FPOS, FPoS, FPOSS, First Responder, FROS or FREC?

An objective review of Level 3 Pre-Hospital Care Courses

This page contains large tables which may not fit on the screen of your mobile device; it is best viewed on PC or Laptop

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 FPOS’s 25 questions MCQ test.   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 Award from one training provider.

Pearson First Person on Scene Certificate and Extended Certificate – Level 4

First Person on Scene - 2nd Edition Adam Gent (Real First Aid) & Nic Gunn

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.  Our Director, Adam Gent, was one of the contributors to the course design and co-author of the accompanying textbook “First Person on Scene 2nd Edition”. 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. 

AOFAQ First Person on Scene Intermediate Level 3

In a rather spectacular move, Pearson who had trademarked the term “FPOS” but not the phrase “First Person on Scene” found another competitor now trading off their name.   FPOS and First Person on Scene had by now become synonymous with any 4 or 5 day advanced first aid course.

From 2016 until December 2018 we had been offering the above three courses and the AOFAQ First Person on Scene course had been the most popular course we have provide at this level.   It fits the 4-5 day model which candidates and employers expect but without the admin vortex of paperwork required for FREC.  Of the three it was the closest to the original FPOS level 2 course.

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.

The Great AOFAQ Incident of 2018

In a moment that will go down in education folklore, the qualifications regulators, Ofqal, placed a Direction upon AOFAQ in December 2018 to cease registrations of new candidates or the supply of certificates to learners whilst an investigation was carried out into the organisation’s quality assurance practices.  This unprecedented move left many training providers in a dire situation and left the market with essentially a choice of one – Qualsafe’s FREC Level 3 - until the Direction was lifted in the middle of 2019.

In response, two further AOs launched their own pre-hospital care courses to fill the FPOS gap:

  • Qualifications Network -  First Responders Award – Level 3

  • Industry Qualifications – First Person on Scene Support – Level 3

As an independent subject matter expert, Adam consulted on the the development of both of these courses.


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






Non Directed









18 x Assignments








19 x Assignments

Highfields Award First Aid Response







MCQ  + Practical assessments








13 x Practical assessments

3 x MCQ Papers

4 x Skills tests








MCQ  + Practical assessments


First Responders







MCQ + Practical assessments

First Person on Scene Support







MCQ + Practical assessments


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)

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’.

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.

The “Total Qualification Time” is the number of hours needed to complete the course in total.

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.
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.

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.


At this stage the notable odd-one-out is the Pearson 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.

Also of note is the 13 practical assessments, 4 skills assessments and three test papers required for FREC making it the most paperwork-heavy Level 3 course.


Each of the Learning Outcomes (LOs) for each of the remaining 5 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.


  • Heat stroke / hypothermia
    Only included on QN First Responders and FREC Level 3 - this is noteworthy especially for candidates working in remote areas or overseas.

  • Chest Injury
    Not included in AoFAQ FPOS or IQ FPOSS - This is a serious omission.
    Limited to open chest wounds in FREC

  • Spinal Injury
    There is too much onus on spinal injury in IQ FPOSS - 15 LOs compared to 3, 4 and 5 LOs in QN First Responder, AOFAQ FPOS and FREC L3 respectively.

  • Pulse Oximtery
    Only included in QN First Responder - This noteworthy as pulse oximtery is an essential component of the provision of supplemental oxygen.

  • Laryngeal Airways
    No courses cover laryngeal airways (e.g.Igel)

  • FREC Level 3
    The only course to cover nasopharyngeal airways (NPAs), pelvic splintage and Recognition of Life Extinct.


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, drowning, the ability to perform basic joint examinations and 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.


The QN First Responder hits more PHEM Skill competencies at Level D (20) as well as matching the most competencies in total. 


Level D Competencies

Total Competencies

QN First Responder



Qualsafe FREC Level 3



IQ First Person on Scene Support



AOFAQ First Person on Scene



Highfield First Aid Response




From a training providers perspectives the costs must also be included, not to rule out the most expensive but to compare value (some things are worth paying more for), flexibility (regarding minimum spend criteria) and ongoing costs.



  • Centre Registrations

    Pearson, Highfield and Industry Qualifications charge £400 for centre registrations, Qualifications Network £300, AOFAQ charge £100 AOFAQ do not charge for Centre Registrations.

  • Minimum Spend
    Pearson and Highfield have the highest minimum spend of £1,000 per year.  Industry Qualifications do not appear to have a minimum spend.

  • EQA Vistis
    Industry Qualifications and Highfield both appear to charge for annual EQA visits (£300 each) where others do not.

  • Certification Fee
    The average certification cost is around £35 across the board with the exception of Pearson’s FPOS Level 4 (£55) and Highfields First Aid Response (£25)

  • First Year Costs
    Entering a nominal 32 candidates per year, AOFAQ are the cheapest Awarding organisation for the first year followed by Qualifications Network.  Increasing adjustments above this nominal figure do not change the rankings.

  • Second Year Costs
    In the second year (without centre registration fees) Highfield is the cheapest followed by Qualifications Network. 



As a training provider we have always offered at least two pre-hospital care courses to provide our candidates with choice rather than dictating the training that they we believe they should have.

  • Highfield Level 3 First Aid Response
    We have never offered the Highfield Level 3 First Aid Response courses, despite being accepted by the SIA as an appropriate First Aid course for licencing purposes. This course is not really comparable in terms of content or credibility as the other courses discussed here.

  • Pearson First Person on Scene - Level 4
    Despite the quality of this course, it’s size and cost makes it unattractive compared to the Level 3 courses. As such we have ceased offering this course.

  • AOFAQ First Person on Scene - Level 3
    As a result of the quality assurance issues with AOFAQ we have ceased delivering their Level 3 First Person on Scene course is concerned.

  • Qualsafe FREC - Level 3
    FREC has very much established itself as an industry standard over the last few years with no issues of quality assurance and a reasonable and representative syllabus.
    Because the progressive pathway to paramedic registration is not as simple as it is promoted, nor is it an any way guaranteed, we do not see the progressive pathway as an actual selling point.

  • IQ First Person on Scene Support versus QN First Responder?
    Of the two new courses available we have chosen to offer the QN Level 3 First Responder Award as our primary Level 3 Pre-Hospital Care course based on the content of the course being more balanced and comprehensive than the IQ First Person on Scene Support.

Which course is right for you?

The choice is entirely yours. We hope this in-depth and objective review has provided you with enough information to make your own decision. The QN Level 3 First Responder Award is now our primary Pre-Hospital Care course for those who have identified in their First Aid Needs Analysis that their staff need training requirements are above that of First Aid at Work. This course is also ideal for those who wants to exceed the ‘minimum’ requirement for licensing with the SIA to differentiate yourself against others in the job market.