Racism subthemes, with illustrative quotations
| Subtheme | Description | Illustrative quotation |
|---|---|---|
| Stereotyping | ||
| Perceived misuse of EMS | Community members, health care leaders and paramedics identified a stereotype of First Nations community members’ requesting 9-1-1 for nonhealth or nonemergent needs, and frequently described this as “misuse” of EMS | I think there is also a poor relationship with patients when they’re viewed to have misused the system in the view of the paramedic. I don’t think that’s all that uncommon of an occurrence, unfortunately, and it’s not necessarily just the bad practitioners that do that. — P14, community paramedic There are preconceived notions and there are shorter temperaments surrounding First Nations communities because of what some would view as an inappropriate use of an ambulance service, like going to get your prescription refilled. I know that can be frustrating for practitioners old and new. Ultimately, we can’t deny you care. We can’t tell you “No, you’re not allowed to come in the ambulance,” and I don’t know that we are capable of always making that decision. — P19, paramedic It [utilizing paramedic services for access to primary care] is ultimately a misuse of the ambulance service because we are an emergency service. With them [First Nations community members] calling, they know somebody’s going to come and somebody is going to check [their] blood pressure and somebody’s going to talk to [them]. — P19, paramedic |
| Substance use | First Nations community members identified instances when paramedics and health care professionals held stereotypes of First Nations patients as substance-using, in ways that affect care | My children’s father had to deal with the racist part of EMS and paramedics. This is a man who doesn’t like to take medication whatsoever for anything. He was experiencing quite a bit of pain, enough that we had to phone the ambulance, and he was labelled as drug-seeking. The ambulance didn’t take him, they left him. — P28, First Nation community member With my parents being elderly, there’s those misconceptions of why they’re at the health centre or in emergency — it’s assumed they would just want opioids. No, both my parents don’t take opioids, and that’s the first thing they’re offered. “Here. Okay. Here’s your prescription. You can go.” But it doesn’t help the problem and get them to further medical treatment for their diagnosis or really find what’s wrong with them. I find it’s “push them out fast” kind of thing, but yet if it was anybody else, that next person down the road, they are talked to in a different way, they’re treated in a different way. A lot of our people aren’t going to look like some of the other society or what they [providers] want them to look like. But they’re comfortable with themselves. Yet we’re looked at as … poor bums or whatnot. We have a lot of those issues. When you come into the health care centres, the racism, there’s no way around that. — P1, First Nation community member |
| Discrimination | Participants shared instances when First Nations experienced race-based negative treatment from paramedics when receiving care | I know sometimes I get treated really good by ambulance, and there’s other times I don’t get treated right because they [paramedics] are not talking to me right. I really feel confused or misunderstood in regard to what it is I’m wanting. Am I just somebody that’s giving them money from Indian Affairs, and nobody gives a hoot about it? — P32, First Nation community member I think, unfortunately, there’s overt racism where people, all they see is the assumptions that they came in with. They don’t see the patient for who she is or who he is, and they’re just filling in the blanks already; they’re enforcing a narrative on them and they’re acting accordingly. They’re not listening. They’re not taking in anything from the patient. … [They’re] not seeing, or [they’re] not listening to what [the patient] is telling you they need; [they’re] not being responsive to that. [They’re] replicating that imbalance in the system where [the patient] doesn’t have access to care any other way at that moment, other than the 9-1-1 system. [They’re] professionally acting in a way that reinforces that barrier, that [patients] are up against. — P14, community paramedic |
| Discrimination at transition to ED care | Paramedics reported that, when First Nations community members are transported to hospital and care is transferred from paramedics to the ED, the patients often face discrimination by ED providers | [At] some of the hospitals in the south, the common comments were “Oh, [the patient] is drunk, how come you’re bringing them here? They’re just drunk.” Well, how do you know they’re just drunk? Did you just spend the last 40 minutes with them in the ambulance, do you know their history? Were they drinking? Do they drink? A lot of the Elders don’t drink. Everything is always a preconceived notion in the south. — P4, EMS manager When I brought my patient in, I’m giving a report to the nurse, and I mentioned … alcohol was on board. They [emergency department providers] just chatter amongst us, not even caring who was around or where the patient is. And it’s just “Oh yeah, I told you so,” telling the other nurse. Like, why are you doing that in front of me, first of all, and the patient is right there. — P12, First Nation paramedic To say that we don’t see a different treatment for the Indigenous population would be a lie. Bringing patients into hospitals and not being Indigenous, you would see the different reactions from the health care providers in the hospitals. It’s very disturbing, because I was always taught that everyone’s state of emergency is different, and we don’t judge it. If [you] feel they need to go into the hospital, you bring them into the hospital. — P4, First Nation EMS manager |
| Racism toward First Nations providers | First Nations providers described experiencing racism and its impacts on them | I’m obviously First Nations, but walking down the hallways with EMS crews — doesn’t matter which hospital it’s at … 95% of the time, the practitioners in the city will continue to see me as something at the bottom of their shoe. It was the same yesterday. It’s going to be the same today. It’s people’s own personal perspectives, and racism is still rampant in the health care system. That’s a struggle day by day. — P15, First Nation paramedic I’m even racist to myself almost. … You have that ingrained idea that you’re probably not really that special anyway, so what the heck? … I’ll just grin and bear it, and we’ll just get along in this society. — P20, community member/health care professional |
Note: ED = emergency department, EMS = emergency medical services.