Guidance for health professionals considering travel to First Nations Communities to provide services
Target Audience:
Community leadership, employers of health professionals, and health professionals.
Health professionals include, but are not limited to, nurses, environmental public health officers, mental wellness workers, dentists, and oral health care workers.
Background:
The COVID-19 global pandemic is an unprecedented situation that continues to evolve. First Nations and Indigenous Services Canada (ISC) is faced with numerous challenges in the safe delivery of health services in First Nations communities. ISC is committed to working continuously with communities, staff and service delivery partners to ensure access to needed health services for community members, while minimizing risks.
Many First Nations communities are vulnerable to infectious disease outbreaks, a result of social, environmental and economic factors such as inadequate housing, food insecurity, and pre-existing health conditions. The remoteness and isolation of some communities may serve as a barrier to prevent importation of the COVID-19 virus. However, if introduction of the virus occurs, a serious outbreak can quickly develop. The threats from an outbreak in a remote community can be disproportionate to the size of the community. Many First Nations communities have adopted strategies to prevent the introduction of COVID-19, e.g., by restricting all non-essential travel in and out of the community.
The risks to a community from health professionals travelling into the community to provide services may vary depending on: the nature of the service; client vulnerability; ability to implement risk mitigation strategies (e.g. infection prevention and control practices); and the incidence of COVID-19 in the area where the health professional comes from. These risks should be weighed against the risk of clients being exposed to the virus during travel out of community or at their final destination to receive these services.
FNIHB has implemented Directives for Nurses and Environmental Public Health Officers employed by ISC. However, First Nation communities, particularly those that are remote and isolated, often receive health services from other local, regional, provincial or private health organizations that have historically provided in-person services.
Purpose:
This guidance is intended to provide general advice to First Nation communities, employers of health professionals, and health professionals travelling into First Nations communities, to help minimize risks of COVID-19 transmission. This guidance is not intended to address all situations and communities are encouraged to assess and consider all potential risks and factors unique to their needs and circumstances.
Procedures:
The community and health professionals should use alternate service delivery approaches whenever possible, before considering in-person delivery.
See ANNEX A: Guidance for Communities and Health Professionals Considering Travel to Communities to Provide Services – Decision Tree.
Decisions should be risk informed. Please refer to the Public Health Agency of Canada’s Risk-informed decision-making guidelines for workplaces and businesses during the COVID-19 pandemic https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/guidance-documents/risk-informed-decision-making-workplaces-businesses-covid-19-pandemic.html
Decisions should be based on current public health situations and community specific considerations, as advised by local public health authorities.
All health professionals and their employers are responsible for:
Ensuring occupational health and safety practices are followed and ensuring infection prevention and control practices within their workplace/context align with local public health authority recommendations;
Being familiar with, and abiding by, the applicable Federal/Provincial/Territorial and professional college/regulatory body requirements and any additional community requirements governing service provision.
In addition, health professionals should always self-screen before going into communities. This includes prior to travel and during their visit in First Nations communities. If they have symptoms, they should not go into First Nations communities.
ISC has shared the following Directives with ISC and First Nations Health Authority Directors of Nursing:
UPDATED Healthcare Professional Self- Screening of COVID-19 Symptoms and Exposure During Assignment in First Nations Communities.
UPDATED Self-Screening for COVID-19 All Healthcare Professionals Prior to Assignment intro First Nation Communities
If not provided along with guidance, the above Directives are available through the Regional Nursing offices.
While in the community and in the workplace, all health professionals should limit their contact with community members and others (e.g., contractors and other health providers) and maintain physical distancing of 2 meters (6 feet). Where physical distancing is not practicable, a non-medical mask must be worn. While in the workplace, continue to use appropriate PPE for the task being conducted. Carry an adequate supply of PPE.
ANNEX A: Guidance for health professionals considering travel to First Nations Communities to provide services – DECISION TREE IMPORTANT CONSIDERATIONS:
Air travel: A person who cannot self-isolate for 14 days prior to travel CANNOT use the ISC Collaborative Air Response Endeavour (ISC CARE) regularly scheduled charters for essential service providers. Guidance in this regard is available through ISC CARE.
Sickness while in community: Health professionals should establish a self-isolation plan with communities in case they become ill while in the community.