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Improving healthcare services for First Nations people

28 January 2021

News and media


Doctor working on digital tablet on hospital background

By Carissa Lee Godwin

When some First Nations people present to Emergency Departments, they are especially vulnerable due to the historical trauma they bring with them. Patients needing urgent care suffer from additional stress when medical practices are not culturally safe. A recent report Traumatology talks – black wounds, white stitches, investigates how medical treatment can be improved for First Nations people, as presented by Carissa Lee Godwin, Editor, APO’s First Peoples & Public Policy Collection.

First Nations People in Emergency Departments

First Nations people are often overrepresented in Emergency Departments (EDs), and are more likely to delay their care until their illness is advanced. The Australasian College for Emergency Medicine commissioned Karabena Consulting to outline the challenges that First Nations people face when they require emergency care, and how EDs can be improved to be more accessible for these patients. The report, Traumatology talks – black wounds, white stitches is included in APO’s First Peoples & Public Policy Collection. Although this report is about emergency departments, these reflections and recommendations are relevant to all healthcare for First Nations people.

Highlights from the report

Traumatology is “the study of wounds and injuries caused by accidents or violence and the surgery therapy needed to repair the damage.” The report defines Aboriginal and Torres Strait Islander peoples’ traumatology as intergenerational trauma from genocide, forced separation and associated biological changes exacerbated by such things as re-traumatising events and poor social and cultural determinants of health. The main takeaways in this report:

First Nations people are overrepresented in emergency departments, and often feel culturally unsafe acquiring mainstream health services, and as a result are reluctant to attend.
English is a second or third language for First Nations people living in remote communities and they are often required to travel alone for healthcare. Interpreters are usually unavailable and these patients sometimes need to make significant health decisions alone and far from home.
The report’s literature review shows that the main barrier to providing emergency healthcare to First Nations people is poor cultural awareness and safety. This can result in alienating patients and exacerbating psychological trauma.

Key policy recommendations

The report presents recommendations for policy, but also to create cultural competency training for The Australasian College for Emergency Medicine:

There needs to be trauma-informed practices, understanding, and responding to issues of distrust of non-Indigenous staff. This will be assisted by understanding the social, cultural and historical contexts impacting First Nations peoples’ social and economic conditions.
There is a need for more First Nations staff in EDs. The report states that Aboriginal patients and their families have asked for cultural support at this point in receiving healthcare.
An Australasian College for Emergency Medicine cultural safety research program needs to be established including co-designing care models for people living in remote areas and vulnerable communities and a culturally appropriate outreach emergency services program for people experiencing homelessness.

In addition to this, the report states that introducing Social Emergency Care to emergency medicine could support and promote cultural safety for First Nations patients. Social Emergency Care incorporates social environments and circumstances of patients into emergency department practices and strategies.

Far-reaching benefits

To provide a culturally safe environment there needs to be flexibility allowing for diverse health beliefs and priorities to be incorporated into emergency healthcare. This gives First Nations patients more of a say in how they are treated and have their cultural and personal needs better understood by their emergency practitioner. Positive interpersonal relationships between clinicians and patients can result in better clinical outcomes and communication is a vital part of that. If health services also take the time to establish relationships with the local First Nations communities, there is an opportunity to work together to identify and implement environmental improvements to enhance cultural safety and the general comfort of First Nations people coming into care, as well as for healthcare workers.

As part of its mission to improve Indigenous policy in Australia and Aotearoa-New Zealand, ANZSOG is working to increase knowledge of Indigenous culture and history. Part of this is our support of the Analysis & Policy Observatory’s (APO) First Peoples & Public Policy Collection, launched at our Reimagining Public Administration conference in February 2019.

APO is an open access evidence platform that makes public policy research accessible and usable. It contains more than 40,000 resources, including specialist collections, grey literature reports, articles and data.

The First Peoples & Public Policy Collection is curated from a broad selection of key Indigenous policy topics, and provides a valuable resource on Indigenous affairs, with a focus on diverse Indigenous voices.


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