FPOS, FPoS, FPOSS, First Responder, FROS or FREC?
An objective review of Level 3 Pre-Hospital Care Courses
13th January 2019 revised 22nd October 2020
There was a time, a simple time, when the Pearson (then Edexcel) First Person on Scene Intermediate course was the only accredited pre-hospital care course on the market. It provided candidates with advanced First Aid skills and knowledge beyond First Aid at Work and, usually delivered over 4 or 5 days, it was commercially attractive for both candidates and course providers.
Whilst it was originally written for Community First Responders it gained significant traction when it was chosen by the security industry as the minimum first aid standard for Close Protection operations and was even adopted as the benchmark course for foreign businesses and contracts; not because it was necessarily ideal in terms of content or context but because it was accredited – there was a top-level reassurance from both the Institute of Health and Care Development (IHCD) and the Royal College of Surgeons of Edinburgh (RCS).
And it was a good time as well. Prior to this the market had been flooded with unregulated EMT or ‘Medic’ course with no standardisation, no quality assurance and no credibility but Gucci certificates for the unsuspecting consumer.
Since then the original FPOS-I course has been redeveloped into a much longer 10 day course, Qualsafe introduced the game-changing FREC suite of courses which provides a progressive pathway, AOFAQ have been placed under direction from the regulators Ofqual and a number of other courses have appeared to join the market.
Currently Available Courses
Qualsafe First Response Emergency Care (FREC) Award – Level 3
Qualsafe were the first Awarding Organisation (AO) to see the commercial potential of a competing pre-hospital care course to break the monopoly Pearson had enjoyed and it had three important factors that helped secure this.
Most notably in 2012 changes to First Aid at Work meant that these courses were now placed on the qualifications framework as Level 3 Awards yet FPOS was originally placed as a Level 2 Award. All of a sudden FPOS, the gold standard of Advanced First Aid, was now a Level 2 course, beneath First Aid at Work.
The first FREC Award was instantly placed at Level 3. It was, straight away, perceived to be a ‘better’ course than the FPOS Level 2
The FREC suite of qualifications were more academically robust. FREC Level 3 Award has three separate MCQ test papers, each with 30-60 questions versus a comparatively simple 25 question MCQ test for FPOS. At a time of dodgy medic courses, this added credence to FREC.
The FREC suite of qualifications offer a progressive pathway to Paramedic registration…in theory. The Health Care Professional Council (HCPC) offer registration to Paramedics as long as their qualification is via an approved route. The HCPC currently only accept the FREC Level 6 qualification from one training provider, however.
Pearson First Person on Scene Certificate and Extended Certificate – Level 4
First Person on Scene - 2nd Edition
Adam Gent (Real First Aid) & Nic Gunn
In response to this new found competition and a need to re-position the course on the qualifications framework, FPOS was reviewed and re-written. Whilst the course is undeniably a solid pre-hospital care course, current and educationally robust which fit’s the remit for Community First Responders, it’s 10 day duration is not commercially appealing for training providers or candidates. Requiring both twice the time and cost of the FREC Level 3 Award it just does not compete to the same commercial audience.
In October 2020, Pearson relaunched a shorter, more fitting Level 3 FPOS course.
Qualifications Network UK - First Responders Award – Level 3
In response to the AOFAQ incident, QNUK were one of the first organisations to launch a 4 day Level 3 Pre-Hospital Care course to fill the void which was, at the time, dominated by FREC in the beginning of 2019.
The QNUK Level 3 Award for First Responders is a great course, of the same ilk of the original Pearson FPOS but with a wider context and bit more educational rigger, similar to FREC, but without the onerous paperwork for candidates and training providers.
The QNUK First Responder course gained traction early on but has been held back simply because it is not called “FPOS” or “FREC” ; something customers seem to crave.
SFJ Awards - First person on Scene Support - Level 3
At the same time, Industry Qualifications launched their version of FPOS….FPOSS. The qualification did not gain as much traction and since that time Industry Qualifications has now become SFJ Awards.
Highfields – First Aid Response – Level 3
Whilst also being a Level 3 award pitched at the ‘pre-hospital care’ market this course has not gained traction as it is essentially First Aid at Work plus supplemental oxygen. This is evident in the course content analysis below.
2020 Update
In October 2020 two Awarding Organisations have launched additional Level 3 Pre-Hospital care qualifications:
Qualifications Network - First person on Scene - International – Level 3
A slightly paired down version of their First Responder course with additional content on Ballistic Injuries, this new course, with a more familiar name is aimed squarely at Close Protection audience and those who work in hostile environments.Pearson – First Person on Scene – Level 3
In an attempt to regain market share, Pearson have stripped back their Level 4 certificate and squashed it into a 5 day Level 3 certificate.
The Specs
The table below shows a breakdown of the key differences between each course:
Click on the course name for a direct link to the course specification
| Course Name | Level | Accredited | RCS | TQT | GLH | Non Directed | Assessment |
|---|---|---|---|---|---|---|---|
| Pearson FPOS L4 Ext | 4 | RQF | Yes | 177 | 88 | 89 | bgcolor="lightgrey"18 x Assignments |
| Pearson FPOS L4 Ext | 4 | RQF | Yes | 184 | 98 | 86 | 19 x Assignments |
| Pearson FPOS L3 | 3 | RQF | No | 131 | 37 | 94 | 24 assignment-based assessments |
| Qualsafe FREC L3 | 3 | RQF | Yes | 153 | 35 | 118 | 13 x Practical assessments + 3 x MCQ papers + 4 x Skill Tests |
| QNUK First Responder | 3 | RQF | No | 30 | 24 | 6 | MCQ + Practical assessments |
| QNUK FPOS - International | 3 | RQF | No | 30 | 28 | 2 | MCQ + Practical assessments |
| SFJ Awards FPOSS | 3 | RQF | No | 40 | 32 | 8 | MCQ + Practical assessments |
| Highfields Award First Aid Response | 3 | RQF | No | 32 | 32 | 0 | MCQ + Practical assessments |
Key
Level
The difference between a Level 3 and a Level 4 course is the level of understanding the candidates need to demonstrate to achieve a pass. On a Level 3 course the candidates are typically required to ‘describe’ or ‘demonstrate’, on an Level 4 course candidates are expected to be able to ‘explain’ or ‘discuss’
Award or Certificate?
The designation of Award or Certificate is based on the number of hours required to complete the course. An Award is achievable for any qualification under 130 hours. Course between 130 and 360 hours are designated a Certificate. Courses over 360 hours are a Diploma. The FREC L3 Award is 153 hours in total but has been designated a an Award rather than a Certificate because of the short amount of Guided Learning Hours (35 hrs)
Accredited
If a qualification is accredited by Ofqual, it is recognised on the older Qualifications and Credit Framework (QCF) or newer Regulated Qualifications Framework (RQF). If a course is accredited by Ofqual on one of these frameworks it can be compared fairly against other courses of the same level. If a course is not accredited by Ofqual, it is essentially an 'In House' qualification even though the certificate may be awarded by an ‘Awarding Organisation’.
RCS
Endorsement by the Royal College of Surgeons (RCS) Faculty of Pre-Hospital Care means the content has been approved by the UKs most credible advisory body on pre-hospital care. RCS endorsement is not essential and nor does it provide a ‘license to practice’ but it means that the course has been externally scrutinised in line with current best practice.
TQT
The “Total Qualification Time” is the number of hours needed to complete the course in total.
GLH
Guided Learning Hours is the minimum number of hours of face-to-face delivery that the training provider must provide. This can included ‘blended learning’ i.e. a mixture of face-to-face teaching with on-line education and assessment but does not include pre-course reading.
Non-Directed
The remainder of the TQT is made up of Non-Directed Learning hours. This is time the students need to spend in their own time on learning, and record and evidence, before they get the qualification. It does not include assessments.
Non-directed learning can be anything which adds value to a CPD portfolio. More information on CPD development is available here.
Assessment
All of the courses are assessed in different ways from simple Multiple Choice Question (MCQ) papers to written assignments, skills tests, practical assessments or a combination. The method of assessment is an indication of level of understanding required to pass the course. An MCQ requires the retention of knowledge but less understanding. Written assignments require a deeper understanding and the ability to present that understanding in a clear, coherent manner.
Outcomes
At this stage there are noticeable differences
The clear odd-one-out is the Pearson Level 4 FPOS; where as all other courses on the market are between 24 and 35 GLH (i.e. face-to-face time) which can easily be accommodated in 4 or 5 days, an 88-98 GLH course does not fit the popular model. The Pearson Level 3 FPOS course was recently released to counter this.
On inspection of Person’s new Level 3 specification, where all other Level 3 courses are assessed by MCQ and Practical Observation, Pearson appear to have simply stripped back the Level 4 qualification and squashed it into 37 hours (Please note the practical assessments must be completed over 7 hours so this is really a 44 hour course) and retained the assignment-based assessments which are typical of a Level 4 qualification and not what one would typically expect in a Level 3 qualification.
This is not appealing for candidates or training providers in terms of the time required to produce and mark these assignments.Also of note is the 13 practical assessments, 4 skills assessments and three test papers required for FREC making it the similarly a very paperwork-heavy Level 3 course.
Content
Each of the Learning Outcomes (LOs) for each of the remaining 7 Level 3 courses have been cross-matched against each other. Below is a table which outlines the LOs of each course. The information for this table comes from the Specifications for each qualification which are publicly available. You can view the specification for each course by clicking on the course name in the table above.
LOs highlighted in grey are common across all courses. These can be considered as the “Standard” LOs for a Level 3 Pre-Hospital Care course. The differences between the courses are most notable in the non-highlighted LOs.
A full page spreadsheet can be viewed here.
Outcomes:
Heat stroke / hypothermia
These are not covered on Highfields FAR or SFJ Awards FPOSS - this is noteworthy especially for candidates working in remote areas or overseas.Chest Injury
Not included in SFJ Awards FPOSS - This is a serious omission.
Limited to open chest wounds in FRECSpinal Injury
There is too much onus on spinal injury in SFJ Awards FPOSS - 15 LOs compared to 3 to 5 LOs in all other courses.Pulse Oximetry
Only included in QNUK First Responder and QNUK FPOS as part of their modular Oxygen or Medical Gas courses - This is noteworthy as pulse oximetry is an essential component of the provision of supplemental oxygen.Laryngeal Airways
No courses cover laryngeal airways (e.g.Igel)Ballistic & Blast Injury
This is only covered on QNUK FPOS.Travel Related Illness
This is only covered on QNUK FPOS
It is clear at this point that whilst all of these courses are Level 3 pre-hospital care courses, they are not equal in content. The SFJ Awards FPOSS and Highfields FAR are all lacking.
PHEM Skills Framework
The RCS Faculty of Pre Hospital Care PHEM Skills Framework was the product of a wide spectrum of pre-hospital provider groups from First Aid Societies to Level 8 Pre-Hospital Emergency Medicine (PHEM) practitioners as well as colleagues from non-medical professional organisations such as the Police, Fire & Military services and multi-representation from the UKSAR group.
PHEM Skills Framework with the purpose of developing a series of levels to allow a greater understanding of the clinical skills/competencies of various pre-hospital care providers arriving at an incident.
Most Pre-Hospital Care courses are pitched at PHEM Skills category C or D:
C: Nationally certificated pre-hospital responder (use of airway adjuncts & oxygen) eg Community First Responder
D: Nationally certificated non health care professional pre-hospital provider caring for patients as a secondary role eg Police Officers in Specialist Roles, Fire Service IEC, equivalent UKSAR trained personnel, Enhanced Community First Responder
These levels have been designed specifically for the purpose of facilitating good inter-agency working on scene and are not related to educational attainment. By cross-mapping each of the courses LOs to the PHEM Skills Framework we can, however, see which courses are a best fit to each of the PHEM Skills categories.
Not all elements are included as there are 118 elements of the PHEM Skills framework at Level D, many of which do not feature in any of the above courses (e.g. pneumonia or public health risks of chemical agents). Only the elements of the PHEM Skills framework which are covered in one or more of the courses have been included.
| Course | Level D Competencies | Total Competencies |
|---|---|---|
| Pearson FPOS L3 | 24 | 88 |
| QNUK First Responder | 21 | 86 |
| QNUK FPOS | 20 | 82 |
| Qualsafe FREC Level 3 | 17 | 76 |
| SFJ Awards FPOSS | 9 | 64 |
| Highfield First Aid Response | 12 | 46 |
A full page spreadsheet can be found here.
Outcomes
The Pearson FPOS L3 hits more PHEM Skill competencies at Level D (24) as well as matching the most competencies in total, closely followed by both QNUK Level 3 courses.
Conclusions
Which course is right for you?
Only you can answer that question but in a crowded market place I think it is fair to say that:
For a similar price and duration; the offerings from Highfields, SFJ Award and EQ do not provide as much value, content and, in some cases, credibility as those from Pearson, QNUK and Qualsafe.
Pearson’s choice of assessment methods for the Level 3 FPOS is effectively commercial hara-kiri. Not learning the lessons of their L4 FPOS that ‘more is not always more’, a balance needs to be found between rigour and accessibility. And this is not it. This is a real shame because on paper Pearsons new Level 3 FPOS ticks more boxes than any of the others.
If you want to develop your skills, knowledge and understanding beyond First Aid at Work, either QNUK courses or FREC Level 3 are completley appropriate but the QNUK First Responder course is our preference covering more PhemSkill competencies than FREC Level 3 and with less onerous assessment methods.
If you are keen to progress through the levels toward paramedicine, FREC might be a prefered pathway.
Over the next few months we will be delivering QNUK’s new First Person on Scene specifically to our clients in the Close Protection sector to properly compare and contrast these two offerings.