Power relations and role boundaries between community first responders and ambulance clinicians in England: a qualitative study

Abstract Power relations between clinical volunteers and professionals within health services constitute a key determinant of role relationships and boundaries. Community First Responders (CFRs) are trained lay volunteers who respond to emergencies, interacting with patients and ambulance professionals. We aimed to explore the power relationships between CFRs and ambulance clinicians. We conducted 40 in-depth interviews with 4 ambulance clinicians, 21 CFRs and 15 CFR-leads from six ambulance services in England. Thematic analysis, guided by theories of subordination and boundary work, enabled the identification of themes and subthemes. The analysis revealed experiences of power relations, hierarchy and negotiations of role boundaries, characterised by subordination of CFRs and development of collaborative relationships between ambulance clinicians and CFRs. A collaborative relationship was established when clinicians recognised the voluntary nature of CFR roles and their significant contributions to ambulance services. Ambulance clinicians had the professional power to influence these relationships and negotiations of role boundaries. Power dynamics between professional ambulance clinicians and volunteer CFRs affect their relationship and CFR roles. These power relations were consistent with subordination and role boundaries and demonstrated how power theories relate to CFRs.