is a literal term to describe the first medically trained responder to arrive on scene (police, fire, EMS, lay rescuer). A "certified first responder" is an actual title given to fill the gap between a basic first aider and an EMT-Basic.

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 120 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.

Scope of Practice
First Responders in the US can perform a variety of medical techniques not available to First Aiders.


 * Oxygen Therapy
 * Childbirth
 * Triage and Multiple Trauma
 * Airway Management
 * Moving Patients
 * Assisting Patients in using medications such as inhalers, epinephirine auto-injectors, nitroglycerin pills, etc.
 * Transportation of Patients
 * Assisting medical professionals

First responder skills and limitations
Lifesaving skills in the first responder course include recognizing unsafe scenes and hazardous materials emergencies, protection from bloodborne pathogens, controlling bleeding, applying splints, conducting a primary life-saving patient assessment, in-line spinal stabilization and transport, emergency defibrillation, when to call for more advanced medical help, and the use of oxygen and airway adjuncts. First Responders can recognize and treat a wide variety of ailments, including, but not limited to, strokes, heart attacks, poisonings, shock, hypo- and hyperglycemia, and heat- and cold-related emergencies. First Responders are also trained to assist with the delivery of babies. However, a first responder does not have an EMT's skill at patient assessment and evaluation. They also lack the basic pharmacology training EMTs receive, and are thus not allowed to administer oral Glucose and Activated Charcoal, or assist with Nitro or inhalers. First responders do not have enough training to be the highest level of certification on a BLS ambulance, but may be present, although this is not their primary duty. They 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 somewhat limited provider of emergency medical care.

First Responders can also administer the following airways when indicated and where standard of care permits:


 * Oropharyngeal Airway
 * Nasopharyngeal Airway

Rescue
NFPA regulation 1006 and 1670 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, low angle, 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.

The first responder level of emergency medical training is often required for police officers (in California, this training is referred to as "Title 22" after the law mandating such training).

Non-traditional first responders
Many persons can be trained as first responders who would otherwise receive only an eight-hour first aid class. Typically, these persons are selected for first responder training because they are either likely to be the first on the scene of a medical emergency, or because they work far from medical help. These non-traditional first responders include:


 * lifeguards
 * park rangers
 * utility workers
 * teachers, childcare workers and school bus drivers
 * worker-volunteers in a large facility (industrial plant) or at a remote site (fish-packing plant, commercial vessel, oil rig)
 * truck drivers
 * security guards
 * bodyguards
 * general aviation pilots and commercial flight attendants
 * sports coach
 * hunting and fishing guides
 * Search and rescue personnel
 * Community Responders

First responder training is a cost-effective way to extend the reach of the emergency medical system, but not a substitute for EMT-Basic training for those employed to provide emergency medical services on a daily basis.

First responders 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 the paramedics. The first responders are thus the most frequent answer to emergency calls.

First aid associations (about 15 nationwide associations, including the French Red cross, St John ambulance, order of Malta and the volunteers of the Civil protection) also train their volunteers as first responders; the diploma (CFAPSE) is exactly the same as the firefighters. They usually act in preventive first aid post, e.g. for concerts, sporting or cultural events.

The volunteers first responders can take part of an emergency rescue team in case of disaster; due to the bad response time (usually some hours to gather the teams), they usually deal with minor casualties, but could theoretically act in first line. In some places (e.g. in Paris), the volunteers take part of the public rescue and partly replace the firemen during the weekends.

The diploma required to be first responder is the CFAPSE (certificat de formation aux activités des premiers secours en équipe, "certificate of training to team first aid"). It lasts about 50-60 hours, and the final exam is under the responsibility of a physician, a representative to the préfet (responsible of emergency situations in the département) and several instructors (usually from various associations and from the fire department). They must also follow every year 6 hours of continuing training.

The first responders activity is called secourisme ("rescuism") or prompt secours ("fast aid"), to make the difference with the premiers secours ("first aid") performed by the bystanders (although the name of the diploma contains the words premiers secours...).

Education (CFAPSE)
The organization will change in 2006. The following describes the situation between 1991 and 2005

The CFAPSE (50-60h) is made of ten modules: It is possible to follow only a partial course (12h) with the E1, E2, E7, E8 and E9 modules. This "first-level" course is called the attestation de formation complémentaire aux premiers secours avec matériel–AFCPSAM (additional first aid course with equipment).
 * E 1. - the CFR team (team work, organisation of the civil defense and integration in an emergency operation, as professional rescuer or as community emergency response team)
 * E 2. - Assessment and evaluation and voice radio communication
 * E 3. - emergency casualty movement and patient positions for transportation
 * E 4. - Casualty lifting
 * E 5. - Casualty movement
 * E 6. - Bleedings, wounds, burns
 * E 7. - airway permeability (recovery position made by three CFR after motorcycle helmet removal and neck immobilisation by a cervical collar, mouth vacuum aspiration of mucosity)
 * E 8. - Mechanical ventilation with devices (bag valve mask)
 * E 9. - Oxygen first aid, cardiopulmonary resuscitation and Automated external defibrillation
 * E 10. - Immobilisations (splints)

Medical Responders in the UK
In Britain "Rapid Responders" are paid ambulance crew who drive special responder vehicles. The vehicles are marked with high-visibility ambulance markings with blue flashing lights and sirens. The vehicles are generally single-crewed, as opposed to the double-crewed ambulances.

UK Community Responder Schemes
A 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 AED, O2 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.

Medical First Responders in Canada
The Medical First Responder program is the new "Standard" for Volunteers First Aid providers in Canada. This program is the same as is being used by Canadian Coast Guard Rescue Specialists, Reserve Medical Corps attached to Department of National Defence (DND), the Industry sector, and Volunteer Fire Departments. The course is a minimum 40 hours, with elective modules possibly making the course, up to, 80 hours. In Canada, Volunteer or Hired First Aid providers are usually requested to attend large gatherings and events 'just in case'. Medical First Responders are not a replacement for EMTs, rather; they are used as a 'Primary Care Provider' until professional assistance arrives. First Responder courses are also the minimum level of certification required by some private stable transport companies that provide inter-hospital transfer for patients in need of a bed, but who are stable and do not require continual EMS care.

St. John Ambulance teaches a series of first responder courses to their volunteer brigade, auxiliary brigades (such as Campus Emergency Response Teams) and select members of the general public. The course series includes as well as an Advanced Medical First Responder course. The Canadian Red Cross Society also conducts advanced first aid courses titled First Responder (a 40hr course matching the description above) and the Emergency Medical Responder course (80 hours) which while similar in scope, has higher standards of evaluation and meets the Paramedic Association of Canada's NOCP (National Occupational Competency Profile) and can be used as a recognized vocational certification in some parts of the country for working EMS.

Medical First Responder limitations
The Medical First Responders fall under the protection of the Good Samaritan law in Canada. Directed to provide first aid when necessary and will be immune from prosecution if assistance was given in good faith up to, and not beyond, the limits of certification and training. No conscious person can be forced to accept any medical treatment. It is widely believed, and taught, that an unconscious person has given Implied Consent although this concept has never been treated by the courts and it outlined in the Good Samaritan Act. Organizations teach unconscious is implied consent because, theoretically, a reasonable person would want assistance if their condition were so serious as to cause a loss of consciousness.

Example of Modules

 * Anatomy & Physiology
 * Respiratory Emergencies & Oxygen Administration
 * Airway Management
 * Cardiovascular Emergencies & CPR
 * Severe Bleeding
 * Chest Injuries
 * Medical Emergencies
 * Automated External Defibrillation
 * Head/Spinal/Pelvic Injuries
 * Poisons. Bites and Stings
 * Behavioural Emergencies
 * Gastro-intestinal/Genito-Urinary Injuries
 * Multiple Casualty Management