ABSTRACT
BACKGROUND: 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.
Subject(s)
Emergency Medical Services/organization & administration , Emergency Medical Technicians/organization & administration , Health Services Accessibility/organization & administration , Health Services, Indigenous/organization & administration , Rural Health Services/organization & administration , Ambulances/supply & distribution , Arctic Regions , Burnout, Professional/epidemiology , Community-Based Participatory Research , Emergency Medical Dispatch/organization & administration , Emergency Medical Technicians/education , Emergency Medical Technicians/psychology , Health Workforce/organization & administration , Healthcare Disparities/organization & administration , Humans , Indians, North American , Ontario , Personnel Selection , Qualitative Research , Volunteers/education , Volunteers/psychologySubject(s)
Community Health Services/organization & administration , Emergency Medical Services/organization & administration , Health Services Accessibility/statistics & numerical data , Health Services, Indigenous/organization & administration , Patient Safety , Canada , Female , Humans , Male , Medically Underserved Area , Models, Organizational , Needs Assessment , Rural PopulationABSTRACT
CONTEXT: Community-based first aid training is the collaborative development of locally relevant emergency response training. The Sachigo Lake Wilderness Emergency Response Education Initiative was developed, delivered, and evaluated through two intensive 5-day first aid courses. Sachigo Lake First Nation is a remote Aboriginal community of 450 people in northern Ontario, Canada, with no local paramedical services. These courses were developed in collaboration with the community, with a goal of building community capacity to respond to medical emergencies. ISSUE: Most first aid training programs rely on standardized curriculum developed for urban and rural contexts with established emergency response systems. Delivering effective community-based first aid training in a remote Aboriginal community required specific adaptations to conventional first aid educational content and pedagogy. LESSONS LEARNED: Three key lessons emerged during this program that used collaborative principles to adapt conventional first aid concepts and curriculum: (1) standardized approaches may not be relevant nor appropriate; (2) relationships between course participants and the people they help are relevant and important; (3) curriculum must be attentive to existing informal and formal emergency response systems. These lessons may be instructive for the development of other programs in similar settings.
