National Defence Committee on April 3rd, 2008

[LGen Michel Gauthier]

I'll speak from an operational perspective and a command perspective, and then Colonel Bernier can give a sense of his own perspective.

The fact is, as the commander, I have a staff that sifts through all the information that flows. Clearly lots of information flows up and down the chain. They bring me the important nuggets, which either they know I will naturally be interested in or they need my help with to steer things in a certain way.

In this area, I would say I get as much of my information by doing commander things as I do because information flows up; in other words, by going in to visit Afghanistan and talking to soldiers, talking to platoon commanders, company commanders, and battalion commanders, hearing their stories, and going into the Role 3 and the Role 1 and talking to them and getting their sense of how things are going.

In this particular area, the area of operational stress and mental health, we all understand that it's not black and white. It's very grey in terms of the dividing line between what is an injury and what is just normal wear and tear. There are a lot of stresses and strains in-theatre. The troops come together--and General Laroche and I had this conversation in the not-too-distant past--and there is a natural reaction in response to difficult things that happen over there. Elements of that are fear, stress, and various other things. How do they overcome that? At the first level, the immediate level, the team they're part of comes together--and we all understand this well in the military--and they draw strength from that. They, together, find a way to step up and face the next challenge.

There have been very few instances reported to me up the chain in which there's been a red flag--none, in fact, I would say--for a significant issue associated with operational stress that would demand my attention. At the same time, I understand that in that very tough environment, operational stress is high. There are a number of different ways that it needs to be dealt with. Some of them are medical, professional, and technical. Some of them are just soldiers getting together and responding in the right way. Some of them are associated with leadership, and so on.

So there's a rambling answer to your question. I will say that I think I have a good sense of the demands in-theatre, the challenges, and whether or not there are problems on a range of issues, of course. There's a system in place that can let me know if there's a red flag that should be raised and if I need to deal with a specific issue, and we do that regularly.

[The Chair, Conservative, Rick Casson]

You have less than a minute left.

[Laurie Hawn, Conservative, Edmonton Centre, AB]

All right.

[Col Jean-Robert Bernier]

I'll just quickly mention that we have weekly reports of certain types of clinical visits, and that ives us a good idea of what kinds of trends are taking place and where the demands are.

There are multiple daily contacts by the staff to the staff in the Role 3 and the health service support unit, and multiple daily contacts between the unit and General Gauthier's medical advisor, the CEFCOM surgeon. There are visits by staff. The most important thing is, once a week for one to two hours, I'll speak directly by telephone to the CO of the health service support unit, and that gives me a lot.

There's a big pile of other things we do--regular after-action reports--so we have a very good feel of what's going on day to day.

[Laurie Hawn, Conservative, Edmonton Centre, AB]

The focus is on Afghanistan, but there are a lot of other missions, as you said, out there. Are there any other areas of concern coming up from those other missions? We tend to forget them because Afghanistan takes all the attention. Are there any unique sorts of concerns that are coming from any of those other missions?

[The Chair, Conservative, Rick Casson]

If you don't mind, we'll have to get back to that. Time has expired.

That ends the opening seven-minute round. We'll go to five minutes, starting with the official opposition, the government, and then the Bloc.

Mr. Murphy, or whoever, you have five minutes.

[Alan Tonks, Liberal, York South—Weston, ON]

I have a very quick question. It's pursuant to the reports you receive and any flags that come up. With respect to post-traumatic stress disorder, you've gone over very carefully the psychiatric and occupational medical practice routine in your overview. Have any flags gone up with respect to the inordinately high use of drugs in the psychiatric treatment of stress disorder?

[Col Jean-Robert Bernier]

I'm not aware of anything related to an inordinately high rate of drug use.

You're speaking of in-theatre use?

[Alan Tonks, Liberal, York South—Weston, ON]

Yes, in the treatment regimen.

I underscore this question, Mr. Chairman, just from a very peripheral knowledge of how post-traumatic disorders are treated, that there have been issues raised in civilian life today with respect to everything from the treatment of Down's Syndrome—and wrong treatments, in some cases—to nursing homes. There's this capacity, it seems, to rely too heavily on drugs. I was interested if this had a relationship to treatment at home, and the implications of it, because I can just imagine the pressures our forces are under. I just wondered if the military was flagging this issue, because this does have some inherent other issues associated with it.

[Col Jean-Robert Bernier]

We have not detected any problem with excessive prescription of drugs. All of our practices are evidence-based; whatever use of drugs occurs is based on good evidence.

In particular, in our circumstance, there's a very selective use of drugs because of the potential side effects and the potential for occupational impact. So we have an even greater incentive than most to ensure that we minimize the use of drugs in the treatment of our casualties.

Everything we do, everything our mental staff does, is based on best practices, supported by evidence.

[The Chair, Conservative, Rick Casson]

Mr. Murphy, for five minutes.

[Shawn Murphy, Liberal, Charlottetown, PE]

I have one question involving the whole issue of the increased use of reservists.

Bear in mind that I'm not a regular member of the committee, but I do have a significant number of military families in my community. In all my experience, I've never heard any complaints or concerns about the medical treatment in-theatre. Your testimony today I think supports that, and you are to be congratulated. Of course, we as Canadians would not expect anything less, and we are proud of it.

But the situation I see on the ground is that the men and women who are coming back—and probably significantly more among the reserves than the regular forces—are not adjusting well on their return to society. They don't make a self-diagnosis when they come back; it usually comes from their partner or, more likely, from their parents that the person is not adjusting well. Sometimes a job is lost or there are alcohol issues, or just adjustment issues.

In a lot of cases they're disappointed with the follow-up treatment from the Department of National Defence. I know this is not within your bailiwick, but going forward, because we're obviously going to be in-theatre for another couple of years anyway—three years—do we run the risk of having more reservists with this problem and much more severely than now?

I'm making a comparison between a reservist who perhaps was an accounting clerk and goes into theatre for six months and comes back, but doesn't adjust, as opposed to a career force member who perhaps doesn't experience the same level of readjustment coming back to Canada—and I don't know this; that's why I'm looking for your advice.

That's what the situation is on the ground, speaking as a member of Parliament, but in-theatre, I've never heard anything but compliments.

[The Chair, Conservative, Rick Casson]

I'm sorry, you only have a minute or so to respond. I apologize.

[LGen Michel Gauthier]

I can't comment; it's certainly outside my focus.

[Col Jean-Robert Bernier]

I would just mention that we have recognized for a long time that there's a difference in social support, because they are taken away from the unit and the troops they are deployed with, so there are fewer supports in their home units when they get back to their home towns. So they don't get as much benefit from peer support as regular force members would, and there is the issue of the distance of access.

But there are outreach efforts that we're making, and we're progressively increasing them. I'm not sure if CMP has mentioned any of them, but I know some of them have been publicly mentioned, including the possibility of establishing enhanced outreach through link nurses with reserve field ambulances or medical companies to increase their ability to stay on top of these individuals and their problems, and to enhance and remove barriers to their access to Canadian Forces treatment should they need it.

[The Chair, Conservative, Rick Casson]

Ms. Gallant, and then back over to Mr. Bouchard.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

Thank you, Mr. Chair.

Through you to our witnesses, what are the top three injuries suffered by soldiers deployed to Afghanistan? I mean serious injuries, not blisters or twisted ankles.

[Col Jean-Robert Bernier]

It depends on the phase of the operation and what rotation has occurred. It has been different with each one.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

Okay, IED casualties.

[Col Jean-Robert Bernier]

Currently, for example, because of IEDs, the greatest burden has been lower leg, pelvic, and head injuries.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

Thank you.

What I would like to see is a graph, a bar graph, with the most common injuries along the X axis—dismemberment, above the leg, below the knee, arms, hands, and so on—and then on the Y axis, the number of incidents, just so that we have an idea of the types of injuries.

You mentioned the pelvic area and the leg area for IED injuries. I understand that some of the forces have a special groin protector. In other militaries, that's part of their normal kit. Is there a program or a project under way to procure these groin protectors for our army personnel in theatre?

[LGen Michel Gauthier]

The short answer is yes. You could get more details of that from the army. The commander of the army could speak to that. Or we can get you that information.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

Are they being issued now?

[LGen Michel Gauthier]

The last time I was in-theatre, I was told they were just being introduced.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

Introduced in the trial stage?