Abstract Background Recent cardiopulmonary resuscitation (CPR) guidelines highlight the role of local, trained individuals in responding to out-of-hospital cardiac arrest (OHCA). In addition to healthcare professionals, medical students can be integrated into smartphone alerting systems (SAS) as potential locally active community first responders. However, there is a limited understanding of confounding factors which may stimulate or hinder student engagement. This study explores multiple factors to further support targeted recruitment and training strategies. Methods This prospective pre-post study was integrated into an emergency medicine course with the clinical medical curriculum. Participants completed anonymized digital questionnaires before and after the course. The curriculum included basic life support and introduced the SAS Region of Lifesavers . The questionnaire focused on self-assessed preparedness, willingness to participate, and motivational factors related to community first responder engagement. Ethical approval was obtained (DRKS00034599). Results Of 412 students invited to participate in pre- and post-course surveys, 93.2% (384) were matched for analysis. The cohort was 64% female, mean age of 23 years. Prior medical CPR training was present in 25% (95/384); only 13% (12/95) of these were active as first responders. Confidence in BLS increased, with self-rated skills rising from 4.9 to 7.6 (Likert 0–10); confidence regarding cardiac arrest response improved from 3.9 to 7.9 (both p < 0.001). Intention to join as first responders was noted in 80.2% of participants, mainly motivated by “willingness to help” (48.3%) and “the topic is important” (22.6%). The main barriers were lack of self-confidence (41.3%) and perceived personal stress (37.3%). Conclusion This study highlights strong motivation among medical students and identifies practical training targeting on CPR confidence as a key determinant of enhanced first responder engagement. Pre-existing curricular emergency medicine courses offer a structured opportunity to promote awareness of first responder systems and to prepare students for potential future involvement. Trial registration German Clinical Trials Register, DRKS00034599, date of registration: 16.12.2024.
Ganter et al. (Thu,) studied this question.