Course teaches residents in remote northern community emergency response skills

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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 ATV 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.

The key aspect that sets apart the Sachigo Lake Wilderness Emergency Response Education Initiative is that it isn't top-down teaching, said Dr. Aaron Orkin, one of the researchers who helped create the course.

"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?"

Orkin 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," he said.

Orkin said the typical mode of transportation is a snowmobile or all-terrain vehicle and accidents involving the vehicles are relatively common, as are injuries.

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," he said.

The program, described by Orkin and colleagues in this week's issue of PLoS Medicine, continues to be revised to better meet the needs of residents.

But it also offers the basis for similar emergency response courses in other remote communities in Canada's north — tailored to their individual environments, he said.

"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."

Organizations: First Nations, Northern Ontario School of Medicine, Sachigo Lake Wilderness Emergency Response Education Initiative PLoS Medicine

Geographic location: Sachigo Lake, TORONTO, Ontario Manitoba Canada

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