Abstract
ABSTRACTBackground: Approximately 24,000 Ontarians live in remote Indigenous communities with no road access. These communities are a subset of Nishnawbe Aski Nation (NAN), a political grouping of 49 First Nations communities in Northern Ontario, Canada. Limited information is available regarding the status of emergency care in these communities.Objective: We aimed to understand emergency response systems, services, and training in remote NAN communities.Design: We used an environmental scan approach to compile information from multiple sources including community-based participatory research. This included the analysis of data collected from key informant interviews (n=10) with First Nations community health leaders and a multi-stakeholder roundtable meeting (n=33) in October 2013.Results: Qualitative analysis of the interview data revealed four issues related to emergency response systems and training: (1) inequity in response capacity and services, (2) lack of formalised dispatch systems, (3) turnover and burnout in volunteer emergency services, and (4) challenges related to first aid training. Roundtable stakeholders supported the development of a community-based emergency care system to address gaps.Conclusions: Existing first response, paramedical, and ambulance service models do not meet the unique geographical, epidemiological and cultural needs in most NAN communities. Sustainable, context-appropriate, and culturally relevant emergency care systems are needed.
Highlights
In 2015, Canada’s Auditor General identified inequitable health services among remote First Nations communities, including severely under-equipped nursing stations and healthcare staff working beyond their scope of practice [1]
It was outside the scope of practice for Health Canada nurses to respond to emergencies outside of a nursing station, as stated by one informant: “Nurses are stuck in the nursing station because of the memo.”
Some nurses may not act according to this memo, the policy has led to challenges, as another informant indicated that “a patient died on the road in front of the nursing station, and during this incident the nurse could not leave the nursing station”
Summary
In 2015, Canada’s Auditor General identified inequitable health services among remote First Nations communities, including severely under-equipped nursing stations and healthcare staff working beyond their scope of practice [1]. Elevated rates of chronic and infectious disease manifest as critical health emergencies including mental health and addictions crises, myocardial infarctions, diabetic emergencies, and acute sepsis [1,2]. These service deficiencies coupled with increased risk of emergency health conditions exacerbate the potential for severe illness or death. 24,000 Ontarians live in remote Indigenous communities with no road access. These communities are a subset of Nishnawbe Aski Nation (NAN), a political grouping of 49 First Nations communities in Northern Ontario, Canada.
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