National Defence Committee on April 17th, 2008

[Claude Bachand, Bloc, Saint-Jean, QC]

Was it in Panjwai?

[Col Omer Lavoie]

Panjwai and Zhari, sir.

[Claude Bachand, Bloc, Saint-Jean, QC]

What happens when soldiers set out on patrol from a forward operating base? If a soldier is injured, is he able to receive immediate care?

[Col Omer Lavoie]

Yes, sir. If I can just explain, the medical support in theatre for combat troops is really categorized. There are three hierarchies of medical support. At the very front, at the fighting edge, in your example, a patrol that would leave a forward operating base outside the wire is a company with at least one medic per platoon as well as a number of soldiers, at a ratio of one to ten, who have advanced tactical combat care training or advanced first aid.

The next level of support is our forward role, two-unit medical station, which would be, if you could envision, a mini MASH unit. These would be pushed forward enough--in the case of Medusa I had them pushed forward on my two axes of attack--so they were never more than three or four kilometres from the front line where the fighting was occurring. And this organization had either a doctor in it or a physician's assistant and a number of medics who could provide a fairly high degree of stabilization support for a casualty before they were put onto an air medevac system and flown back to Kandahar airfield, which is considered our role 3 facility, which has all the combat medical support you'd find in any hospital in Canada.

[Claude Bachand, Bloc, Saint-Jean, QC]

Yes, we've been there.

I read that when an injured soldier needs to be evacuated, the Americans provide the helicopter. What is the procedure followed? If a soldier has lost a leg, does help arrive immediately or two hours later?

[Col Omer Lavoie]

No, sir; and unfortunately I came across that situation a number of times during our combat operations.

The air medevac system is an ISAF provision, under Regional Command South, and it's multinational. The Americans provide some support, but I've had air medevac support from the British, and from the Dutch as well, in our case.

It is very transparent to a soldier at the front. I've been in a number of situations where I've had to request air medevac for, unfortunately, mass casualty incidents. It's very transparent; I as commander or anybody else get on the radio and put across what's called a “line 9” medevac request, which is a programmatic request for air medical support. It details the types of casualties, the numbers, and the degrees of seriousness. From there, helicopters are pushed forward almost immediately to air-medevac the casualties out. In my case, most times it happened within 20 to 30 minutes of the request.

[Claude Bachand, Bloc, Saint-Jean, QC]

Is it in fact true that part of the military operational planning process on a forward operating base involves ensuring that before an operation is undertaken, helicopters are available to evacuate soldiers? In other words, is this a deciding factor, for example, in sending soldiers out on patrol from an advanced base?

[Col Omer Lavoie]

Yes, sir, that's absolutely so. For Operation Medusa specifically, when we were going through the operational planning process for that, my medical officer, who's a doctor, made, with her staff, an integral part of our planning in terms of making sure we had sufficient medical capability going forward. Every mission that goes out, as part of the orders given, will have a paragraph dedicated to medical support.

The availability of air medevac is monitored by my operations cell back at Kandahar airfield. If we're told that sandstorm season is about this time of year, a sandstorm does move in, and word comes across that this would mean no air medevac support, then I would make the decision--I can say unequivocally that I have done so many times--to either reduce the type of operations we were doing or the proximity of the operations from Kandahar so that I could always guarantee it.

I think, sir, it speaks very much to what I call the “social contract” in my job. Part of my job, unfortunately, is to put troops in harm's way, but the other part is to make sure that every measure possible to, if necessary, get them out of harm's way is put in place beforehand.

[MGen Tim Grant]

Perhaps to give you a more complete picture, at Regional Command South it was the job of the commander and his staff to make sure that across all of the provinces in Regional Command South there were not so many operations ongoing that, if things went wrong, it would overwhelm the medevac system. There were often times when the commander of Regional Command South, my boss, would actually tell us to delay or push operations to the right to make sure that he could in fact respond to possible air medevac requirements across the region.

[Claude Bachand, Bloc, Saint-Jean, QC]

Earlier, you spoke about tours. As you know, the US government recently reduced the length of a soldier's tour from 15 months to 12 months. We have often heard it said that tours come up too frequently. Have Canadian Forces considered either shortening or extending tours of duty so that soldiers do not have to return as often to the theatre of operations?

[MGen Tim Grant]

Sir, my understanding is that the commander of the army, General Leslie, has been asked to look at the length of tours. At some point he will come back and present some options to the Chief of the Defence Staff.

[The Chair, Conservative, Rick Casson]

Ms. Black.

[Dawn Black, NDP, New Westminster—Coquitlam, BC]

Thank you very much.

It's a pleasure to see you all here in Canada. When we met the first time, it was in Kandahar. I just wanted to share with you that the visit we had as a defence committee to Kandahar had a very profound effect on me. I want to thank each of you for the role you played in ensuring that we had the briefings we did.

I might just mention that the person who was the close personal protector was terrific.

[The Chair, Conservative, Rick Casson]

You tried to take him home with you.

[Voices]

Oh, oh!

[Dawn Black, NDP, New Westminster—Coquitlam, BC]

Yes--he was just lovely.

[Laurie Hawn, Conservative, Edmonton Centre, AB]

This is not in camera.

[Dawn Black, NDP, New Westminster—Coquitlam, BC]

He was terrific, as was everyone who dealt with us there. I thought about all of you when I was home again, and I'm glad to see you home and safe in Canada. I'm sure everyone here feels that way.

The stories that have been shared with me about post-traumatic stress disorder all have the same ring to them. I've spoken to families and to some returning soldiers from Afghanistan who suffered through this. Each of them has told the same tale, and I found it very dramatic that the incidents replay through their minds over and over again. They can't switch channels. They can't turn it off.

Another common refrain is that in most instances they felt, while they were in theatre and had their military family--even when we heard testimony in camera--they had the support they needed there. But once they came home, they and their families certainly didn't feel--and families who testified here in camera didn't feel--the support was there to help them get through their disorders and get healthy again.

I want to ask you if you have any recommendations. How do you feel that part of the health system is working? What improvements could be made?

On a supplementary question to that, the ombudsman's report came out about reservists returning, and how the care, attention, and services they've been able to access have been dramatically less.

I wonder if you can comment on those two things.

[MGen Tim Grant]

I would start with the family support issue. I agree with you that in theatre, as Colonel Hetherington said, living very closely together, it's a very tight-knit community. Those bonds tend to break when you come back home and go back to your own life with your family. Single soldiers clearly have greater challenges, since they don't necessarily have families to go back to on the bases to which they're posted.

But the issue in my mind is not whether the medical system is able to support them. The medical system is there for them. The challenge we face is getting them connected with the medical system to identify them, or have them identifiy themselves, so we can get them the help they need. That's an ongoing challenge, and it really rolls into the reservist issue in very much the same way.

I speak again from my time in western Canada. The challenge I faced working with reserve unit commanding officers was keeping track of reservists who went back--making sure we kept an eye on them and that they went through the screening process. The hard part is when a reservist comes back and gets out of the military. He loses not only that peer support group he had in theatre, but whatever support his unit could give him. That does cause me concern--how we can continue to track them.

At the end of the day, I don't think it's because people are not concerned and not trying. The system's not perfect, and if there were an easy solution we would have put it in place by now.

[Dawn Black, NDP, New Westminster—Coquitlam, BC]

You said in your presentation that when you went to Cyprus for decompression you thought you'd rather be anywhere else, or obviously at home with your family. Then in hindsight you thought it was a valuable service for you personally. If you're comfortable telling us, what made you feel that way in hindsight?

[MGen Tim Grant]

I think in my experience there were two things. One was the battlemind program that was presented to us, and the chance we had to select a number of facilitated programs where we could discuss issues, whether it was command and leadership, or family relationships. It allowed us to go into a fairly benign environment and have access to some very qualified medical folks who could help us with some issues.

I found it therapeutic that I could just unwind, have a shower every day, eat some food, have a couple of beers, and socialize almost one last time with the team I had spent nine months with. But I have told the Surgeon General that I think we can make it better. We have great mental health folks there, but we don't necessarily have people there right now who can facilitate the discussions between soldiers and those mental health specialists. There are big groups, and sometimes we need people who are a little more gregarious to draw out the soldiers.

But it is a good program, and one that I know General Jaeger is looking to make better. The military side of the house, the chain of command, is looking to make it better, but even though I didn't go through nearly some of the challenges as soldiers in the PRT or the battle group, at the end of the day I found it useful.

[Dawn Black, NDP, New Westminster—Coquitlam, BC]

I'm wondering whether at the higher ranks you go through the same routine as the troops around the issues of operational stress injuries, as you call them, in terms of being prepared before an event. Is it different? Is the predeployment and time before you go out on patrol different for the higher levels than for the troops?

[LCol Simon Hetherington]

If I could start, I'd like to say that we, as officers and senior NCOs, spend our careers getting ready for that sort of position. It's called leadership. It's developing experience along the way, doing professional development, and learning to be a leader in understanding potential stressors and how to deal with them.

With regard to specific training, as Colonel Lavoie mentioned, part of that ten-month work-up cycle did involve professional development studies, not so much into post-traumatic stress, but in dealing with stressful situations. I wouldn't say that we had specific-to-rank training; the entire contingent has training in recognizing these things as part of command. It's part of what we do. And that's what I believe has contributed to my ability to deal with certain situations that I have faced.

[The Chair, Conservative, Rick Casson]

Thank you. Sorry, we have to move on.

Mr. Hawn.

[Laurie Hawn, Conservative, Edmonton Centre, AB]

Thank you, Mr. Chair.

I thank you all for being here.

I'd actually like to follow up on that a bit, because that is one of the areas I was going to address as well.

In terms of the training, as you said, you are groomed through promotions and so on for that. Obviously the operational lessons learned from deployment to deployment come back on a daily basis. Do you get a chance to sit down, commander to commander, between rotations and pass on not just the operational lessons, but the lessons dealing with the human situations?