Conceptualizing and Managing Medical Emergencies Where No Formal Paramedical System Exists: Perspectives from a Remote Indigenous Community in Canada.

Jeffrey Curran,Stephen Ritchie,David Vanderburgh,John Lewko,Karen Born,Aaron Orkin,Jackson Beardy

doi:10.3390/ijerph15020267

Abstract

(1) Background: Remote communities in Canada lack an equitable emergency medical response capacity compared to other communities. Community-based emergency care (CBEC) training for laypeople is a model that has the potential to enhance the medical emergency response capacity in isolated and resource-limited contexts. The purpose of this study was to understand the characteristics of medical emergencies and to conceptualize and present a framework for what a medical emergency is for one remote Indigenous community in northwestern Ontario, in order to inform the development of CBEC training. (2) Methods: This study adhered to the principles of community-based participatory research and realist evaluation; it was an integrated component of the formative evaluation of the second Sachigo Lake Wilderness Emergency Response Education Initiative (SLWEREI) training course in 2012. Twelve members of Sachigo Lake First Nation participated in the training course, along with local nursing staff, police officers, community Elders, and course instructors (n = 24 total), who participated in interviews, focus groups, and a collaborative discussion of local health issues in the development of the SLWEREI. (3) Results: The qualitative results are organized into sections that describe the types of local health emergencies and the informal response system of community members in addressing these emergencies. Prominent themes of health adversity that emerged were an inability to manage chronic conditions and fears of exacerbations, the lack of capacity for addressing mental illness, and the high prevalence of injury for community members. (4) Discussion: A three-point framework of what constitutes local perceptions of an emergency emerged from the findings in this study: (1) a sense of isolation; (2) a condition with a potentially adverse outcome; and (3) a need for help.

Highlights

Remote communities in Canada face a disproportionate burden of health emergencies and a lack of emergency medical services [1,2,3]
The purpose of this paper is to present how people in one remote Indigenous community in northwestern Ontario understand and conceptualize medical emergencies, and to offer an analysis of how local notions of emergencies might inform the development of local emergency care management systems
The results are organized into two sections that reflect the two research questions: (1) the nature of health emergencies encountered by community members; and (2) the informal response system within the community and in the remote context of traditional land

Summary

Introduction

Remote communities in Canada face a disproportionate burden of health emergencies and a lack of emergency medical services [1,2,3]. Community-based emergency care (CBEC) training is a model that has the potential to reduce inequities in prehospital care in isolated communities [4]. Emergency care training for laypersons increases helping behavior [5] and recognition of mental health issues [6], and decreases response times and mortality rates in many resource limited areas [7,8]. Conventional first aid training contains language, pedagogy, and curriculum that is often inappropriate for remote Indigenous communities that do not have a formal response system for medical emergencies [9]. Health leaders in remote northern Ontario communities have confirmed the need for a community-based solution to existing service gaps, and identified four issues related to the current state of emergency response systems: (1) inequity in response capacity and services;

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Methods

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Discussion

Conclusion