Thank you very much, Mr. Chair and honourable members. I will try to keep my remarks relatively short and stick to the comments I have in front of me. I can't guarantee the same approach to answers to questions, of course. We'll see how that works out.
Good afternoon.
I am pleased to have this opportunity to speak with you about Canadian Forces health services in support of deployed operations.
As you know, as Commander, Canadian Expeditionary Force Command, I am responsible for all Canadian Forces personnel deployed on international missions. I take strategic direction from the Chief of Defence Staff, produce plans, and oversee the resulting operations. In current Canadian Forces language, I am a Force Employer. The Force Generators, most notably the Navy, Army and Air Force, have the task of producing, equipping and making ready their personnel for both domestic and international assignments. These are then assigned under my operational command while employed overseas consistent with direction provided by or on behalf of the CDS.
Currently, there are a total of 16 overseas missions, involving roughly 3,000 Canadian Forces personnel, both regular and reserve. Overseas missions have varied widely in the past several years. They have included traditional peacekeeping, maritime interdiction, evacuation of non-combatants, and humanitarian assistance. The missions vary widely in terms of local conditions, but, in general, all assigned personnel serve in environments that pose heightened personal risk and hardship.
Clearly, the Canadian Forces' largest, highest profile, and most demanding mission is the one in Afghanistan. This mission is not as large as some of the missions of the past 15 years, notably the mission in Bosnia at its height. But it is clearly the most intense, in that it involves counter-insurgency operations against the determined enemy. Of course, this means our personnel in Afghanistan experience psychological stresses associated with physical hardship, violence, and danger on a significant scale.
Command authority over personnel during periods when they're undergoing mission-specific training prior to deployment rests with the appropriate force generator, principally, commander of the army, commander of the navy, and commander of the air force. It also reverts back to them, of course, once these forces arrive home for recuperation and preparation to resume their normal duties. Therefore, I will focus my remarks on how I discharge my command responsibilities for the provision of health services to personnel deployed overseas and concentrate on Afghanistan, the largest effort.
For any potential overseas task, CEFCOM conducts an analysis process to determine the composition and size of forces necessary in relation to the assessed operating environment, the mission, tasks, and the concept of operations. Force protection, logistics support, and health care requirements are all specific red-line imperatives for which the CDS must be satisfied that the deploying force has what it needs to assure mission accomplishment.
As the mission evolves, force composition is scrutinized in great detail between ourselves and force generators every six months to ensure it remains relevant and appropriate to the mission requirements. Likewise, through a relatively robust lessons learned framework, lessons are captured on a continuing basis in-theatre and analysed by force generators to adapt and improve doctrine, equipment, training, and operating methods for those deploying on future rotations in a very dynamic way.
In Afghanistan, our medical and dental presence is the most comprehensive we have deployed since the Gulf War, with a total of 166 health service personnel, a small number of civilian contracted clinical augmentees and a further 21 in direct support at other forward locations. A tiered system, based on progressively larger and more diversified levels of care, addresses the needs of our in-theatre personnel inside and outside the wire.
At the basic level, all troops are Combat First Aid qualified and able to provide immediate rudimentary care. Many are trained to a more specialized standard of Tactical Combat Casualty Care. Though clinically non-professional, these individuals provide an initial and potentially critical first response. The first level of professional medical expertise is defined as role 1. At this level, medical technicians, the equivalent of civilian paramedics, deploy on high-risk patrols and provide emergency stabilization in situ. Role 1 also includes physician assistants and medical officers at forward operating bases providing routine medical care and care beyond the scope of a medical technician. This ability to provide urgent initial treatment is extremely important to increasing survival chances and more complete recovery.
Where the seriousness of the injury requires more complex care, the patient is rapidly evacuated to our Role 3 medical facility in Kandahar, which is capable of surgical and other specialist interventions. This world-class facility, which I believe a number of you have seen, is multinational in composition, but is led and predominantly staffed by Canadian Forces personnel. Through the skilful and dedicated application of modern battlefield medicine, these individuals have saved many lives. I make a point of visiting the Role 3 facility just about every time I go into theatre.
Patients whose conditions are serious enough to preclude continued involvement in the mission are repatriated to Canada after undergoing a limited period of advanced care and stabilization at the United States military's Landstuhl Regional Medical Center in Germany, another world-class facility, where a number of Canadian lives have been saved.
With over 20 visits into theatre now over the last six years, I have a very positive view of the health support foundation we have in place in Afghanistan, in terms of health care professionals, trained soldiers, and a chain of command that's absolutely seized with the importance of looking after our men and women. I believe our soldiers have a strong sense of confidence that wherever they happen to be in harm's way, they will be looked after quickly and with the best of care.
In addition to the physical injuries our personnel can sustain, those related to operational stress receive equal attention and commitment of resources. I can assure you that leaders at all levels of the chain of command, from the section or crew level right up to the chief of defence staff, are acutely aware of the high-risk character of operations in Afghanistan and are absolutely mindful of their responsibility to ensure that the necessary in-theatre support framework is in place and the units, as coherent teams and as individuals, are as well prepared as they can be to face the associated challenges.
In this whole area, the Canadian Forces in general has made significant strides in the past decade, in that operational stress injuries are increasingly viewed in the same context as physical ones.
During force generator-conducted pre-deployment training, every effort is made to simulate, as realistically as possible, the conditions under which our troops will operate. Knowing what to expect can enhance an individual's ability to cope with stressful situations. But the training also includes educating leaders at all levels to detect signs of undue stress and pressure in their subordinates and means of providing support and referring to professional mental health workers who are part of our health services component in-theatre.
Once referred, patients are carefully screened to determine if treatment is required and, if so, whether that level of treatment would restrict them from continuing the mission. These assessments are only made by competent clinical professionals, while keeping the chain of command apprised of any consequent employment limitations and patient requirements. You will hear more from Colonel Bernier about the health services infrastructure in-theatre as it relates to mental health.
I would simply add to this that the first layer of both response and protection is the team that surrounds each soldier, whether it's a vehicle crew or an infantry section, together with the leaders at each level, all of whom see themselves as having a central role to play in looking after each other.
Under my direction, an interim post-deployment decompression activity is an integral part of the return process for all deployed personnel. The purpose of this program is best thought of as an inoculation against reintegration stress by providing an interim venue between the dangerous, fast-paced, rigid structure of the combat theatre, and the domestic home environment. Designed to provide a positive environment away from the pressures of the operational treater, troops are able to socialize, relax, reflect on their experiences and receive educational briefings on stress-related injuries. This process has been well received by our personnel, though the true measure of its effectiveness will only be apparent over time.
With respect to health issues in general, and mental health issues in particular, information is maintained by our CF health care professionals, and it is analyzed and discussed with the operational chain of command as appropriate.
In my experience of a bit more than two years of commanding operations in Afghanistan, I can say that operational stress injuries have not been identified by any of the three theatre commanders--General Fraser and then General Grant and then General Laroche--at any time as having either a detrimental effect on operations or in posing them with a challenge that was beyond their capacity to handle. The most obvious indicator of mental health issues adversely affecting operations would be the number of personnel who need to be repatriated from theatre for operational stress-related injuries. So far these numbers have been extremely low. It is indicative of the success of our mental health provider footprint and pre-deployment training.
From a very practical point of view, the health and well-being of our people is essential to mission accomplishment. Naturally, confidence in our ability to provide necessary health care is an important contributor to strong morale among deployed forces.
Finally, there's a much more general principle in the ethos of military leadership that exercising diligent care for those under one's command is a moral and ethical necessity and commitment, especially in light of the acceptance of ultimate risk that those individuals have taken.
As commander responsible for the mission in Afghanistan and other deployed forces, I'm confident that our personnel who are deployed in harm's way are receiving an excellent standard of attention and care. Given the challenges they face in Afghanistan in particular, they deserve nothing less.
I'd be happy to take any of your questions, though I caution that I'll defer to Colonel Bernier on matters of a specific medical nature. Of course, I'll hold off on answering your questions until Colonel Bernier has spoken.
