National Defence Committee on April 29th, 2013

[The Chair, Conservative, James Bezan]

Mr. Alexander, the last round of questions goes to you.

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

Thank you so much for being here, Major Wiss.

Thank you for reminding us of the heroism of our medics in the Canadian Forces. We have all known and heard about the talent, the sheer knowledge, and the medical experience that you and your colleagues bring to the table, but sometimes we forget how important that operational dimension has always been.

You showed us eight faces here that speak louder and more truthfully to that valour than any of our voices could, but you also remind us it has deep roots in the Canadian Forces, whether it's Canadian medics who've won the Victoria Cross—and there are many—in different conflicts in different services....

I was reminded of Private Richard Rowland Thompson, who was given The Queen's Scarf, some say a higher honour than the Victoria Cross, though—

[Maj Ray Wiss]

There are only six of them.

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

Exactly. It was certainly a rarer honour, way back in the Boer War.

I think this is one of the keys to the excellence of the Canadian Forces, that you are the force multipliers that you are, and the incredible spur to morale. It's an honour to have you here.

[Maj Ray Wiss]

Thank you.

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

Thank you also for your literary contribution in telling this story, because without the books you've written, it simply wouldn't be known to as broad an audience, and you've done it with great talent and gusto.

[Maj Ray Wiss]

Thank you again.

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

We are all in your debt in that respect, and really, around this table, we've shared stories from your books and benefited from the insights.

I want to ask you about the bigger picture, though. I was just looking at the book again. I remember reading at the time the beginning of your first book, in which you talk about your commitment to the mission in Afghanistan—and I certainly share it—a moral war, a just war, an authorized military operation with our allies, the sort of thing we've always prepared for and have been prepared for. But then you talked about how we were a nation divided in spite of all those advantages, and that there were some on one side of the issue saying we were peacekeepers and we should never again be in shooting wars, and then some on the other side were saying that we should just go there and do damage, again, in a very superficial and unhelpful characterization of the conflict.

You said we were a nation divided in 2007, and I certainly think we remained that in the subsequent years we were in combat.

What kind of impact does that division in public opinion and in public support have on the ability we as a country have to motivate soldiers, to care for them in the field, and to care for them when they come home?

[Maj Ray Wiss]

We're soldiers. We don't practice democracy; we protect it.

I think the overarching message that I want to pass to you is that we have absolutely no problems with people who oppose the missions that we're sent to go on. In fact, several of my very best friends, to this day, oppose the mission. They have read both my books and they agree that when we debate, I win the debate, but they still oppose the mission. I think they're great people, and I went to Afghanistan to defend them and to defend their right to disagree with me.

The thing that I can't stand is the person who came up to me in 2008, when I came back from my first mission, and said, “Hey, I heard you were in Iraq.” That's hard to take. There's the person who came up to me in 2009, when I am about to deploy for a second time—this is a physician in Toronto, someone with access to as much information as anyone on the planet—who said to me, “So, Afghanistan. Are we peacekeepers over there?” That hurts.

I speak a lot about Afghanistan. Even now I still get an invitation or two a month to speak to somebody, and I'll go and speak to anybody. It could be six people in a grade school; I'll go. The most common comment I get from adults at my public presentations is, “I had no idea.” After 158 dead and 10 years of war, I have a hard time with that. That hurts veterans.

If I can ask you to do one thing, it's to just tell people what we did. It doesn't have to be partisan; it doesn't have to be to make a point; it doesn't even have to be pro-mission. People who oppose the mission have enjoyed reading my books because I call it like it is. Make sure people know why we were there, what we did, and what we suffered and what we lost.

To go there and to realize that so many Canadians just didn't know, that hurts us, and that will decrease our operational effectiveness, if you want to couch it in those terms. People have to know. People have to remember them.

[The Chair, Conservative, James Bezan]

Thank you.

I have one question for you, Major.

I was going to give you an opportunity to say what that final message was that you wanted to leave with the committee. I think Mr. Alexander gave you that opportunity to do it.

One thing we're trying to do in this study is lessons learned. How do we get better at what we do? From your perspective, how do we get better in the field with regard to traumatic injury and dealing with that? You were already asked about some things that we've resolved—backpacks, body armour, what we're carrying in our kits. We know for a fact that your ultrasound equipment is now being developed more by DRDC for more advanced operations right in the field by our medics.

You mentioned, and you showed, how traumatic improvised explosive devices, IEDs, are on our LAVs. We know we've cut them all down, we're putting in V-hulls, and we're reinforcing them so they're more blast-proof, which hopefully increases the survivability and decreases the injuries of our brave men and women who have to ride around in them.

In your mind, what else could we be doing better in the field to protect our troops, either at the FOB or even right with the medics who are dealing with those very first injuries?

Don't feel pressured that you have to answer it today. You can always write back to us.

[Maj Ray Wiss]

I'm very much going to take you up on that, because I'd have a tough time formulating a brief answer right now. Let me leave you with a concept.

Right now, the Canadian Forces Health Services is an extraordinarily effective construct. It has a 98% survival rate in modern warfare. That's higher than what the major trauma centres in Canada are achieving. It's higher than any army that has deployed into the field in war has achieved. It's phenomenally effective. It is, however, a house of cards. Don't think for a second that you can change one part of it without it rippling through the entire edifice. You have to keep all these aspects going; you have to especially keep training and research going.

We know what we could have done better last year because we've worked on it. If you keep the training going at the intensity it is at right now, and if you keep the research going at the intensity it is at right now, we'll figure out what to do better next year. That's a question we don't have the answer to right now.

We've kept studying what's been going on. Every one of our guys who was killed had an autopsy. We analysed whether his protective equipment did well or not—every single one. That's why the Highway of Heroes ends in Toronto. Did everybody know that? That's why it ends there, because the Chief Coroner for Ontario looks at every one of our dead, does that study, and sends a report back. We've studied the past.

Right now, keep the machine going so that we can try as much as possible to anticipate the future.

[The Chair, Conservative, James Bezan]

Thank you so much.

[Maj Ray Wiss]

But I will write you back on that, with a wish list.

[The Chair, Conservative, James Bezan]

Yes, please do, anything from logistics to equipment to how we train.

[Maj Ray Wiss]

There will be a picture of an ultrasound machine in there.

[The Chair, Conservative, James Bezan]

All those things are important in what we're doing here in our study.

On behalf of the committee, I want to thank you for taking the time to appear, and for bringing your family with you. It's nice to meet them as well. Thank you for your passion to your country and your fellow soldiers, and for really bringing a unique perspective that we hadn't heard around this table yet.

[Maj Ray Wiss]

If you meet these young soldiers, sir, it's easy to be passionate about them.

Thank you very much.

[The Chair, Conservative, James Bezan]

Yes, I agree.

With that, we'll suspend and clear the table in preparation for our next witness.

[The Chair, Conservative, James Bezan]

We'll continue. We have most of the members back at the table.

Joining us for the next hour, from the Department of National Defence, we have Major Lisa Compton. She is the manager of the maintenance of clinical readiness program. She is accompanied by Dr. Mark Zamorski, who is the head of the deployment health section.

With that, Major, I'll let you offer your opening comments.

[Major Lisa Compton, Manager, Maintenance of Clinical Readiness Program, Department of National Defence]

Thank you, Mr. Chair and members of the committee.

Ladies and gentlemen, I want to thank you for your interest and support for the care of Canadian Forces members. I'm a Canadian soldier and I'm a nurse. I have been privileged to work in the Role 3 Multinational Medical Unit, the hospital shack built of plywood and miracles, and as the only Canadian at the Craig Joint Theater Hospital in Bagram Airfield, Afghanistan. Given your interest in the care of the ill and injured, my role and experiences as the Role 3 trauma nurse coordinator, Bagram trauma nurse coordinator, Canadian liaison nursing officer, and Canadian Forces national trauma nurse coordinator are likely of most interest to you.

The Canadian Forces has been part of the joint theatre trauma system since 2007. It was during that time that the CF began using the joint theatre trauma registry, a robust trauma registry that not only enabled life-saving research, but real-time performance improvement in a combat zone. It provides the ability to perform data-driven, battlefield-level process improvement of trauma care that drives morbidity and mortality to the lowest possible levels.

The mission of JTTS is to improve trauma care delivery and patient outcomes across the continuum of care, utilizing continuous performance improvement and evidence-based medicine driven by the concurrent collection and analysis of data maintained in the joint theatre trauma registry. Ultimately, it means the right patient, the right place, the right time, and the right care. One of the most valuable resources from JTTS is the clinical practice guidelines, as they are the backbone of the theatre performance improvement system. Historically, since the early outset of the in-theatre trauma system, these guidelines have been developed and implemented by clinical subject matter experts in response to needs identified in the area of operations. To the greatest extent possible, JTTS CPGs are evidenced-based. As one can imagine, for many reasons, trauma care needs to be delivered differently in a war zone than back home in a large trauma centre. These CPGs not only address how to improve care in a combat zone, they also provide clinical guidance on dealing with injuries that are unique to the combat environment.

During my time at the Role 3, I not only witnessed the unbelievable bravery of CF members, but I was proud to be a part of a medical team that provided the best care anywhere. Last year, Canada was the recipient of the Larrey Award from NATO for excellence at the Role 3.

CF members accept extreme risks and are asked to make the greatest of sacrifices. Whether it be in a plywood shack or a pristine medical clinic, they deserve the very best care anywhere. The CF Health Services are committed to excellence.

I would be pleased to answer questions to the best of my ability, and any information I cannot immediately provide I will provide at a later time.

Thank you.

[The Vice-Chair, NDP, Jack Harris]

Thank you, Major Compton.

Dr. Zamorski, we'll hear from both of you first, and then we'll have a round of questions.

[Dr. Mark Zamorski, Head, Deployment Health Section, Department of National Defence]

Thank you, Mr. Chairman and ladies and gentlemen of the committee, for the opportunity to appear before you today.

I am Mark Zamorski, and I am the head of the deployment health section of the Canadian Forces Health Services group. My section mainly does research in the domain of mental health and related problems, such as suicide and family violence. We have also developed and actually support the enhanced post-deployment screening program for mental health. In addition to research, we participate in other scientific activities, notably three recent expert panels on traumatic brain injury, suicide prevention, and the prevention of family violence. Over the past year alone, our three scientific staff have been authors or co-authors of 10 peer-reviewed publications and have presented 15 abstracts at national and international scientific meetings.

We currently have three major active research protocols, two of which deal with understanding the effects of mental disorders and traumatic brain injury, respectively, on occupational fitness. I am also the principal investigator of the 2013 Canadian Forces mental health survey. This study, done by Statistics Canada on behalf of DND, involved interviewing 9,000 currently serving personnel to explore, first, how the mission in Afghanistan and, second, how the renewal of our mental health system have influenced the need for mental health care in the CF.

By training, I am a family doctor, with additional training in public health. Before joining DND, I was on the faculty of the Department of Family Medicine at the University of Michigan Medical School for nine years.

I am prepared to answer questions on the research and other scientific activities of my section. I can also comment generally on the science that lies behind the prevention and control of mental health problems and related phenomena in military organizations.

Thank you again for the opportunity to appear here before you today.

[The Chair, Conservative, James Bezan]

Thank you very much.

With that, again, I think we'll stick with five-minute rounds.

Mr. Harris you have the floor.

[Jack Harris, NDP, St. John's East, NL]

Thank you, Chair, and my thanks to both of you for your presentations.

Dr. Zamorski, I understand you're the director of research. You talked about this mental health survey, which I think is very positive. I want to read you something, though, that I'd like your response to. We heard Dr. Wiss and others talk about what a great system we have, and I know the things that we do, we do well. Dr. Wiss talked about the Trident trauma services and the direct response in the field to post-traumatic stress disorder. That's probably ahead of the curve across the world. But I will read you what we were told on March 20 by the Canadian Forces ombudsman, Pierre Daigle, who said:

I am troubled that the Canadian Forces still does not have an appropriate system in place to provide a current and consistent portrait of the number of members affected by post-traumatic stress disorder and other operational stress injuries.

How can the institution know if it has in place the most appropriate priorities and resource levels to manage its broader operational stress injury initiative when their data is incomplete and their research is not focused on measuring performance?

He talked earlier about performance. Perhaps you've read that testimony. Would you care to comment on it? This survey that you're part of, is that the answer to this, or is there more that needs to be done?

[Dr. Mark Zamorski]

The survey is a very important part of the answer. There are two criticisms in there, and they're sort of related and sort of different. One is the ability to understand the magnitude of the problem, who has it and who doesn't, and whether problems are increasing or decreasing. That's an important public health surveillance function that we need to have, and we have pieces of that in place. We also need to understand how CF operations are affecting the mental health of CF members if we're going to appropriately manage our program and take care of our people. We absolutely get that, and we agree with that 100%.

A second functionality is also very important, and we agree 100% with the ombudsman that we need to do a better job of documenting, in detail, what kind of care we're providing and how the quality of it compares with our aspirations. We also need to document better the outcomes of that care. Where we disagree with the ombudsman is in the best strategy for doing that. The ombudsman's office has been fixated for quite some time on this idea of having some kind of a database that lists all the people with operational stress injuries, so that at any given time we can press a button and say, “As of today the magic number is 3,722”, or whatever it happens to be.

As a public health expert, as someone who's supposed to keep on track with this, I can tell you this is not very helpful to me. Instead, the path that we've chosen is to use a bunch of different ways of answering these fundamental demands—to understand the care we're delivering, the effect it's having, and how the mission is affecting health.