First Nations communities cope with lack of emergency response resources

When six-year-old Jedediah Barkman from Sachigo Lake First Nation in northwestern Ontario broke his arm on Sept. 11, he had to wait two days to be flown out for an X-ray.

The local nursing station has an X-ray machine, but it doesn't work — an all-too-common situation in First Nations communities in northwestern Ontario. 

When you call 911 here, all you get is a busy signal- Jackson Beardy, Sachigo Lake health director

Most remote communities in the region have limited emergency response resources, meaning they often have to get creative when faced with an injury or illness.

"When you call 911 here, all you get is a busy signal," said Jackson Beardy, community health director for Sachigo Lake, which is 560 kilometres northeast of Winnipeg. "The next best thing that you can do is call help from your neighbour … and there's no way anybody's going to ignore [your] call for help."

Jedediah ended up needing surgery at the Winnipeg Children's Hospital to reset the bone because his arm had started to heal incorrectly by the time he received medical care. 

Even getting Jedediah to the nursing station was difficult; there are no paramedic services on northwestern Ontario First Nations. Nurses and doctors aren't allowed to leave the nursing station because of liability issues, Beardy said.

Jedediah was in a lot of pain, said his mom, Geraldine Beardy.

"I didn't want to touch his arm myself, because even when I tried, he would just cry out more," she said.

A group of women in the community made a homemade splint out of cardboard and tied it on his arm with garbage bags.

He was then loaded onto the community's medical vehicle — an old beat-up Chevrolet Tahoe driven by a man with basic first aid training — and taken to the nursing station.

Without a functioning X-ray machine and no doctor in Sachigo Lake, the nurses weren't able to diagnose Jedediah properly.

"[The nurses] were kind of guessing, saying 'He didn't break it,' or 'It probably popped out and then popped back in,'" his mom said. "They were just guessing away."

Jedidiah's injury wasn't deemed severe enough to warrant an air ambulance to be flown out under the Non-Insured Health Benefits Program, the federal program that covers reserve health care outside the provincial health-care system.

That meant the little boy had to wait for the next available scheduled flight to Thunder Bay, which was two days later.

"Non-insured does not find that fractures are a high priority. Why?" said his mom. "He's so young. He's only six years old, and what if it's something that needed to be taken care of right away?"

'Wasn't urgent enough'

Jedediah's situation is not unusual — many families in Sachigo Lake have similar stories.

"My understanding is that any child that's hurt or sick — at any level — is an emergency," said health director Beardy.

"This summer we've had a lot of children that had injuries that we felt should have been sent out immediately, but it didn't happen — the nurses or physician felt that it wasn't urgent enough."

Heather Larsen, the NIHB senior manager for the Ontario region, said the severity of an injury is determined by the medical professional working in the community.

Because Sachigo Lake First Nation does not currently have a doctor and there isn't a working X-ray machine, the severity of the injury is analysed by a nurse. Larsen didn't say when the Sachigo Lake X-ray machine will be fixed.

Getting by without paramedics

Northeastern Ontario First Nations do have a paramedic service, the James Bay Ambulance Services, which covers five communities: Attawapiskat, Fort Albany, Kashechewan, Moose Factory and Moosonee.

In Sachigo Lake, there are trained first responders in addition to the medical driver who has basic first aid training.

Anyone in the community with first aid training who wants increased skills can take the first responder training, which goes beyond the basics, covering how to check vitals, administer oxygen and properly move injured people.

First responder training is not readily available in cities.

"In an urban setting, typically they will not have a first response team, just for the simple fact that they already have established paramedic bases throughout the city," said Damien Boyer, who is a first responder trainer from the Ontario Ministry of Health and Long-Term Care's Kenora campus.

"There's no real need for first response teams in urban settings, just because response times are so quick."

Because communities like Sachigo Lake are a flight away from a hospital, first response teams play a vital role in providing emergency care for the community.

'Resilience and determination'

Dr. Lisa Letkemann, who works in Sandy Lake First Nation, 120 km southwest of Sachigo Lake, has seen first-hand how First Nations communities use every resource available to them to support one another and get by with limited medical supports.

"Communities themselves are providing wonderful support and there are so many programs … that have been set up with a little bit of funding by Health Canada," said Letkemann.

"I can't speak enough about the resilience and determination of communities to try and meet the needs [of the people]."

Get involved, help other people  

​Gwen Tait decided to take first responder training after her niece, Karma Barkman, got in an ATV accident and hit her head on the ground in June 2015.

"There was no one around. We had to look for the medical driver … and the people that were there, they didn't know what to do," said Tait.

"That's why I joined the course, to know what to do and be calm … to help not just my family members, but other people."

There are 36 people in the community who have the training, the health director said.

"If there is an emergency on the west side, [it's] guaranteed that you'll have six community members that are trained with what to do with the situation," Beardy said.