Epidemiologic features of medical emergencies in remote First Nations in northern Ontario: a cross-sectional descriptive study using air ambulance transport data

Abstract

A lmost all residents of Ontario, Canada live within 30 minutes of an emergency department. 1 However, for about 25 000 Ontarians living in remote commun ities, accessing a doctor in an emergency department requires flying in a plane or helicopter. 1 Patients in these northern com munities access medical care through a local nursing station, with intermittent incommunity physician coverage. Patients with highacuity conditions are transported from remote com munities to hospital by Ornge, the provincial medical air ambulance service provider. 2,3 Even under ideal conditions, these transfers take several hours. Air transports from these communities can face delays due to weather, visibility, mechan ical issues and personnel issues. More than half of the associ ated remote airports do not have key visual aids that pilots use to land aircraft during periods of reduced visibility, which makes medical transports dependent on weather conditions. 4 First Nations populations living in remote communities are known to face challenging social determinants of health: isolated geography, insufficient housing, unemployment, and the cultural impact of colonialism and residential schools. 5 Access to potable water is an issue in many communities, with 188 boil water advisories in First Nations in the Sioux Look out area between 2007 and 2016. 6 These populations face trauma at rates 2.5-8 times greater than the Canadian aver age. 7-10 People living in these communities face elevated rates of chronic disease, which manifest as critical health emergen cies including mental health, infectious disease, diabetic and cardiovascular emergencies. 11-14 The characteristics of patients requiring air medical trans port in this region have not been well described, with only a handful of published papers describing medical emergencies in these remote communities over the last 35 years. 2,6,7,15,16 We aimed to describe who is transported from 26 remote Nish nawbe Aski Nation communities in northern Ontario to access hospitalbased emergency medical care and to describe the primary clinical reason for their transport as stated in the

Learning From Our Strengths: Exploring Strategies to Support Heart Health in Indigenous Communities

“…The included studies specifically targeted the following diseases of focus: CVD; n = 8); heart health (n = 5); hypertension (n = 2); stroke (n = 2); coronary artery disease (n = 2); rheumatic fever (n = 1); or a combination of multiple chronic diseases (eg, CVD, diabetes; n = 1). 2 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 The aim of each study varied, in reflection of the following categories (note that some studies were identified as falling within multiple categories; Table 2 ): risk factor—understand discrepancies in or origins of heart health (n = 10); intervention—design/implementation of program or strategy (n = 9); and heart health management—Indigenous and/or Western approaches to manage heart health (n = 8). …”

“… 2 , 14 , 25 Several studies described stories in which, owing to racial biases, individuals were provided with dismissive clinical interactions in the emergency department (eg, being prescribed antibiotics for a heart attack) or were forbidden to embrace their cultural values (eg, were unable to bring traditional foods to hospitalized community members), creating a sense of emotional harm when seeking care and support. 2 , 25 , 26 , 27 , 28 , 29 , 30 …”

Access to Cardiovascular Care for Indigenous Peoples in Canada: A Rapid Review

“…For example, in Northwest Ontario, approximately 10% of air ambulance flights are for cardiovascular emergencies. 47 …”

Demographics of mental healthcare presentations in a northwest Ontario emergency department

“…Many patients require the initiation and coordination of medical transportation from their remote community. A recent analysis of regional emergency air transportations ('medevacs') document that 54% of cases from the 26 fly-in First Nations communities in northwest Ontario were directed to SLMHC (mean annual number of transports 1146) [21]. Of these, 7.5% were for toxicologic emergencies and 11.3% were for accidental/nonaccidental trauma.…”