By Melissa Jackson
BBC News Online health staff
A pioneering scheme which uses unpaid volunteers to attend medical emergencies ahead of ambulance crews has won a national award.
CFRs reach out to rural communities
It was initially set up to help reach emergency cases more rapidly in dispersed rural communities of Shropshire.
The scheme is the first of its kind in the UK.
It is the model for similar systems across Britain despite accusations of "health care on the cheap".
The Shropshire Ambulance First Emergency Responders (Safer) scheme was launched in January 2001 and has recently received an Emergency Care Award from the Department of Health.
It was based on systems already in place in the US and Australia, said community response co-ordinator Rod Jordan, who pioneered it.
He said: "Shropshire is the largest landlocked county in England with a poor communication network.
"We wanted to improve the link between the community and the service we provide at the ambulance trust and we wanted to improve community knowledge of basic life support.
"We also wanted to improve our emergency response to these communities - if we could get a competently trained person to a cardiac arrest, then that would benefit the community we serve."
Response times are the criteria on which ambulance trusts' success or failure is measured.
Mr Jordan admitted it was cheap health care, but it was supporting the work of crews from the West Midlands Ambulance Service NHS Trust in Shropshire.
He said: "I hold my hands up to that, but we can't stick a paramedic on every street corner.
"But do we say, 'you can't have an ambulance', or do we say 'there's something else we can do', which is the route we took."
The volunteers, who are known as community first responders (CFRs), are mobilised by ambulance control and although they often arrive ahead of the paramedics, an ambulance is always automatically despatched to any call attended by them.
CFRs go through a formal selection process, which involves completing an application form and an interview to test their suitability for the job.
They complete 64 hours of training over an eight-day course and have to pass a written and practical exam before receiving volunteer status.
By the end of 2001, there were six teams operating across the county.
There are now 32, with 207 CFRs providing 24-hour cover, seven days a week.
Mr Jordan said: "If we can get a CFR on the scene they can make a difference in the first couple of seconds of an emergency before the ambulance can get there."
The most common cases they deal with are heart attacks, people with chest pains and those with breathing difficulties.
Mr Jordan admits there was a degree of suspicion and scepticism from the public when it was first suggested, but that seems to have disappeared.
He said: "Once you got the volunteers out and they had been seen responding and once aunt Bessie had been treated, people thought it was a great idea.
"There has also been a lot of fundraising in the community for the equipment they need and I think that's a measure of acceptance."
There has been a lot of support from local communities, parish councils and the British Heart Foundation - all of whom have donated money to provide defibrillators for the volunteers.
There are certain jobs CFRs are automatically excluded from attending, including road traffic accidents, incidents involving violence and hazardous substances and maternity call-outs.
CFRs also have the option to decline to attend any job if they wish.
Each volunteer wears a red uniform while on duty and is equipped with a portable kit, including oxygen, a defibrillator and first aid tools.
Sarah Hunter, 34, has been a CFR for two years and loves helping out in the community, even if it does mean being called out at 3am.
She said: "It's very rewarding and I have had quite a few letters back from people to say you made a real difference."
Most of the time she is called out to emergencies involving elderly people to deal with heart or respiratory problems.
She said: "I really get something out of being involved in the community."
Volunteers have responded to more than 10,000 emergency calls over the past three years and some have enjoyed their work so much, they have joined the ambulance service as full-time employees.
Other ambulance trusts have followed Shropshire's example and set up their own schemes.
Mr Jordan's believes this is a huge vote of confidence.
"It's a nice reflection of our success," he said.
"If it wasn't working, no-one else would be doing it."