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Quebec’s air ambulance policy separating kids from parents reeks of paternalism

"Barbarous," "untenable," "cruel" – just some of the epithets pediatricians are using to describe the Quebec government practice of denying parents the ability to accompany their children when they require medical evacuations from remote northern communities.

No parent – nay, no one with even half a heart – can be unmoved and outraged by the idea of a gravely ill child being whisked hundreds of kilometres away while their mother or father is left behind, not knowing if the child will live or die.

"Without his Mom. Alone in the air, his little brain stopped working. I never had the chance to say goodbye. When I finally arrived, it was too late," Catherine Hudon wrote in a heart-wrenching letter published in La Presse.

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An air ambulance was required to transport her almost three-year-old son, Matteo, from the remote Cree community of Chisasibi to Montreal. She was left at the airport, scrambling to find a commercial flight. In the 12 hours they were separated, Matteo's condition deteriorated and he suffered brain death.

Stories like this are legion.

Yet, Évacuation aéromédicales du Québec (ÉVAQ), the agency responsible for medical transport, essentially shrugs its shoulders and says the rules are the rules.

Dr. Samir Shaheen-Hussain and colleagues at Montreal Children's Hospital blew the whistle on this bureaucratic perversity a couple of weeks ago in a stinging letter to the Ministry of Health. They were compelled to speak out after witnessing distraught parents chasing planes down the runway, trying to console inconsolable children and having to make life-or-death decisions without parents present.

While the "no parent" policy applies to all of Quebec, it is largely First Nations and Inuit families who are affected. Last year alone, the Children's Hospital treated 219 children from fly-in communities in Nunavik (Inuit territory) and 146 children from remote Cree communities.

It is standard practice for air ambulance teams across Canada to not only allow but encourage a parent or loved one to accompany patients on urgent air transfers. They do so not just because it's the humane thing to do but because there is clear evidence that having family members present results in better outcomes for critically ill children.

While this issue has made headlines in Quebec in recent weeks, the government has insisted the policy is for everyone's good and not changeable.

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Health Minister Gaétan Barrette said he sympathizes with the plight of families, but there is simply no room for parents on medical evacuation aircraft because of the way they are configured. (The Challenger aircrafts feature three stretchers, an incubator and other medical equipment.)

That is a pretty lame excuse.

First of all, while space is at a premium in the rare instances when the plane is full, a blanket ban is not justified. Secondly, if there's no room in the air ambulance for the people who should be there, then clearly it's the wrong aircraft for the job. Thirdly, there are few travel alternatives for distraught parents; it can sometimes be several days between commercial flights, not to mention the exorbitant costs of travel in the North.

This policy reeks of paternalism hiding behind a veneer of safety and efficiency.

Air ambulances and helicopters and ground ambulances all across the country manage to squeeze in parents when they are transporting babies and children. The only time they don't is when there are multiple casualties, as weight restrictions would put the flight at risk.

"Separating a child from their parent when they are frightened, hurt or when they may be at risk of dying is cruel," said Catherine Farrell, president-elect of the Canadian Paediatric Society.

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It is doubly cruel given the sordid history of Indigenous children ripped from their communities and sent to residential schools, to adoptive families in the Sixties Scoop and to foster care today. Leaving parents behind is rife with historical baggage.

This is not a new issue. Residents of Cree and Inuit communities in Quebec's Nunavik region have been complaining about the "no accompaniment" rule for almost three decades. That they have been ignored is a reminder of how treating Indigenous people as second-class citizens is ingrained in our public policies.

The reconciliation process requires not only that we recognize this but that we make a concerted effort to correct these daily indignities that First Nations, Inuit and Métis people have had to put up with for too long.

We can no longer tolerate pathetic justifications for cruel inequity the way Quebec has done.

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