An environmental scan of emergency response systems and services in remote First Nations communities in Northern Ontario

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.

KEYWORDS:

• Indigenous health
• aboriginal health
• emergency medical services
• remote health
• health services
• Nishnawbe Aski Nation
• environmental scan
• community-based participatory research

Acknowledgements

We would like to sincerely thank the key informants and roundtable participants for their knowledge and interpretation of results. We would also like to thank André McDonald, Julia Russell Jozkow, Jeffrey Curran, and Natalie Hansen for providing comments towards this manuscript and Baijayanta Mukhopadhyay in the development of the key informant interview questions. We would also like to thank Jill E. Sherman from the Centre for Rural and Northern Health Research for the development of the map presented in Figure 1.

Conflict of Interest

AO and DV declare a non-financial conflict of interest through their affiliation with Remote Health Initiative, a non-profit entity dedicated to enhancing care in remote settings. The remaining authors declare no conflicts of interest.

Additional information

Funding

The Northern Ontario Academic Medicine Association project grant number is Project #A-15-07.