National Defence Committee on March 27th, 2013

[Col Homer Tien]

The study that I quoted, about two deaths out of 63, was actually in the first 20 months of the war. In fact, it's important to realize that almost all the deaths that occurred from Kandahar occurred in the pre-hospital setting. The tactical combat casualty care that we had implemented, which is a pre-hospital way of caring for patients, was actually well entrenched at that time already. The use of tourniquets was probably the most life-saving. So for that reason I think there wasn't a huge change in the potentially preventable death rate. I think it was quite low right at the outset; that's what our study showed. There was little room for improvement in the pre-hospital death rate.

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

In addition to the Department of National Defence physicians and doctors, there were also civilian doctors, as you mentioned. How did you find the integration of the civilian doctors into theatre at the Role 3?

[Col Homer Tien]

I can speak only to my own experience on that. I thought it was very smooth. It helped that the trauma and the specialist community in Canada is actually fairly small. The people I deployed with were people I knew from the academic environment in Canada anyway, so it was very easy to integrate them. They realized that they did not know the military environment and would obviously take guidance in that part, but what they did know was how to look after critically injured patients.

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

The chair mentioned that you were posted to base Petawawa. When you were there, how did you keep up your skills? Did you work at a local hospital?

[Col Homer Tien]

Yes. While I was there I did shifts in the emergency departments at various hospitals in the Ottawa Valley.

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

How did you find the difference in injuries from the time you were posted to Bosnia versus what you saw in Afghanistan?

[Col Homer Tien]

There was very little comparison in terms of the sheer number of injuries. Obviously, in Bosnia, thank goodness, there weren't too many Canadian casualties. Also, in terms of the mechanism, there were no blast injuries—at least when I was deployed there. It was mostly road traffic accidents and the occasional gunshot wound, whereas the norm in Kandahar was severe blast injuries and gunshot wounds.

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

In your opinion, do you feel there is enough treatment and care, and are there enough programs, to take care of our ill and injured?

[Col Homer Tien]

If you're referring to programs or care for the ill and injured acutely, I think so. And this is what I do.

I can compare to a level one trauma standard in Toronto, where I work; you have to understand that when you're at Sunnybrook, it's Canada's largest and first trauma centre, but we do other things, including cancer care, so the resources are divided.

At the Role 3, the whole focus was on providing trauma care to injured Canadian soldiers, so everything happened quickly. We had very quick access to resources that I sometimes wish I could have on the civilian side.

[The Chair, Conservative, James Bezan]

Thank you, Ms. Gallant. Your time has expired.

Mr. McKay, you have five minutes.

[John McKay, Liberal, Scarborough—Guildwood, ON]

Okay. Thanks very much. I apologize for not being here earlier.

When we were at Downsview, we were exposed to some interesting research, particularly with respect to a computer system that would give you an in-the-field diagnosis. I frankly don't know how far advanced the research is or was, and I don't know whether they are going to be affected by the budget cuts.

I wonder whether you've had any exposure to that research, because it does seem to me that it fits directly within your field of interest and expertise.

[Col Homer Tien]

It does, and I've actually been involved with that project, if it's the same project that I'm thinking about. This is a project on automated ultrasound diagnosis in the field. The researcher is trying to come up with an algorithm for looking for specific diagnoses in the field.

It can take years to train a radiologist to interpret an ultrasound. You don't have that luxury with a combat medical technician. If we can deploy an automated diagnosis system to the field, that might help that combat medic.

[John McKay, Liberal, Scarborough—Guildwood, ON]

It seems to me to fit within the conversation that has been going on as to, “Do you still need doctors?”

[Voices]

Oh, oh!

[John McKay, Liberal, Scarborough—Guildwood, ON]

I think it's in New York, but I'm not absolutely certain, that they're working on loading Watson—that's the name of the computer—with a whole range of potential diagnoses so that the diagnosis is far more accurate and done far more quickly.

It seemed to me that what they were doing at Downsview was kind of a precursor of that. Am I correct about that?

[Col Homer Tien]

I can't say. I'm not aware of the U.S. program that you're referring to. The Canadian program has a very specific focus. It's really to diagnose bleeding in the abdomen in the field.

That is helpful in terms of improving the triage of that patient. If we knew they were bleeding in their abdomen, we might prioritize them in an evacuation scheme more quickly.

[John McKay, Liberal, Scarborough—Guildwood, ON]

How far along has that research gone? It obviously has civilian applications. Have you maintained contact with that program?

[Col Homer Tien]

It's not at the clinical trials level yet. It's still at the preclinical trials level.

[John McKay, Liberal, Scarborough—Guildwood, ON]

What does it take to move that up from “this is a really good idea for a field hospital or for a unit operating in the field” to that stage?

[Col Homer Tien]

I don't know. The current problem is that it's really an issue at the level of mathematics and physics, in terms of how you use sonar.

So I really don't know. I'm sort of waiting for it at the clinical level. I would then be involved with the clinical trials.

[John McKay, Liberal, Scarborough—Guildwood, ON]

I'm assuming that the army in particular would say that would really be a leap forward in battlefield trauma.

[Col Homer Tien]

We're very interested in it. I am very interested, and I think health services is interested in it. We're following it along, but obviously certain aspects of science are difficult to push along.

[John McKay, Liberal, Scarborough—Guildwood, ON]

Okay. Thanks very much.

[The Chair, Conservative, James Bezan]

Thank you.

Mr. McKay, I'm glad you brought up our trip to Downsview and the research we saw there. I was interested to hear how that research has been progressing as well.

Let's continue on with Mr. Alexander.

[Chris Alexander, Conservative, Ajax—Pickering, ON]

Thanks, Chair.

It's great to have you here, Colonel Tien. Congratulations on your achievements, especially in Afghanistan, but all through your career. You've broken a lot of ground in the most critical fields of trauma and advancing our knowledge and our practice on behalf of the Canadian Forces.

It says in your biography that you're the medical director for the Tory Regional Trauma Centre. I just want to point out to members opposite that there's no partisanship associated with that.