TORONTO - Imagine living in a remote Canadian community where the nearest hospital is hundreds of kilometres away, reachable only by plane after at least four hours in the air. Now imagine a loved one has been seriously injured in an accident while out hunting.
This is a very real scenario for the 400 residents of Sachigo Lake, a First Nations community in Northern Ontario near the Manitoba border, and one that could leave them feeling helpless.
But an innovative educational program is trying to address the lack of prompt access to medical professionals by turning some residents into emergency responders with the skills to provide interim care to their fellow residents.
The course began as a research project at the Northern Ontario School of Medicine, initiated by two doctors who saw the inadequacy of standard first aid programs in an isolated community with a paucity of on-site medical resources.
"Call 911 in Sachigo Lake and you get a busy signal, no sirens and no paramedics," said Dr. Aaron Orkin, one of the researchers who helped create the program, which is described in this week's issue of the journal PLoS Medicine.
He said the key aspect that sets apart the Sachigo Lake Wilderness Emergency Response Education Initiative from other first aid courses elsewhere in Canada's north is that it isn't about top-down teaching.
"The most important feature of this whole project is not teaching a certain first aid curriculum that we think is the right idea," Orkin said Tuesday. "It's not about a bunch of physicians and paramedics coming in to a far northern community and saying 'these are the skills we think you need to know.'"
"This project is about an iterative and lasting collaboration with the community, where we have worked with the locals at various levels of leadership ... to say: 'What are the kinds of emergencies that have happened here? What are the kinds of things that make you worry if you're in the community or out on the land and hunting, fishing, trapping? ... What are the things that you think you need to know?"
He said the program ended up being shaped by the needs of Sachigo Lake residents, based on their experiences and elevated rates of traumatic injury, chronic disease and mental health issues.
"So really the product that we have here is not a first aid course, it's a collaboration," said Orkin, who also specializes in emergency medicine at Humber River Regional Hospital in Toronto.
Orkin said that because the typical mode of transportation in Sachigo Lake is a snowmobile or all-terrain vehicle, injuries from accidents involving the vehicles are relatively common.
As well, high rates of chronic conditions like cardiovascular disease and diabetes among aboriginal Canadians can mean dealing with patients experiencing heart attacks, stroke or diabetic coma.
"So these kinds of emergencies become more common and as a result locals feel a real heightened need to be able to have their basic skills to respond and care for people at the moment an emergency like that happens," he said.
The training program doesn't only teach participants such skills as fashioning a tourniquet or applying pressure to stop bleeding, Orkin noted, but also how to keep the patient and themselves safe in what could be a hostile environment — for instance, out on the land with a disabled snowmobile in -40 C weather, nearing dark.
"And that to us is the key to people feeling they have more capacity, that they're safe and the community has more resilience to manage emergencies."
One course participant reported that the medical emergency scenarios dealt with during the course "made me realize that it could actually happen to me if I need to help someone … When I did (previous training courses), it didn’t really click in with me. This course was set in an environment that it might happen."
Jackson Beardy, Sachigo Lake health director, said he is glad he enrolled in the course, though he hasn't yet had to use what he learned in an emergency.
"There are a lot of times like this morning that we had to go out and search for overdue hunters," Beardy said Tuesday from Sachigo Lake. As it turned out, the hunters were found and had not been injured. But he said having emergency medical training would have been crucial had that not been the case.
"It teaches us how to use the environment around us," he said. "For instance, when we go hunting we don't take a stretcher along with us. We have to create a stretcher if an emergency arises out there."
That could mean cutting stout tree branches and fashioning a make-shift stretcher with the addition of a tarp and rope, items that residents typically carry with them while hunting.
"We use whatever we have. We use birch bark for casting (broken bones) for stability," Beardy said.
The program continues to be revised to better meet the needs of Sachigo Lake residents, said Orkin.
But it also offers the basis for similar emergency response courses in other remote communities in Canada's north — tailored to their individual environments, of course.
"It's a model for working with a community to develop local first response capacity. It's not a curriculum that we can sort of wrap up in a binder, put on the Internet and say you can deliver this anywhere."
"I believe that this local training is part of the answer we have been looking for," he said. "How many medical professionals are going to come and teach us? It would be great to see this program across all of our First Nations."
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