Alcohol Withdrawal Management Nursing Resource

This document outlines clinical measures to be taken if a community member or a family member calls the Nursing Station because someone is experiencing the symptoms of alcohol withdrawal. This resource is intended for a Nurse and is specific to the COVID-19 pandemic. It guides the care between a Nurse who is in a NAN community, and the Physician who is providing medication orders to the nurses to minimize the effects of alcohol withdrawal. 

The Alcohol Withdrawal document refers to two assessment scales, the CIWA-Ar (Clinical Institute Withdrawal Assessment for Alcohol) and the SHOT (severity of symptoms of Sweating, Hallucinations, Orientation & Tremor) scale. The Nurse can use whichever is most familiar. The CIWA-AR is available here and the SHOT is available here. The Physicians who produced this document are Drs Lindsay Hancock and Sharon Cirone, who both work in remote First Nations. NAN thanks them for their efforts.

THIS RESOURCE IS ONLY INTENDED TO BE REFERENCED BY TRAINED, REGISTERED NURSES. The information in this document is not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment. Nishnawbe Aski Nation (NAN) makes no representation and assumes no responsibility for the accuracy of information contained on or available through this resource, and such information is subject to change without notice. Nurses, NAN community members, and the general public are encouraged to confirm any information obtained from or through this resource with other sources, and to review all information regarding any medical condition or treatment with a community physician or other medical professional. NEVER DISREGARD PROFESSIONAL MEDICAL ADVICE OR DELAY SEEKING MEDICAL TREATMENT BECAUSE OF SOMETHING YOU HAVE READ ON OR ACCESSED THROUGH THIS WEBSITE.

Alcohol Withdrawal Management Nursing Resource

Opioid Withdrawal Management Nursing Resource

This document outlines clinical measures to be taken if a community member or a family member calls the Nursing Station because someone is experiencing the symptoms of opioid withdrawal. This resource is intended for a Nurse and is specific to the COVID-19 pandemic. It guides the care between a Nurse who is in a NAN community, and the Physician who is providing medication orders to the nurses to minimize the effects of opioid withdrawal. This document refers to a COWS scale (Clinical Opioid Withdrawal Scale). The Physicians who produced this document are Drs Lindsay Hancock and Sharon Cirone, who both work in remote First Nations. NAN thanks them for their efforts.

THIS RESOURCE IS ONLY INTENDED TO BE REFERENCED BY TRAINED, REGISTERED NURSES. The information in this document is not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment. Nishnawbe Aski Nation (NAN) makes no representation and assumes no responsibility for the accuracy of information contained on or available through this resource, and such information is subject to change without notice. Nurses, NAN community members, and the general public are encouraged to confirm any information obtained from or through this resource with other sources, and to review all information regarding any medical condition or treatment with a community physician or other medical professional. NEVER DISREGARD PROFESSIONAL MEDICAL ADVICE OR DELAY SEEKING MEDICAL TREATMENT BECAUSE OF SOMETHING YOU HAVE READ ON OR ACCESSED THROUGH THIS WEBSITE.

Opioid Withdrawal Management Nursing Resource

NAN COVID-19 Bulletin- October 1, 2020

Nishnawbe Aski Nation (NAN) COVID-19 Update                                                                                                                                           

Thunder Bay District Health UnitTotal Number: 107*
Active Cases: 3
Recovered: 103
Deceased: 1
* TBDHU has stated that they were advised by the province that the first five cases reported in Kasabonika Lake FN would not be considered TBDHU cases for reporting purposes and would not be included in TBDHU’s case counts. However, the sixth case was considered a TBDHU case and is included in this total.
Porcupine Health UnitNumber of cases: 83
Active Cases: 3 (last case reported on September 30)
Recovered: 71
Deceased: 9
Northwestern Health UnitTotal Number: 56 (55 positive test results, 1 probable case)
Active: 6 (last case reported on September 30)
Recovered: 50
Deaths: 0
Public Health Sudbury & DistrictsTotal Number: 108
Active: 2 (last case reported on September 30)
Recovered: 100
Deaths: 2
Timiskaming Health UnitTotal Number: 18**
Active: 2 (last case reported on September 30)
Recovered: 16
Deaths: 0
** On September 28, THU announced that it had removed 3 cases from its official case count, as 3 of the previously announced 19 cases were determined to have home addresses in another health unit. On September 30, 2 positive cases– who have home addresses in THU, but who are currently out of the area and not have resided in THU in some time– were added to the case count. There is no risk of local exposure from the 2 active cases.

NAN GRAND CHIEF UPDATE

  • Yesterday was Orange Shirt Day – NAN acknowledges and honours the Indian Residential School Survivors, those who are still with us, those who never made it home, and their families.
  • NAN Executive acknowledges Muskrat Dam Chief Vernon Morris, who will serve his last day as Chief next week. We thank him for all of the work that he did during his term. NAN also congratulates Wapekeka First Nation Chief Brennan Sainnawap and Wunnumin Lake First Nation Chief Sam Mamakwa on their re-elections this week.

COVID-19 UPDATE

  • There has been an increase in COVID-19 cases across Ontario including NAN communities.
  • We may need to re-evaluate pandemic plans and reinstate preventative measures that were

in place before to ensure the virus doesn’t come into our communities.

  • NAN will ensure the communities that have positive cases receive all the supports that they need. The Task Team has been in regular communication with the pandemic leads in these communities and will continue to support them in the days and weeks ahead.
  • We cannot afford to let our guard down. NAN will continue to support leadership with decision-making and advocate for anything they need.
  • There have been concerns in Thunder Bay as First Nations patients were denied access at Wequedong Lodge because the communities they travelled from had cases of COVID-19. We have been assured that it is being addressed at the board level.
  • The issues surrounding the lack of a public health system in NAN territory has come up multiple times in our planning and response to COVID-19. With the flu season approaching and hopefully a COVID-19 vaccine, communities will need the capacity at the community level to administer these vaccinations.
  • Grand Chief Fiddler participated on the AFN Chiefs Committee on Health and spoke to Dr. Theresa Tam, Chief Public Health Officer for Canada. He reminded her of the lack of a public health system, including human resources in NAN territory.
    • He also asked Dr. Tam for her support in the request for 50 additional nurses for NAN territory, which will be followed up by formal correspondence.
  • Choose Life has been a critical piece in responding to the COVID-19 pandemic, as well as throughout the years that NAN communities have received this funding.
    • Choose Life needs to be made permanent.
    • Currently, two reviews are on-going with teams from Queens University and Lakehead University. These reviews are intended to assist us in our advocacy for permanency of the funding.
    • Communities will be receiving calls, emails, and faxes from these teams. NAN encourages leadership to work closely with their Choose Life Coordinators so that the information included can be as comprehensive as possible.

·       REMINDER: NAN Chiefs Virtual Fall Assembly – October 20/21 – a draft agenda will be circulated tomorrow. Please get back us with any suggestions that you have as soon as possible.

  • PLEASE SEND UPDATED COMMUNITY GUIDELINES and/or RESTRICTIONS TO emergency@nan.ca.

NAN COVID-19 Task Team                                                              

  • In recent weeks, new daily cases of COVID-19 in Ontario have returned to the numbers we saw at the height of the first wave of COVID-19 in the spring.
    • The 700 new cases announced on September 27, set a single-day record high in Ontario, making it clear that the second wave of COVID-19 is here.
  • Ontario released its fall preparedness plan on September 30, as well as modelling that indicates Ontario could see up to 1,000 new cases a day by early October.
  • Northern Ontario is currently seeing scattered cases of COVID-19. This could change quickly, and it is important to continue following measures that have kept us safe thus far.
  • Community members and leadership may feel anxious about medical travel during the second wave, but it is important to continue to access essential healthcare during this time.
  • Community members can take several measures to reduce their risk while travelling.
    • Wear masks on the whole duration of flights, when indoors or in places where physical distancing is impossible, keep 2 metres of space in between themselves and anyone outside of their household, wash or sanitize their hands frequently, avoid touching their face, and minimizes trips outside of where they are staying.
    • Community members should monitor themselves for symptoms of COVID-19 and get tested if any develop.
  • FNIHB representatives joined the Task Team at the September 29 meeting to discuss medication supplies, surge plans, and immunizations.
    • FNIHB has asked nursing stations to order extra medications to avoid supply disruptions that might be caused by lockdowns or flight delays.
    • Dexamethasone, a common anti-inflammatory drug that that may be beneficial for severely ill COVID-19 patients, is on the nursing station formulary and stockpiled in Sioux Lookout for quick deployment to communities if needed.
    • The Task Team emphasized the importance to FNIHB of considering the geography of the North and the difficulty with transporting supplies and accessing care in many NAN communities.
  • The Task Team continues to meet on a weekly basis to advise on and respond to issues relating to the pandemic and can be reached at emergency@nan.ca if you have any questions.

Rapid Testing Update

  • The Task Team continues to monitor developments in COVID-19 rapid testing.
  • The Task Team is working with SLFNHA and the National Microbiology Laboratory to support the rollout of the NML GeneXpert testing program in the SLFNHA region.
    • The supply of testing cartridges remains a challenge. The GeneXpert will only be used for high-priority testing for now.
  • That Task Team is also supporting WAHA’s work with the NML to resolve the licensing requirements that have paused the rollout of GeneXperts in James Bay communities.
  • Health Canada recently approved the Abbott Diagnostics ID Now test and the federal government announced a plan to purchase 7.9 million of these tests.
    • While this is a promising development, this test still needs to be validated by Public Health Ontario. Even if it preforms well, it will take time before all of the tests ordered by Canada are ready for distribution.

We encourage leadership to be vigilant when approached to purchase treatments or testing kits from third party suppliers. If you have questions or concerns please do not hesitate to reach out to the Task Team for guidance.

NAN Hope

  • NAN Hope offers:
    • 24/7 toll-free rapid access to confidential crisis services.
    • Rapid access to clinical and mental health counselling.
    • Navigators who provide connection to existing mental health and addictions support services in home communities and the region.
  • The number of inquiries received by the NAN Hope program continues to increase every week.
  • Last week the program partners sent out materials about the program to band offices, nursing stations, NAPS departments and Northern Stores and will send another shipment of materials this week.

·       Please continue to share NAN Hope with anyone who might need help, from youth to Elders.

  • There are language speakers available through this program.

o   NAN Hope can be accessed through 1-844-NAN-HOPE (1-844-626-4673) and www.nanhope.ca

  NAN Update – DGC Smallboy                                                              

  • Deputy Grand Chief Jason Smallboy provided an update during a meeting last week on the lawsuit that was launched by COO, the lawsuit launched by three NAN First Nations and NAN communities writing their own environmental laws.
    • Deputy Smallboy and his team will develop templates and will be seeking input.
  • A Chiefs Committee on Environmental Climate Change and Impacts on Forestry, mandated from Resolution 19/14: Ensuring Emergency Back-up Power Source Remains in First Nations Communities, is being established. Chiefs are being asked to participate.
    • A Terms of Reference has been drafted and will need approval for ratification by Chiefs- in-Assembly.
    • We encourage you to reach out to DGC Smallboy and his team on these important issues including if you wish to participate in this committee.

Nishnawbe Aski Police Services (NAPS)                                                              

  • All NAPS employees are back to work in office.
  • 6 new police recruits have recently graduated from OPC including one from Attawapiskat First Nation.
  • There are currently 6 recruits at OPC
    • Unfortunately, had to pull back on non-essential courses due to a positive COVID-19 case from an OPC teacher.
  • Deputy Chief Darryl Snider announced good news from funding partners with respect to addressing some of the infrastructure deficiencies at 10 of the NAPS detachments.

Communications                                                              

  • Members of the NAN Executive Council will continue to appear on Wawatay Radio on Tuesday at 12 pm EST and on Friday at 1:05 pm EST.
  • COVID-19 Tools and Resources are being translated into Oji-Cree, Ojibway, and Cree to assist the communities in spreading awareness and public health messaging on COVID-19. They are posted on the NAN website under COVID-19 Tools and Resources.
  • Please send all new and updated community memos, statements, By-Laws, BCR’s and relevant community restriction information to emergency@nan.ca so that NAN and applicable partners can remain aware and respectful of your communities wishes.

·       Please see the Free Online Emergency Management Training Course poster that has been distributed along with this briefing. This is an opportunity for any and all community members to receive training on the Incident Management System (IMS) for use during response to emergencies and coordination with NAN, government and all relevant parties.

Urban Communities                                                              

  • NAN has posted specific information on the NAN website for members living off-reserve in urban centres across northwestern and northeastern Ontario.
    • This includes how to find shelters, food banks, social and mental health services, as well as Indigenous organizations that can assist.
  • Please continue to visit www.nancovid19.ca. It is updated daily with the most current information.

Due to the uptick in COVID-19 activity, we will be going to back to weekly calls with leadership.

NEXT CALL: Thursday, October 8, 2020 | 1p.m. EST | 12p.m. CST

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Free Online Emergency Management Training Course