Emergency Response Systems and Services in Remote First Nations · 2019. 3. 19. · thResearch...
1
www.postersession.com Introduction 1 Division of Clinical Sciences, Northern Ontario School of Medicine; 2 Centre for Rural and Northern Health Research, Laurentian University; 3 Sioux Lookout First Nations Health Authority; 4 Nishnawbe Aski Nation; 5 Dalla Lana School of Public Health, University of Toronto. E. Mew 1,5 , S.D. Ritchie 2 , D. VanderBurgh 1 , J. Gordon 3 , J.L. Beardy 4 , A. Orkin 5 Emergency Response Systems and Services in Remote First Nations Communities in Northern Ontario: An Environmental Scan 1. Glazier RH, Gozdyra P, Yeritsyan N. 2011. Geographic Access to Primary Care and Hospital Services for Rural and Northern Communities: Report to the Ontario Ministry of Health and Long-Term Care. Toronto: Institute for Clinical Evaluative Sciences. 2. Born K, Orkin A, VanderBurgh D, Beardy J. 2012. Teaching wilderness first aid in a remote First Nations community: the story of the Sachigo Lake Wilderness First Response Education Initiative. International Journal of Circumpolar Health 71: 19002. 3. Orkin A, VanderBurgh D, Ritchie SD, et al. 2014. Community-Based Emergency Care: An Open Report for Nishnawbe Aski Nation. Thunder Bay: Northern Ontario School of Medicine. Available at: www.nosm.ca/cbec. 4. Canada NewsWire. 2011, Jul 20. AFN supports calls for action and effective emergency response to fires in Northwestern Ontario. Retrieved from http://www.afn.ca/en/news- media/latest-news/afn-supports-calls-for-action-and-effective-emergency-response-to- fire 5. Nishnawbe Aski Nation. 2015, Apr 28. News Release: Auditor General report shows Ottawa out of touch with health care reality in First Nations. Retrieved from http://www.nan.on.ca/upload/documents/comms-2015-04-28-ag-report.pdf - Nishnawbi Aski Nation (NAN) is the political organization representing 7 Tribal Councils and 49 First Nations communities in northern Ontario. - Over 25,000 Ontarians live in 27 remote NAN communities. 1 - Sioux Lookout First Nations Health Authority (SLFNHA) coordinates health services provided through local nursing stations. - BUT, limited information on status of pre-nursing station emergency care in these remote communities. 2 ES was a flexible and effective method. Existing systems, efforts and programs are grossly inadequate and unsuccessful. Expansion of conventional ambulance or first responder programs would not be an appropriate nor realistic solution. Novel, sustainable, and community-based innovations in emergency health services delivery are urgently needed. Interpretation of interview results by inter-disciplinary group of stakeholders. II. Multi-Jurisdictional Roundtable Supported by the Northern Ontario Academic Medicine Association (NOAMA) AHSC AFP Innovation Fund award and the Indigenous Health Research Development Program (IHRDP). Purpose Methods 10 structured telephone interviews conducted primarily with Health Directors from the Nishnawbe Aski Nation Health Advisor Working Group. All interviews transcribed and member-checked. Inductive analyses using NVivo 9.0 and Microsoft Excel. I. Health Director Interviews References 29 remote communities with no 911 service. Community members provide first response care and transportation. Existing services include the First Nations Emergency Response Program, James Bay Ambulance Service, and the Sachigo Lake Wilderness Emergency Response Education Initiative. These programs are fragmented and heterogeneous. Fives Themes identified: 1. Many communities have limited, if any, emergency response capacity and services. 2. Lack of consistent, reliable and standardized telecommunication. 3. Turnover and burnout in volunteer emergency response teams. 4. Inability of nurses to leave nursing stations to respond to emergencies. 5. Challenges related to First Aid training. Shared Vision: People in remote and isolated communities should have access to excellent community- based first response emergency care. Recommended Actions: Develop working group with key partners. Abide by the following principles: community-based, sustainable, capacity-building, collaboration, integration, and excellence. Plan and test model for community-based emergency care. Phase I: Primary Sources Results Phase II: Secondary Sources Consisted of two parts: 1. Academic and grey literature review: • Searched ProQuest, Web of Science, Medline, Scopus, and Google. 2. Targeted web searches of existing programs (in progress): • Programs include James Bay Ambulance Service, Red Cross, First Nations Emergency Response Team Program, and Canadian Ranger Program. Further Information Please email [email protected] or visit www.nosm.ca/cbec II. Multi-Jurisdictional Roundtable 3 I. Health-Director Interviews Results 42 articles identified: 10 news articles stating need for improved emergency services. Quotations include: “Northern Ontario plane crash highlights lack of emergency services on reserves” 4 “There are no 911 services in remote First Nations. The barriers faced in the delivery of healthcare causes undue suffering and countless losses due to a lack of…local emergency response, [among others]...” 5 Remaining articles offered no novel information. Supplemental Literature Review Methods - To better understand the current status of emergency response systems, services, and training in remote FN communities in Northern Ontario. - Apply an environmental scan (ES) approach that adheres to principles of community-based participatory research (CBPR) and OCAP principles. AO and DV declare a non-financial conflict of interest through their affiliation with the Remote Health Initiative. The remaining authors declare no conflict of interest. Discussion “Our community doesn’t have a program to address emergency response…[nor an] ambulance response service, and that is required. We make use with what we have. We've been lucky so far.” - First Nations health leader
Transcript of Emergency Response Systems and Services in Remote First Nations · 2019. 3. 19. · thResearch...
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Intr
oduc
tion
1 Div
isio
n of
Clin
ical
Sci
ence
s, N
orth
ern
Ont
ario
Sch
ool o
f Med
icin
e; 2 C
entre
for R
ural
and
Nor
ther
n H
ealth
Res
earc
h, L
aure
ntia
n U
nive
rsity
; 3Si
oux
Look
out F
irst N
atio
ns H
ealth
Aut
horit
y; 4 N
ishn
awbe
Ask
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ion;
5 Dal
la L
ana
Scho
ol o
f Pub
lic H
ealth
, Uni
vers
ity o
f Tor
onto
. E.
Mew
1,5 ,
S.D
. Ritc
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, D. V
ande
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J. G
ordo
n3, J
.L. B
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A. O
rkin
5
Emer
genc
y R
espo
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Syst
ems
and
Serv
ices
in R
emot
e Fi
rst N
atio
ns C
omm
uniti
es
in N
orth
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Ont
ario
: An
Envi
ronm
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l Sca
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lazi
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11.
Geo
grap
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Acc
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toP
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are
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pita
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sfo
rRur
alan
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mun
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:Rep
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oth
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tryof
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lthan
dLo
ng-T
erm
Car
e.To
ront
o:In
stitu
tefo
rClin
ical
Eval
uativ
eSc
ienc
es.
2.Bo
rnK,
Ork
inA,
Vand
erBu
rgh
D,
Bear
dyJ.
2012
.Te
achi
ngw
ilder
ness
first
aid
ina
rem
ote
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atio
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itiat
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02.
3.O
rkin
A,Va
nder
Burg
hD
,Ritc
hie
SD,e
tal.
2014
.Com
mun
ity-B
ased
Em
erge
ncy
Car
e:A
nO
pen
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ortf
orN
ishn
awbe
Ask
iNat
ion.
Thun
der
Bay:
Nor
ther
nO
ntar
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hool
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edic
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Avai
labl
eat
:ww
w.no
sm.c
a/cb
ec.
4.C
anad
a N
ewsW
ire. 2
011,
Jul
20.
AFN
sup
ports
cal
ls fo
r act
ion
and
effe
ctiv
e em
erge
ncy
resp
onse
to fi
res
in N
orth
wes
tern
Ont
ario
. Ret
rieve
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m h
ttp://
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edia
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and-
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e-em
erge
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resp
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-to-
fire
5.N
ishn
awbe
Aski
Nat
ion.
2015
,Ap
r28
.N
ews
Rel
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:Au
dito
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ener
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ttaw
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hw
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Ret
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ents
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ms-
2015
-04-
28-a
g-re
port.
pdf
-N
ishn
awbi
Aski
Nat
ion
(NAN
) is
the
polit
ical
or
gani
zatio
n re
pres
entin
g 7
Trib
al C
ounc
ils a
nd 4
9 Fi
rst
Nat
ions
com
mun
ities
in
north
ern
Ont
ario
.-
Ove
r 25,
000
Ont
aria
ns li
ve
in 2
7 re
mot
e N
AN
com
mun
ities
.1-
Siou
x Lo
okou
t Firs
t Nat
ions
H
ealth
Aut
horit
y (S
LFN
HA)
co
ordi
nate
s he
alth
ser
vice
s pr
ovid
ed th
roug
h lo
cal
nurs
ing
stat
ions
.-
BUT,
lim
ited
info
rmat
ion
on
stat
us o
f pre
-nur
sing
sta
tion
emer
genc
y ca
re in
thes
e re
mot
e co
mm
uniti
es.2
ES
was
a fl
exib
le a
nd
effe
ctiv
e m
etho
d.
Exis
ting
syst
ems,
effo
rts a
nd
prog
ram
s ar
e gr
ossl
y in
adeq
uate
and
un
succ
essf
ul.
Ex
pans
ion
of c
onve
ntio
nal
ambu
lanc
e or
firs
t res
pond
er
prog
ram
s w
ould
not
be
an
appr
opria
te n
or re
alis
tic
solu
tion.
N
ovel
, sus
tain
able
, and
co
mm
unity
-bas
ed
inno
vatio
ns in
em
erge
ncy
heal
th s
ervi
ces
deliv
ery
are
urge
ntly
nee
ded.
Inte
rpre
tatio
n of
in
terv
iew
resu
lts b
y in
ter-d
isci
plin
ary
grou
p of
st
akeh
olde
rs.
II. M
ulti-
Juris
dict
iona
l Rou
ndta
ble
Supp
orte
d by
the
Nor
ther
n O
ntar
io A
cade
mic
Med
icin
e As
soci
atio
n (N
OAM
A) A
HSC
AFP
Inno
vatio
n Fu
nd a
war
d an
d th
e In
dige
nous
Hea
lthR
esea
rch
Dev
elop
men
t Pro
gram
(IH
RD
P).
Purp
ose
Met
hods
10
stru
ctur
ed te
leph
one
inte
rvie
ws
cond
ucte
d pr
imar
ily w
ith H
ealth
D
irect
ors
from
the
Nis
hnaw
beAs
kiN
atio
n H
ealth
Adv
isor
Wor
king
Gro
up.
Al
l int
ervi
ews
trans
crib
ed a
nd m
embe
r-che
cked
.
Indu
ctiv
e an
alys
es u
sing
NVi
vo9.
0 an
d M
icro
soft
Exce
l.
I. H
ealth
Dire
ctor
Inte
rvie
ws
Ref
eren
ces
29
rem
ote
com
mun
ities
with
no
911
serv
ice.
Com
mun
ity m
embe
rs p
rovi
de fi
rst r
espo
nse
care
and
tran
spor
tatio
n.
Ex
istin
g se
rvic
es in
clud
e th
e Fi
rst N
atio
ns E
mer
genc
y R
espo
nse
Prog
ram
, Jam
es B
ay A
mbu
lanc
e Se
rvic
e, a
nd th
e Sa
chig
oLa
ke
Wild
erne
ss E
mer
genc
y R
espo
nse
Educ
atio
n In
itiat
ive.
Thes
e pr
ogra
ms
are
fragm
ente
d an
d he
tero
gene
ous.
Fi
ves
Them
es id
entif
ied:
1.
Man
y co
mm
uniti
es h
ave
limite
d, if
any
, em
erge
ncy
resp
onse
ca
paci
ty a
nd s
ervi
ces.
2.La
ck o
f con
sist
ent,
relia
ble
and
stan
dard
ized
tele
com
mun
icat
ion.
3.
Turn
over
and
bur
nout
in v
olun
teer
em
erge
ncy
resp
onse
team
s.
4.In
abilit
y of
nur
ses
to le
ave
nurs
ing
stat
ions
to re
spon
d to
em
erge
ncie
s.
5.C
halle
nges
rela
ted
to F
irst A
id tr
aini
ng.
Sh
ared
Vis
ion:
Peop
le in
rem
ote
and
isol
ated
co
mm
uniti
es s
houl
d ha
ve
acce
ss to
exc
elle
nt c
omm
unity
-ba
sed
first
resp
onse
em
erge
ncy
care
.
Rec
omm
ende
d Ac
tions
:
Dev
elop
wor
king
gro
up w
ith k
ey
partn
ers.
Abid
e by
the
follo
win
g pr
inci
ples
: co
mm
unity
-bas
ed, s
usta
inab
le,
capa
city
-bui
ldin
g, c
olla
bora
tion,
in
tegr
atio
n, a
nd e
xcel
lenc
e.
Plan
and
test
mod
el fo
r co
mm
unity
-bas
ed e
mer
genc
y ca
re.
Phas
e I:
Prim
ary
Sour
ces
Res
ults
Phas
e II:
Sec
onda
ry S
ourc
es
Con
sist
ed o
f tw
o pa
rts:
1.Ac
adem
ic a
nd g
rey
liter
atur
e re
view
:•
Sear
ched
Pro
Que
st, W
eb o
f Sci
ence
, M
edlin
e, S
copu
s, a
nd G
oogl
e.
2.Ta
rget
ed w
eb s
earc
hes
of e
xist
ing
prog
ram
s (in
pro
gres
s):
•Pr
ogra
ms
incl
ude
Jam
es B
ay
Ambu
lanc
e Se
rvic
e, R
ed C
ross
, Firs
t N
atio
ns E
mer
genc
y R
espo
nse
Team
Pr
ogra
m, a
nd C
anad
ian
Ran
ger
Prog
ram
.
Furt
her I
nfor
mat
ion
Plea
se e
mai
l sr
itchi
e@la
uren
tian.
caor
vis
it w
ww.
nosm
.ca/
cbec
II. M
ulti-
Juris
dict
iona
l Rou
ndta
ble3
I. H
ealth
-Dire
ctor
Inte
rvie
ws
Res
ults
42
arti
cles
iden
tifie
d:
10
new
s ar
ticle
s st
atin
g ne
ed fo
r im
prov
ed
emer
genc
y se
rvic
es. Q
uota
tions
incl
ude:
“Nor
ther
n O
ntar
io p
lane
cra
sh h
ighl
ight
s la
ck o
f em
erge
ncy
serv
ices
on
rese
rves
”4
“The
re a
re n
o 91
1 se
rvic
es in
rem
ote
Firs
t N
atio
ns. T
he b
arrie
rs fa
ced
in th
e de
liver
y of
hea
lthca
re c
ause
s un
due
suffe
ring
and
coun
tless
loss
es d
ue to
a la
ck o
f…lo
cal
emer
genc
y re
spon
se, [
amon
g ot
hers
]...”5
R
emai
ning
arti
cles
offe
red
no n
ovel
info
rmat
ion.
Supp
lem
enta
l Lite
ratu
re R
evie
wM
etho
ds-
To b
ette
r und
erst
and
the
curre
nt s
tatu
s of
em
erge
ncy
resp
onse
sy
stem
s, s
ervi
ces,
and
tra
inin
g in
rem
ote
FN
com
mun
ities
in N
orth
ern
Ont
ario
. -
Appl
y an
env
ironm
enta
l sc
an (E
S) a
ppro
ach
that
ad
here
s to
prin
cipl
es o
f co
mm
unity
-bas
ed
parti
cipa
tory
rese
arch
(C
BPR
) and
OC
AP
prin
cipl
es.
AO a
nd D
V de
clar
e a
non-
finan
cial
con
flict
of
inte
rest
thro
ugh
thei
r affi
liatio
n w
ith th
e R
emot
e H
ealth
Initi
ativ
e. T
he re
mai
ning
au
thor
s de
clar
e no
con
flict
of i
nter
est.
Dis
cuss
ion
“Our
com
mun
ity d
oesn
’t ha
ve a
pr
ogra
m to
add
ress
em
erge
ncy
resp
onse
…[n
or a
n] a
mbu
lanc
e re
spon
se s
ervi
ce, a
nd th
at is
re
quire
d. W
e m
ake
use
with
w
hat w
e ha
ve. W
e've
bee
n lu
cky
so fa
r.”
-Firs
t Nat
ions
hea
lth le
ader
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