Veterans Affairs committee  Perhaps we can focus on the individual in Landstuhl, because that's the more complex case. The others may actually be able to return to their mission, depending on the nature of their injuries. From the point of wounding, they will have buddy first aid applied. Then a medical technician will provide some advanced trauma care on the scene.

Veterans Affairs committee  Mr. Chairman, thank you for that question. I will say that at the present time as we look at the management of our patients and the complexity of their care, the way that we try to address the challenges they face with finding care in the civilian health sector is via the option of trying to extend the transition period.

Veterans Affairs committee  The case management decision is made within the Canadian Forces health services. It's primarily the clinicians who are caring for individuals who look at the complexity of the needs of the patients and identify whether or not it will be necessary for them to be referred to a case manager.

Veterans Affairs committee  Thank you very much, Mr. Chair and distinguished members of the House of Commons Standing Committee on Veterans Affairs. I'm very pleased to have the opportunity to talk to you about the medical care offered to our Canadian Armed Forces, or CAF, members, the treatments and services offered to our members in the operational trauma stress support centres, known as OTSSCs, and the support they receive from the case management program when they are transitioning out of the CAF as the result of a medical condition that makes them unfit for military service.

Health committee  Maybe I can answer the first question. As a small health care provider, we're not actually engaged with all of the provinces in discussing what we're doing with electronic health records. We are, however, engaged certainly within the federal government. As I explained earlier, we sit on a committee chaired by the chief information officer of the Treasury Board, where we discuss where the federal government's going with electronic health records and trying to standardize applications across the federal government.

Health committee  Within the spectrum of care for the Canadian Forces health services, we have a full suite of medications available which would include narcotics and non-narcotic pain medications. We also have modalities like physiotherapy, referral to chiropractors, and those types of modalities to help with pain management.

Health committee  I believe the highest percentage of medical releases are a result of musculoskeletal injury, yes.

Health committee  As long as I've been in, and that's for 30 years, our statistic has been that musculoskeletal injuries or problems, have been the number one reason for release. Our soldiers are asked to work in very difficult environments and do very difficult work. Unfortunately, occasionally, that has an effect when you do it over a career.

Health committee  I'm sorry. Could you clarify what link you see to the scope of practice in that field?

Health committee  I'm not sure we've assessed them from a flexibility perspective necessarily. I will say, though, that generally the Province of Ontario provides a fairly well-defined scope of practice that often we're able to look at and use to help formulate where we believe we need to be with our scopes of practice.

Health committee  The health services group has a small cell that looks at performance measurement across our organization. It is an evolving program that we currently have. Certainly we are looking at things like wait times, next available appointment, and process-type things right now to evaluate where we are with the provision of health care.

Health committee  I think we've had discussions certainly around the health human resource table for some time about trying to standardize scopes of practice and licensure to permit mobility across provincial and territorial lines. Although that does present some challenges I believe it is very much worth pursuing as a possible solution to the difficulties or frictions that might arise as a result of different scopes of practice as people try to move from province to province or territory.

Health committee  From what I understand it's not an issue of the professional associations. I believe the professional associations may be open to that, but it's the regulatory bodies from province to province that set the standards. It's a matter of having those regulatory bodies all come to some agreement with respect to what practitioners are permitted to do or not to do.

Health committee  As I had indicated earlier, I would like to say there are no barriers to chiropractic care really. We do access chiropractic care. When I was a physician in Shilo, Manitoba, I had a great chiropractor in Brandon I would refer to regularly for low back pain because it worked and I was trying to do what was best for my soldiers.

Health committee  I wouldn't be prepared to make a commitment at this point in time to a pilot project. The Canadian Institute for Military and Veteran Health Research is investigating the evidence-based treatments for mental health at this point in time—