With the summer months ahead– many of us plan to explore the outdoors, perhaps spend a weekend by a lake or camp in a provincial park. For the vast majority of Ontarians, time spent in the outdoors doesn’t mean that we are far from the safety net and comforts of home. If we run into trouble, help is usually quickly accessible with one phone call to 911. However, there are tens of thousands of Ontarians who do not share in these comforts.
Ontario has dozens of remote First Nations communities, mostly clustered in the Northwestern reaches of the province, with no formal paramedic or 911 services. When there are emergencies in these communities, there is no operator at the end of the line, no paramedics to respond to emergency needs and no ambulance ready for transport. It is community members who are responsible to get their sick or injured family to the nursing station.
The lack of emergency services in these remote communities is compounded by concerning statistics – around higher burdens of injury in these settings, that every minute matters during an emergency, and access to care means a higher likelihood of survival.
First Nations people are four times more likely to experience severe trauma than the average Canadian. While, there is very little research on remote emergency care in Canada, we do know that people living in regions over an hour from the nearest trauma centre are twice as likely to not survive long enough to even reach a hospital when they are seriously injured. Longer waiting times for transport can be a death sentence.
I had the opportunity to listen to some of these community leaders and members at a roundtable meeting I facilitated in Sioux Lookout, which was held in partnership with the Nishnawbe Aski Nation and researchers from the Northern Ontario School of Medicine. These community members spoke about what it feels like to lack a safety net, of trained first responders, in an emergency.
One participant highlighted the patchy nature of services within their communities – and the importance of trained first responders – saying, “There is a willingness to pay for janitors to clean schools, but not in paying first responders to save lives.”
Another participant expressed a common sentiment – of being resourceful and ‘making do’ with what is available, but highlighted the inequities present between their community and vast majority of Ontarians: “Our community doesn’t have a program to address emergency response. We don’t have an ambulance response service, and that is required. We make use with what we have. We’ve been lucky so far.”
There was a clear consensus at this meeting that the status quo is not good enough, and creative approaches are needed.
One such approach is community-based first response emergency care.
What is community-based emergency care? Evidence suggests that training local community members in basic skills to manage emergencies and respond to crises doesn’t just fill in a service gap, it has the potential to reduce morbidity and mortality, and also to build safer, more resilient communities.
One example of this approach is the Sachigo Lake First Nation community’s first response education training program. In Sachigo Lake, which is accessible only by air or seasonal ice roads and where the nearest hospital is more than an hour’s flight away, community members rely on one another during a crisis. With the initial management of an emergency so reliant on community members, this training program aimed to build local first response capacity by developing a training curriculum that responded to stated community needs.
This training course has been delivered to 26 community members, 6% of this community of 450 people. It seems like a small number, but for Sachigo Lake’s community first response capacity, the effect is similar to training approximately 300,000 people in Toronto.
Given some of the more intractable problems of remote geography, higher burdens of traumatic injury and unequal access to services, a program to build local capacity to respond to emergencies may be the solution that some remote communities are seeking around access to excellent emergency care.
The Sachigo Lake experience suggests that these training programs offer tremendous value to communities. There is a great deal of interest from others in the region to have similar models for community-based emergency care training and capacity building programs implemented their communities. Training first responders can make a difference in many different ways in these communities – including saving lives.
The author would like to acknowledge the Community-Based Emergency Care roundtable participants, as well as the organizing team, led by Aaron Orkin, David VanderBurgh, Stephen Ritchie & Melanie Fortune. To learn more about the conversations from the Community-Based Emergency Care roundtable, and some of the next steps based on those conversations, check out this report.