Community-Based Emergency Care: An Open Report for Nishnawbe Aski Nation

On Remote Reserves, Locals Must Perform Life-Saving Emergency Response

Konnie LeMay

Eight minutes.

That is the response-time goal from a 911 call to arrival of emergency services at the patient’s location in most cities. That, too, is why standard first-aid training teaches how to do CPR, to staunch a bleeding wound or to apply other short-term aid until professional help arrives — in about eight minutes.

Two hours.

That is how long it takes a plane with emergency medical professionals to reach the remote northern Ontario community of Sachigo Lake after a call for outside help. In critical situations when minutes count, it’s two hours to arrive and then two hours to traverse the 262 air miles to the nearest hospital in Sioux Lookout. That is why, as Jackson Beardy knows from sad experience, standard first-aid training does not meet the needs of remote Oji-Cree First Nations communities.

Beardy is haunted by the case of a community elder who died of cardiac complications. After her cardiac arrest, he and his brother, with only standard first-aid training, managed to get her breathing and with a pulse. It was more than half-an-hour after that before paramedics arrived, about the time she succumbed.

“She didn’t make it after the paramedics took over,” he said. The health director of the 450-resident community understands well that Sachigo Lake, like more than half of the 49 communities within the Nishnawbe Aski Nation, cannot support a full-time ambulance or EMS staff. Local people are the only viable emergency responders.

“After realizing that, I started looking around to see how we could develop a program, how our people could do the same thing the paramedics could do.”

NAN Deputy Grand Chief Alvin Fiddler is also familiar with the tragic scenarios in communities with heightened incidents of heart ailments, diabetes and mental health and substance abuse issues, but no ready access to emergency services.

“Do chest compression or mouth-to-mouth, and you call 911 and 911 comes in eight minutes or 12 minutes, and 18 minutes after that you are in the hospital — that will not work for our communities,” Fiddler said.

A different kind of emergency training may be on the northern horizon. A recently released report, originating from a 2013 Sioux Lookout meeting, outlines visions for improving the quality and availability of emergency care for remote communities.

“Community-based emergency care will go a long way to improving the health and safety of residents of isolated communities,” said Fiddler in announcing the report. “We are looking for a strong commitment from the federal and provincial governments to put this approach into action.”

The report cites studies showing First Nations people are four times more likely to experience severe trauma than the general Canadian population. In 2012, there were 2,000 medical evacuations from First Nations communities, some of which have small nursing stations not staffed to handle off-site emergencies. Among the 49 NAN communities stretching across two-thirds of Ontario, 29 do not have ready access to 911 or paramedic services.

“What is encouraging about this process is that right from the first meeting, government officials were there,” Fiddler said. “It should be a collaborative effort a team effort.”

Two graduates of the Northern Ontario School of Medicine at Lakehead University in Thunder Bay have added their expertise to the team effort.

Drs. Aaron Orkin and Dave VanderBurgh, both outdoor recreation enthusiasts, decided the kind of emergency-response training linked to camping and wilderness sports might be a workable model for remote First Nations. In both cases, quick access to professional care is not an option.

“From a medical perspective, from the expertise of a family doctor, many of the most tragic outcomes are entirely preventable and easily managed with the right kind of local expertise,” Orkin said. “For about five years, we’ve developed a first-response training program, a medically rigorous program that meets the highest standards. … We narrow it down to the stuff that really save lives.”

The doctors, NAN leaders and the Sachigo Lake community together refined the curriculum to be culturally sensitive and to address the medical emergencies most likely to arise – hunting accidents, cardiac, diabetic or mental health crises and injuries from the most typical transportation modes on ATVs or snowmobiles.

“Our curriculum differs from a standard first-aid curriculum in many ways,” Orkin said. Coursework anticipates managing care for hours, not minutes, until professional help arrives. It includes, as Orkin termed it, a “reciprocity of learning; instructors have as much to learn as students.”

Five percent of the Sachigo Lake population has taken the extensive course, including Beardy. “They’ve come to the point where they are side by side with the nurses, and they know everything from the assessment of the patient, what trauma, to what first responders did when they got to the scene.”

One young Sachigo Lake woman who took the course is now studying to become a certified paramedic and plans to return to help the First Nation’s communities with her new skills, Beardy said.

Orkin believes the Sachigo Lake curriculum can be modified for other NAN communities and perhaps even for other remote locations, such as the Alaskan bush. The NAN deputy grand chief agrees.

“This is sort of the first step,” Fiddler said, “putting together this report, the meetings and forums. The next step is to start engaging the other communities to develop a model that will work for them and implementation of these models, right through the north.”

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