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Introduction: Our national study of rural EDs showed they have limited access to CT scans, ICU, and most specialities, while Level 1 and Level 2 trauma centers are on average 300 km away. However, equivalent information on Northern/remote EDs is scarce. Objectives: This pilot study aimed to: 1) describe local access to services; and 2) mobilize citizens, decision-makers and healthcare professionals to envisage solutions to improving emergency care in a Northern/remote hospital. Methods: This descriptive, qualitative study was performed in a northern ED in Quebec. The head nurse received a prevalidated questionnaire about access to specific services, ED and patient characteristics (Objective 1). Focus groups (5) and individual interviews (11) were conducted with citizens/patients, decision-makers, physicians, nurses, paramedics, pharmacists, and mental health workers (Objective 2). Descriptive statistics are reported as means, medians and percentages for Objective 1. A thematic analysis was conducted for Objective 2. Results: Objective 1: The city (population 2875) is a mining community 962 km from Quebec City. The 2010 annual ED census was 6692. Proportions of patient visits at triage levels 1-5 were 0.2%, 3.2%, 13.4%, 25.4% and 56.7% respectively. The ED was staffed by one physician and two nurses per shift. The hospital had 24/7 access to basic X-ray and laboratory but no local access to speciality care, ICU, CT scan or ultrasound, with nearest services 28 km away. Objective 2: Analysis of qualitative data highlighted concerns for personal safety; telecommunication problems; lengthy transports; limited access to in-service training, advanced imaging, and consultants; and recruitment and retention difficulties. Solutions included pre-hospital training, telemedicine, protocols, and networking with academic centers/medical schools, North Shore colleagues, and Labrador City Hospital. Conclusion: This isolated northern ED has limited access to services. Valuable qualitative information obtained enabled us to better understand the challenges and explore solutions towards improving Northern/remote emergency care.
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