A Contextualized Community First Responder Model for Prehospital Emergency Care in Iran: Validated by experts.

Background Delayed ambulance response times are a major challenge in Iran’s prehospital emergency care system, particularly in densely populated urban areas. Community First Responder (CFR) models have been implemented internationally to reduce critical time gaps before ambulance arrival. However, an evidence-based and context-specific CFR framework for Iran has not yet been developed. The aim of this study is to develop and validate a contextualized CFR model tailored to the specific geographic, cultural, and systemic realities of Iran's prehospital emergency care. Methods This study used a sequential exploratory mixed-methods design. First, a scoping review was conducted to identify existing CFR models and their key components which resulted a conceptual framework. Second, semi-structured interviews were carried out with stakeholders in Iran’s prehospital emergency medical system, including policymakers, EMS managers, clinicians, and academic experts. Qualitative data were analyzed using directed content analysis to inform the development of an initial conceptual model. Finally, a two-round Delphi process was conducted to validate and refine the model through expert consensus. Results Initial evidence from a scoping review defined the core conceptual elements of CFR models globally. Subsequently, qualitative findings from 21 EMS stakeholders identified five foundational categories specific to Iran's context: the necessity of CFR implementation, essential prerequisites, implementation barriers, operational mechanisms, and expected outcomes. Integration of these insights yielded a preliminary model, which was then refined and validated through a two-round Delphi consensus process with 18 national experts. The final model comprises three core components: (a) Prerequisites (e.g., cultural readiness, legal frameworks, training); (b) Implementation Mechanisms (e.g., a tiered dispatch system, defined scope of practice); and (c) Anticipated Outcomes (e.g., enhanced community trust, improved system efficiency). Conclusion This study presents the first expert-validated, contextually adapted CFR model for Iran. The framework provides a practical foundation for pilot implementation and evaluation, with potential to reduce ambulance response delays and enhance community engagement in prehospital emergency care. Further investigation is recommended to test the model in Iranian different context to evaluate effectiveness of model in emergency response time. The next essential step is phased pilot implementation, followed by iterative evaluation and scaling, to translate this validated design into practical, life-saving action.