Solutions subthemes, with illustrative quotations
| Subtheme | Description | Illustrative quotation |
|---|---|---|
| First Nations paramedic perspectives | First Nations paramedics described their unique ability to serve their communities in ways community members value, and the work they do acting as cultural mentors to non–First Nations paramedics | They know they’re going to get the best treatment we can give, and from being down here, we know the language. We know the culture, we know the people, we know the families, the spirituality, and, for myself personally, I bring that on every call I go toward, and people are really open and receptive of that. — P15, First Nation paramedic The community is very supportive of what we’re doing. They’re glad to see one of their Nation members walk through the door. — P15, First Nation paramedic More people, maybe in regard to Calgary zone, need more education in regard to … okay, we have a module out there for Indigenous awareness culture [training]. But I think there needs to be more, because you’re going to get more experience by reaching out to community members, reaching out to our Elders and being like, “What is the right way to interact with First Nations?” I get a lot of questions. — P12, First Nation paramedic |
| Cultural training, paramedic education | Participants described a need for paramedics to better understand First Nations cultures and made suggestions for paramedic education | A recommendation would be to do a different cultural competency training for each territory, for services that are provided in that area. Just to help broaden the knowledge and support for our people when we have to access health care. — P1, First Nation community member We have a module out there for Indigenous awareness culture [training]. But I think there needs to be more, because you’re going to get more experience by reaching out to community members, reaching out to our Elders and being like, “What is the right way to interact with First Nations? I get a lot of questions. — P12, First Nation paramedic The majority of the ambulance paramedics are White. No discrimination, but we do have a different way of treating our people, talking to our people, and delivering service to our people, by our people. — P33, First Nation community member |
| First Nations self-determination | Participants described the importance of First Nations’ determining how their health care services are delivered | I think it goes back to having our own EMS services within our community, because we can have those members that are fluent in our language and even know our members. — P1, First Nation community member We [First Nations ambulance operators] try to align ourselves as closely as we can with Alberta Health Services protocols and guidelines, but, at the same time, we understand the uniqueness of the First Nations field and working on a First Nation where we have that ability to actually change things, to make it better for our clients, which is the people of our First Nations we serve. — P6, First Nations EMS manager |
| Coordination of services | Participants described a need for services to have resources to better coordinate with one another, to better serve First Nations patients and ensure patients receive the services they need | We definitely need more wraparound care, more human resources when it does come to some of these collaborations with resources. Making it stronger because it might sound really cool, really good in a perfect world, but how many people still fall through those gaps in finding those resources? Because you might make that call, but, at the same time, cellphone service. … There are so many different services. Is that like an 8 to 4 kind of thing, too? The hours of services? There needs to be more navigation within those systems, is what I’m trying to say. Which would be beneficial for both health care professionals and the members themselves and our client liaisons; something like that would be really good to see. — P1, First Nation community member We’ve got to do better to make sure that incentives are provided, and that services are at [a given] site so that appropriate services should be delivered. Why should somebody be evacuated via ambulance to get a prescription refill or to get a respiratory issue addressed or a cut addressed or impetigo addressed? — P20, First Nation community member/health care professional |
| New service models | Participants described the possibility of developing new ways of delivering care to improve health care for First Nations members | I know that [the new service model] is something that’s unique for us and that we’re working on, and we’ve done some other really unique stuff for traditional healing. Maybe even a whole different health care model, it could even be that. Trying to change and move those mountains and thinking nothing’s too big. It is lip service from the government. But who’s going to start making these moves? If it is us younger people collaborating with our knowledge holders and other people that provide services, all of those things just streamline the process. It is a heavy, daunting process when you navigate the health system, no doubt about that. It doesn’t matter what it is. Our people are vulnerable at that state when they are sick, and there’s so many different things that come into play when it comes to health care, health determinants, all of those things. — P1, First Nations community member That was one of the things, actually, I was trying to work on there, was to look at a community paramedic being paired with me, and then we could be working on call after hours to deal with those situations [nonemergent cases] … most of those were not emergency situations where the client had to be evacuated. A lot of those were … a sore throat, prescription refill, probably a chest infection. Some of those, they’re not minor, but they need to be addressed. — P20, First Nations community member/health care professional [One possibility is] the new community paramedic program that we’re bringing out here on the Nation, which is going to help take some of that pressure off of the emerg[ency] side of it so that they [paramedics] can handle some of these acute care issues and what have you and, again, free up my EMS units, those truly required units, that I may need to actually do those particular types of calls. …That goes back to running our own type of service. We try to align ourselves, I guess, as closely as we can with Alberta Health Services protocols and guidelines, but at the same time we understand the uniqueness of the First Nation field and working on a First Nation where we have the ability to actually change things, to make it better for our clients, which is the people of the First Nations we serve. — P6, First Nations EMS manager I think [a care model] needs to be very specific to the community and the types of services that are available there. We operate in some communities where there’s a robust public health division or home care service that’s offered as well as emergency services. What is an appropriate access to EMS in that community will be different from a community that has less service. I agree with the comments made … I think it needs to be defined in the context of the community that is relying on the service. — P23, paramedic manager |
| Relationship building | Participants recommended that relationships be developed among First Nations communities and the organizations serving these communities, to facilitate coordination of services and improve patient care | We [First Nations ambulance operators] are grateful to work with people in [name of First Nation health service] and have a strong relationship with home care and with the health centre, and I think that’s important to foster and grow that connection, that EMS is part of a continuum of care, and it’s not simply a transport to the hospital. Our goal is to do a better job of connecting to other services as well. We want to be that conduit to the health centre, to the physicians here in [name of Nation]. — P40, paramedic manager I think a lot of these models out there, when it comes to providing services and care to our members — [name of participant] was saying that being equipped and educated, like, what kind of training is being practised right now? What are the competencies that are lacking within these services? Even if it’s starting there with that kind of work and going out to your closest First Nation territories and working alongside with them and trying to develop something that’s unique. So we can start building that relationship and better the health care in those areas. … That’s where you start to close those gaps and elevate on different resources and supporting those members that are accessing those services to make their experience a lot better and effective for their health outcomes. — P1, First Nation community member |
Note: EMS = emergency medical services.