Emergency department encounters’ impacts on First Nations members, families and communities: Results of a thematic analysis of sharing circles in three treaty areas

First Nations are subject to ongoing colonialism in Canada, including within healthcare. Emergency departments serve a gatekeeping function in healthcare as patients are assessed for immediate assistance, admission to further care or discharge from acute care. They are also among the care settings where racism is most reported. This study draws on accounts of emergency care provided by 41 First Nations community members, 2 non-Indigenous providers invited to participate by their communities, and 4 First Nations health directors. Theoretically informed thematic analysis reveals First Nations members' experiences of being treated as illegitimate patients, discredited, and excluded from care. First Nations participants discussed their awareness that interactions with providers would be shaped by providers’ perceptions of their race. They disclosed the ways emergency care encounters caused lasting personal suffering and negatively impacted their families and communities. We argue that emergency care must be assessed in terms of long-term impacts of emergency care encounters. Findings and conclusions may be useful to providers and health system leaders interested in healthcare equity. Additionally, the work will be of interest to scholars of racism and social exclusion, insofar as the emergency department provides stark insights into everyday practices by which racial hierarchies and harms are enacted.