Aboriginal and Torres Strait Islander people are variously described as: continuing to experience higher rates of infant mortality and lower levels of life expectancy compared to non-Indigenous Australians, overrepresented in emergency departments (ED), and more likely to delay their care until their illness is advanced. The provision of culturally safe and quality acute health care in Australian hospital EDs is vital to true reconciliation with Aboriginal and Torres Strait Islander people.

Key Findings/Recommendations:

• Many Aboriginal and Torres Strait Islander people living in rural and remote locations in Australia experience lengthy and complex patient journeys for both emergency and planned care. Care pathways for First Nations people are often clinically complex due to a higher incidence of comorbidities, and also ‘logistically complex because of the vast geographic distances, the number of healthcare locations and extensive travel required’. Over the course of the patient journey, one Aboriginal and Torres Strait Islander person may interact with 50 or more health professionals as they travel from home to hospital and home again with most of these conversations occurring in English.
• An Aboriginal workforce in EDs is vital to facilitating culturally safe interactions between the culture of the ED environment, and the cultural needs of Aboriginal clients, their families and communities. As already mentioned, miscommunication or miscomprehension can have serious consequences in the treatment of Aboriginal and Torres strait Islander people in critical care, especially in cases of end-of -life care.
• This study found communication and comprehension issues between a practitioner and patient to be a key issue leading to unsafe care, often resulting in poor health outcomes for the patient. Cultural training could provide understanding the impact of power relationships and how this impacts upon language used, the abruptness of language patterns and the unequal power dynamics at play between colonial institutions and colonised people.
• Self-reflection could be undertaken by staff on the existence of systemic racism within the ED. There needs to be a shift of the socialisation in health workplaces where people learn and reproduce racialised stereotypes that negatively impact the way physicians treat patients and, in turn, reinforce racialised health care.
• In the emergency room, advocates are asking to expand the role of diagnosing and treating the social determinants of health and wellbeing for all populations. They are advocating for the introduction of Social Emergency Care, an emerging field of practice that can be delivered in concert with emergency medicine, but one that can more appropriately respond to the social and cultural determinants of health.