Between the alert and the rescue: a scoping review of challenges faced by community first responders

Abstract Smartphone-based Community First Responder (CFR) systems use mobile alerts to mobilize nearby volunteers for Out-of-Hospital Cardiac Arrest (OHCA). They aim to support Emergency Medical Services (EMS) by enabling earlier CPR and, where possible, retrieval and use of an Automated External Defibrillator (AED). However, engagement often decreases at multiple response stages along the emergency response timeline, from alert dispatch to alert acceptance and on-scene intervention. This scoping review examined what is known about the challenges that CFRs face when engaging in OHCA missions. The review followed Arksey and O’Malley’s framework (2005) and is reported in line with PRISMA-ScR. Searches were conducted in July 2025 across PubMed, Scopus, IEEE Xplore, Ovid MEDLINE, Web of Science, Cochrane, and targeted Google Scholar screening. Records were screened in Rayyan via predefined criteria focusing on nonprofessional responders mobilized via smartphone-based alerting and on the CFR experiences across the emergency response timeline. Thematic synthesis was used to synthesize the evidence. From the 1,941 records (651 duplicates removed), 90 full texts were assessed and 23 studies were included. The synthesis mapped the ways in which challenges were expressed across the included studies (referred to as manifestations) and grouped them into 18 themes and 5 overarching clusters: technological, operational, psychological, organizational, and capability. The most frequently reported challenges were personal constraints, navigational challenges, and emotional overload. This structured map of challenges positions CFR engagement as a sociotechnical process shaped by system design, cultural context, and human behavior, and provides a foundation for technology-society research on how digital emergency response infrastructures can be designed to sustain volunteer participation across diverse settings.