Thank you very much for those comments, sir, and for the question.
For our folks deployed overseas now, in the event of a serious injury or illness, we always deploy at least a minimum amount of primary care with those individuals. Sometimes it's pre-hospital care. Depending on the size and extent of the mission, we may send them all the way up to a full tertiary care hospital to support them—or at least one with surgical capability.
Because health resources are difficult and scarce for all of our NATO allies, there are probably greater multinationally integrated health resources than there are in many other elements of the armed forces. Where there's a smaller mission, as in the case of the current operation, Operation Attention, in which Canadian troops are mentoring Afghan National Army folks, because our people are dispersed everywhere we provide Canadian Forces members with immediate acute care at the primary care level—physicians and medical technicians—but we're relying primarily on the U.S. or in some cases the French military hospitals to provide the tertiary care.
So there's always a pre-hospital care component, where people with additional training in tactical combat casualty care.... Very acute life-saving measures are applied within the first 10 minutes to control those things that tend to cause death early, like airway management and excessive bleeding. They apply that kind of care within the first 10 minutes. Then there's always a rapid medical evacuation process to try to get people onto the operating table, if necessary—if surgery is required—within an hour or a maximum of two hours, followed by stabilization in a tertiary care centre before tactical evacuation to, usually, a higher-level hospital.
For us, it will usually be Landstuhl Regional Medical Centre in Germany for additional stabilization and additional detailed surgery before strategic medical evacuation back to Canada to a quaternary care hospital, where all additional care and rehabilitation can occur as close as possible to the maximum social supports and the adequate clinical supports that are necessary.
One of the big changes that has occurred is recognizing the value of providing clinical care as far forward as possible. So for the tactical combat casualty care component with that initial life-saving care, with specific procedures that in Canada may often only be done by an emergency room physician, we've pushed forward and trained not only our medical technicians but our combat arm folks to be able to do a number of those procedures. That intervention within the first 10 minutes will buy a lot of time.
We have good data from something called the joint theatre trauma registry, which was used widely in Afghanistan to demonstrate that we can extend the time to do necessary surgery by up to two hours before, and still maintain the same life-saving capability.
That's a quick summary of the process.