Nursing stations are the only access point into the health care system for some communities and have limited capabilities and resources. We describe characteristics of patients injured in Northern Ontario who present to nursing stations and require transport by air ambulance. Secondary objectives are to compare interventions performed at nursing stations with those performed by flight paramedics and to identify systemic gaps in trauma care.
A retrospective cohort study was performed of all injured patients transported by air ambulance from April 1, 2014, to March 31, 2015.
A total of 125 injured patients were transported from nursing stations. Blunt trauma accounted for 82.5% of injuries, and alcohol intoxication was suspected in 41.6% of patients. The most frequently performed interventions were intravenous fluids and analgesia. Paramedics administered oxygen 62.4% of the time, whereas nursing stations only applied in 8.8% of cases. Flight paramedics were the only providers to intubate and administer tranexamic acid, mannitol, or vasopressors.
Care for patients at nursing stations may be improved by updating the drug formulary based on gap analyses. Further research should examine the role of telemedicine support for nursing station staff and the use of point-of-care devices to screen for traumatic intracranial hemorrhage.
School of Rural and Northern Health, Laurentian University Ramsey Lake Road Sudbury, Ontario, Canada P3E 2C6; ECHO (Evaluating Children's Health Outcomes) Research Centre and Laurentian University Ramsey Lake Road Sudbury, Ontario, Canada P3E 2C6. Electronic address: email@example.com.
Community-based participatory research (CBPR) is a promising approach used with increasing prevalence in health research with underserviced Indigenous communities in rural and remote locations. This case comparison used CBPR principles to examine the characteristics of two collaborative research projects in Canada. Both projects reflected CBPR principles in unique ways with particular differences related to community access and proximity of collaborating partners. CBPR principles are often used and recommended for partnerships involving remote underserviced communities, however many of these principles were easier to follow for the collaboration with a relatively well serviced community in close proximity to researchers, and more challenging to follow for a remote underserviced community. The proximity paradox is an apparent contradiction in the increasing application of CBPR principles for use in distal partnerships with remote Indigenous communities when many of these same principles are nearly impossible to follow. CBPR principles are much easier to apply in proximal partnerships because they afford an environment where collaborative relationships can be developed and sustained.
We describe the development of the first community-based opioid overdose prevention and response program with naloxone distribution offered by a public health unit in Canada (Prevent Overdose in Toronto, POINT).
The target population is people who use opioids by any route, throughout the City of Toronto.
The POINT program is operated by the needle exchange program at Toronto Public Health (The Works) and offered at over 40 partner agency sites throughout Toronto.
POINT is a comprehensive program of overdose prevention and response training, including naloxone dispensing. Clients are instructed by public health staff on overdose risk factors, recognizing signs and symptoms of overdose, calling 911, naloxone administration, stimulation and chest compressions, and post-overdose care. Training is offered to clients one-on-one or in small groups. Clients receive a naloxone kit including two 1 mL ampoules of naloxone hydrochloride (0.4 mg/mL) and are advised to return to The Works for a refill and debriefing if the naloxone kit is used.
In the first 8 months of the program, 209 clients were trained. Clients have reported 17 administrations of naloxone, and all overdose victims have reportedly survived. Client demand for POINT training has been high, and Toronto Public Health has expanded its capacity to provide training. Overall, reception to the program has been overwhelmingly positive.
We are encouraged by the initial development and implementation experience with the naloxone program and its potential to save lives in Toronto. We have planned short-, intermediate-, and long-term process and outcome evaluations.
Section of Emergency Medicine (VanderBurgh, Savage), Division of Clinical Sciences and Human Sciences Division (Dubois), Northern Ontario School of Medicine; Centre for Applied Health Research (Dubois), St. Joseph's Care Group; School of Nursing (Dubois), Faculty of Health and Behavioural Sciences, Lakehead University; Nishnawbe Aski Nation (Binguis), Thunder Bay, Ont.; Windigo First Nations Council (Maxwell); Sioux Lookout First Nations Health Authority (Bocking, Farrell), Sioux Lookout, Ont.; Division of General Surgery (Tien), Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; School of Human Kinetics (Ritchie), Faculty of Health and Centre for Rural and Northern Health Research (Ritchie), Laurentian University, Sudbury, Ont.; Department of Family and Community Medicine (Orkin), University of Toronto; Department of Emergency Medicine (Orkin), St. Joseph's Health Centre and Humber River Hospital, Toronto, Ont.
For about 25 000 Ontarians living in remote northern First Nations communities, seeing a doctor in an emergency department requires flying in an airplane or helicopter. This study describes the demographic and epidemiologic characteristics of patients transported from these communities to access hospital-based emergency medical care.
In this cross-sectional descriptive study, we examined primary medical data on patient transportation from Ornge, the provincial medical air ambulance service provider, for 26 remote Nishnawbe Aski Nation communities in northern Ontario from 2012 to 2016. We described these transports using univariate descriptive statistics.
Over the 5-year study period, 10 538 patients (mean 2107.6 per year) were transported by Ornge from the 26 communities. Transport incidence ranged from 9.2 to 9.5 per 100 on-reserve population per year. Women aged 65 years or more had the highest transport incidence (25.9 per 100). Girls aged 5-9 years had the lowest mean incidence (2.1 per 100). Gastrointestinal issues accounted for 13.3% of transfers. Neurologic issues, respiratory issues and trauma each accounted for about 11% of transfers, and cardiac issues for 9.6%. Patients with obstetric issues accounted for 7.6% of transfers per year, and toxicologic emergencies for 7.5%.
This study provides the epidemiologic foundation to improve emergency care and emergency transport from remote First Nation communities in Ontario.
To explore how birthing and maternity care are understood and valued in a rural community.
Oral history research.
The rural community of Marathon, Ont, with a population of approximately 3500.
A purposive selection of mothers, grandmothers, nurses, physicians, and community leaders in the Marathon medical catchment area.
Interviews were conducted with a purposive sample, employing an oral history research methodology. Interviews were conducted non-anonymously in order to preserve the identity and personhood of participants. Interview transcripts were edited into short narratives. Oral histories offer perspectives and information not revealed in other quantitative or qualitative research methodologies. Narratives re-personalize and humanize medical research by offering researchers and practitioners the opportunity to bear witness to the personal stories affected through medical decision making.
Eleven stand-alone narratives, published in this issue of Canadian Family Physician, form the project's findings. Similar to a literary text or short story, they are intended for personal reflection and interpretation by the reader. Presenting the results of these interviews as narratives requires the reader to participate in the research exercise and take part in listening to these women's voices. The project's narratives will be accessible to readers from academic and non-academic backgrounds and will interest readers in medicine and allied health professions, medical humanities, community development, gender studies, social anthropology and history, and literature.
Sharing personal birthing experiences might inspire others to reevaluate and reconsider birthing practices and services in other communities. Where local maternity services are under threat, Marathon's stories might contribute to understanding the meaning and challenges of local birthing, and the implications of losing maternity services in rural Canada.
Cites: Nurs Inq. 2007 Dec;14(4):266-7818028147
Cites: Can Fam Physician. 2007 Aug;53(8):1268-917872832
Cites: Rev Lat Am Enfermagem. 2008 Mar-Apr;16(2):280-618506348
Cites: BMC Health Serv Res. 2011;11:14721663676
Cites: J Prim Health Care. 2012 Jun;4(2):92-722675691
Cites: Can Fam Physician. 2014 Jan;60(1):e49-5224452578
Cites: Can Fam Physician. 2014 Jan;60(1):e53-624452579
Cites: Can Fam Physician. 2014 Jan;60(1):e57-6024452580
Cites: Can Fam Physician. 2014 Jan;60(1):e61-424452581
Cites: Can Fam Physician. 2014 Jan;60(1):e65-824452582
Cites: Can Fam Physician. 2014 Jan;60(1):e69-7224452583
Cites: Can Fam Physician. 2014 Jan;60(1):e73-624452585
Cites: Can Fam Physician. 2014 Jan;60(1):e77-8024452586
Cites: Can Fam Physician. 2014 Jan;60(1):e81-324452587
Cites: Can Fam Physician. 2014 Jan;60(1):e84-724452588
Cites: CMAJ. 1997 Jun 1;156(11):1593-69176427
Cites: Am J Public Health. 1997 Jan;87(1):85-909065233
Cites: Can Fam Physician. 2014 Jan;60(1):e88-9024452589
Cites: CMAJ. 1998 Jun 2;158(11):1516-79629118
Cites: Can Fam Physician. 1998 Oct;44:2117-249805166