Title: Exploring Paramedic Care for First Nations in Alberta

Authors: John Taplin, Lea Bill, Ian Blanchard, Cheryl Barnabe, Brian Holroyd, Bonnie Healy, Patrick McLane

Introduction: A greater proportion of First Nations emergency department (ED) visits in Alberta arrive by ambulance than non-First Nations visits. First Nations members face inequities and barriers in accessing primary and acute care. They have reported negative experiences and racism when accessing healthcare. Improved understanding of the barriers and gaps that exist in providing care to First Nations peoples can lead to services designed to address the needs of the communities they serve.

Objective: The objective of this study was to understand First Nations community members’ experiences with paramedic services, and paramedic experiences providing care to First Nations in Alberta.

Methods: This study was conducted on the foundation of building ethical space in partnership with experts in Western and Indigenous research approaches and understandings. Four sharing circles were held in July 2021. Participants included First Nations community members with experience accessing paramedic services, and paramedics with experience serving First Nation members and communities, including First Nations paramedics, and health system leaders. A western thematic approach was used to analyze transcripts of circle discussions.

Results: Forty-four participants attended sharing circles. Major themes identified include racism, system barriers, and solutions. Participants described stereotypes of misuse of paramedic systems and substance use leading to racial discrimination by paramedics and ED staff toward First Nations patients. First Nations providers described facing racism from colleagues and the additional work they do to act as cultural mentors to settler paramedics. Discrimination and lack of options to return home following care sometimes led First Nations patients to avoid care. Lack of alternate care options contributed to accessing paramedic care. Paramedics expressed experiencing moral distress when called on to handle issues outside their scope of practice and when discrimination interferes with patient care. Potential solutions described included First Nations self-determination in paramedic service design, cultural training and education for paramedics, and new paramedicine service models.

Conclusions: First Nations face discrimination and systemic barriers when accessing paramedicine. Potential solutions include the integration of paramedics in expanded health care roles that incorporate First Nations perspectives and address local priorities. First Nations should lead in the design of and priority setting for paramedic services in their communities.