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PP26 Power dynamics in out-of-hospital emergency care: understanding the relationship between community first responders and ambulance paramedics in England – qualitative study
  1. Malaika Kapadia,
  2. Niro Siriwardena,
  3. Gupteswar Patel
  1. Community and Health Research Unit, University of Lincoln, UK


Background Community First Responders (CFRs) are volunteers trained by ambulance services in the United Kingdom to deliver emergency and prehospital care, before an ambulance arrives, and handover patients to professional clinicians. Health services scholarship has established how power relationships and practitioners’ interactions influence healthcare delivery. However, CFRs and ambulance clinicians’ relationship and power relations remain under-explored. Therefore, this study explores these power dynamics and how they affect patient care.

Methods Secondary qualitative data were obtained from the Community and Health Research Unit, University of Lincoln. The dataset included nineteen interview transcripts of CFRs, CFR leads, and ambulance clinicians from two ambulance services. Thematic analysis was used to identify themes and subthemes supported by NVivo 12.

Results The analysis revealed collaboration and professional dominance embedded in the CFRs and clinicians’ relationships. The dominant relations resulted from clinicians’ unawareness of the scope of CFRs in practice and their perception of CFRs as a substitute and a threat to clinicians’ employment in the professional arena. However, the dominant relationships were progressively shifting towards collaborative relationships. The characteristics of collaborative relationships were identified predominantly in rural areas, where ambulance arrival time was longer than in urban areas, and the significance of CFR roles in patient care was recognised. The collaborative relationships also promoted teamwork and accelerated patient transfer. The nature of relationships, either dominant or collaborative, influenced patient care. When the relationship was dominant, clinicians’ distrust in CFRs’ assessments of patient conditions were evident during handover, which led to a re-evaluation of symptoms, a delay in care delivery and patient transfer.

Conclusion The notion of power dynamics is evident in the CFR and clinicians’ relationship while delivering emergency and prehospital care. Further awareness and integrated training with defined scope of practices are expected, to minimise professional dominance and improve collaboration, and eventually patient care.

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