Where There Is No Paramedic: The Sachigo Lake Wilderness Emergency Response Education Initiative

Orkin, Aaron; VanderBurgh, David; Born, Karen; Webster, Michael J.; Strickland, Sarah; Beardy, Jackson

doi:10.1371/journal.pmed.1001322

Cited by 16 publications

(20 citation statements)

References 24 publications

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“…The benefits of using CHWs in providing PHC services in small communities without full-time presence of nursing staff are well established ( 12 ), but issues of confidentiality, training needs and clinical support from a distance must be addressed. Community members can all benefit by more widespread dissemination of emergency response skills ( 14 ). This would increase self-sufficiency and reduce the sense of insecurity within the communities.…”

Section: Discussionmentioning

confidence: 99%

Primary health care accessibility challenges in remote indigenous communities in Canada's North

Oosterveer

Young

2015

International Journal of Circumpolar Health

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BackgroundDespite many improvements, health disparities between indigenous and non-indigenous populations in Canada's North persist. While a strong primary health care (PHC) system improves the health of a population, the majority of indigenous communities are very remote, and their access to PHC services is likely reduced. Understanding the challenges in accessing PHC services in these communities is necessary to improve the health of the population.ObjectiveThe objective of the study was to document and analyze the challenges in accessing PHC services by indigenous people in remote communities in Canada's Northwest Territories (NWT) from the perspectives of users and providers of PHC services.MethodsUsing explorative, qualitative methods, our study involved 14 semi-structured interviews with PHC service providers (SPs) and service users (SUs) in 5 communities across the NWT which varied according to population, remoteness, ethnic composition and health care resources. The interview guide was developed after key informant consultations.ResultsBoth SPs and SUs understood the constraints in providing equitable access to PHC services in remote communities. The provision of emergency care was found to be particularly challenging, because of the lack of qualified staff in the community and the dependence on aeromedical evacuations. Wider dissemination of first aid skills among community members was seen to cover some gaps and also increase self-confidence. For non-emergency care, the need to travel outside the community was generally disliked. All recognized the need for more preventive services which were often postponed or delayed because of the overwhelming demand for acute care. As long as services were provided in a community, the satisfaction was high among SUs. SPs appreciated the orientation they received and the ability to build rapport with the community.ConclusionsNorthern SUs and SPs generally acknowledge the health consequences of living in remote communities. The generally high level of satisfaction attests to the overall effectiveness of PHC in the region despite geographical remoteness. Many improvements could be made in terms of upgrading the clinical skills of SPs and community members, improving staff retention, extending the frequency and duration of community visits and providing more attention to preventive services.

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Section: Discussionmentioning

confidence: 99%

Primary health care accessibility challenges in remote indigenous communities in Canada's North

Oosterveer

Young

2015

International Journal of Circumpolar Health

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“…1 Without formal paramedicine systems in many remote First Nations communities in Canada, bystanders, friends, and family members shoulder the responsibility to transport severely ill and injured patients to local nursing stations and clinics. 5,6,10,12 The result is a fragile and unpredictable chain of survival. In spite of the occasional heroic success story, these informal systems are an unsafe and unreliable patchwork of community goodwill and clinical near-misses.…”

Section: Emergency Care In Remote Canadian Communitiesmentioning

confidence: 99%

“…In spite of the occasional heroic success story, these informal systems are an unsafe and unreliable patchwork of community goodwill and clinical near-misses. 6,12 All are characterized by inadequate training, tragic underfunding, and inexcusable inequity. 1,6,10,12 Remote communities and their citizens deserve better.…”

Section: Emergency Care In Remote Canadian Communitiesmentioning

confidence: 99%

“…Supported by a handful of paramedics at the regional level, CEHWs from remote communities would be trained through a customized, comprehensive, and culturally appropriate curriculum, based on their own distinct set of emergency clinical protocols. 6 Hired in remote communities to deliver essential and timely care, transport patients, and collaborate with local nursing and medical staff, CEHWs would also lead local health promotion and disease prevention programs and train local volunteer first responders. This community-based approach to interdisciplinary healthcare delivery, and the integration of acute care, chronic disease management, and health promotion, extends emerging models for community paramedicine to address health care needs in some of Canada's most underserviced settings.…”

Section: Community-based Emergency Carementioning

confidence: 99%

“…4 A community-based approach might answer the urgent call for effective, sustainable, and scalable local care. 5,6…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Community-Based Emergency Care: A Model for Prehospital Care in Remote Canadian Communities

Orkin

VanderBurgh

Ritchie

et al. 2016

CJEM

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Epidemiology of prehospital trauma deaths in Malawi: A retrospective cohort study

Mulima

Purcell

Maine

et al. 2021

African Journal of Emergency Medicine

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Introduction Trauma is among the leading causes of death and disability in both adults and children worldwide. In Malawi, trauma patients are commonly brought in dead (BID). We aimed to describe the prevalence, sociodemographic, and injury-related characteristics of patients BID to Kamuzu Central Hospital (KCH), a referral hospital in Lilongwe, Malawi. Methods We retrospectively reviewed records of all patients BID in the trauma surveillance registry at KCH from February 2008 to September 2019. We excluded patients BID that did not present to the emergency centre, and were instead taken to the mortuary directly. We used descriptive statistics to evaluate the epidemiology of patients BID. Results We reviewed 106,198 trauma records and 1889 (1.8%) were BID patients. Most patients BID were male, in both adult ( n = 1337/1528, 88.4%) and children ( n = 231/360, 64.9%) cohorts. The mean age was 34.7 (SD 11.9) years in adults and 7.8 (SD 5.4) years in children. Among the adult BID patients, 33.2% were unemployed, 25.6% were construction workers, and 10.1% were small business owners or managers. The common injury mechanisms in adults were road traffic-related injuries (RTIs) (47.1%) and assaults (23.6%). In children, injuries resulted from RTIs (39.7%), with 74.4% of those were pedestrians hit by cars, drowning (22.9%), and burns (12.4%). In both groups, most injuries occurred on roads (60.2%) or at home (22.1%). Reported alcohol use at the time of trauma was present in 6.3%. The police (57.9%) and privately-owned vehicles (26.6%) transported most BID patients to KCH. Conclusion Efforts to reduce prehospital trauma mortality must focus on improving prehospital care, including training the police and community in basic life support and improving resources towards prehospital trauma care. Further efforts to reduce prehospital mortality must aim to decrease injuries on the roads and at home.

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Where There Is No Paramedic: The Sachigo Lake Wilderness Emergency Response Education Initiative

Abstract: Aaron Orkin and colleague describe their collaboration that developed, delivered, and studied a community-based first response training program in a remote indigenous community in northern Canada.

Cited by 16 publications

References 24 publications

Primary health care accessibility challenges in remote indigenous communities in Canada's North

Primary health care accessibility challenges in remote indigenous communities in Canada's North

Community-Based Emergency Care: A Model for Prehospital Care in Remote Canadian Communities

Epidemiology of prehospital trauma deaths in Malawi: A retrospective cohort study

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