Inspiration for the rural emergency program
After developing a keen interest in rural emergency medicine during his residency, Dr. Richard Fleet accepted an invitation to direct the emergency department at Kootenay Lake Hospital, in Nelson, British Columbia (2006-2010).
With a population of over 9000, Nelson is nicknamed “Queen City” and is known for an impressive number of restored buildings that are part of the region’s heritage. The town is in southeastern BC at the end of the eastern arm of Kootenay Lake, surrounded by the Selkirk Mountains. It is known as a cultural centre and tourism is its main industry.
Kootenay Lake Hospital has 30 short-term beds and serves a population of about 30,000 people. Its emergency department receives 13,000 people per year. A single physician is on call 24 hours a day, seven days a week. No specialists are permanently available, although gynecologist-obstetriticans and pediatricians are available three days a week.
In 2002, the government closed several hospitals and reduced services in others. The general surgery department and intensive care unit at Kootenay Lake Hospital were closed. Services were transferred to Kootenay Boundary Regional Hospital in Trail, BC, 73 km away and a journey of 75 minutes under ideal conditions. These cuts resulted in an increase in emergency transfers to this hospital. In addition, the closest tertiary care trauma unit is at Kelowna (447 km) or Vancouver (662 km). The numerous challenges of practising rural emergency medicine under these conditions were the inspiration for the Chair’s research program.
In 2010, a paper on patient advocacy in Nelson was presented at the Canadian Association of Emergency Physicians (CAEP) conference (see Abstract 156 ).