Barriers and facilitators while implementing community first responder systems in a western setting: mixed-methods expert consensus

BACKGROUND: Early cardiopulmonary resuscitation and timely defibrillation are key determinants of out-of-hospital cardiac arrest survival. Community first responder (CFR) networks improve early response, yet adoption varies internationally. This study summarizes current key factors affecting CFR-system implementation through an international expert consensus process. METHODS: A mixed-methods design explored barriers and facilitators to CFR system development. Data were collected during an expert consensus workshop in April 2024 Hinterzarten, Germany (46 experts, 14 countries) and an online survey. Experts were invited based on previous authorship regarding CFR systems. Thematic content analysis and descriptive statistics identified recurrent themes and areas of agreement. RESULTS: Experts agreed on core needs for effective CFR systems with high consensus regarding locally adapted dispatch algorithms, clear privacy rules for CFR activation, sufficient CFR training, structured debriefing and psychological support. Congruence was weaker regarding funding, legal or governance frameworks, reflecting variation in responsibilities, liability, and automated external defibrillator- (AED-) registry organisation. Findings were structured around a previously developed roadmap outlining four stages of CFR-system maturation. In the exploration phase, unrecognition of delays in Basic Life Support initiation impedes translation of practice gaps into action. Installation is challenged by recruitment, funding, and coordination among stakeholders. Implementation requires outcome evaluation. Moreover, sustainability is threatened by volunteer attrition and reliance on government budgets. Supportive legal frameworks, centralised AED registries, and integration into national health initiatives facilitate both establishment and long-term stability. CONCLUSION: This exploratory expert consensus process on CFR system implementation highlights the need for stable funding, coherent governance, aligned legal frameworks, comprehensive and exhaustive AED registration, data-driven feedback from practice to system optimisation and targeted training of CFR.