National Defence Committee on April 29th, 2013

[Maj Ray Wiss]

It's not significant, no. The training offered by the Canadian Forces to all level of medics, including physician assistants, is extraordinary. Someone like me, an emergency medicine specialist, brings it up a notch, but just a notch. Most of what I would do in that situation can be ably done by the Canadian Forces senior medics, with the level of training they had. So somebody like me would bring it up a notch, but not a phenomenal notch at all.

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

I want to explore the irony of the Veterans Charter, which actuarially was premised upon a World War II model of a lot more dead soldiers and a lot fewer injured soldiers. But with your efforts and the efforts of your colleagues, it's kind of flipped now. We have way more injured soldiers and fewer dead soldiers, and yet the charter has not been responsive, because you're offering payouts to soldiers that are pretty modest under the circumstances.

Talk to me a bit about how that could be remedied so that the compensation packages bear some relation to the advances in medical science.

[Maj Ray Wiss]

The first thing I would need to do is tweak what you said a little, because all the wars of the 20th century have generated way more wounded than dead. The one thing that's changed now is that we're bringing people back out of the dead group. There's a group of severely wounded people, and it's quite a small group—just a couple of hundred people coming out of Afghanistan are ill-served by the charter. That's it.

The irony is that the folks who got hit before the charter have access to a pension that's quite adequate. As I say in my written submission, that's probably the way to look at it—just go back to the way things were when the combat mission started.

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

With respect to PTSD, we're going to get a presentation after you that says that the suicides among soldiers are actually at the Canadian average, if not below the Canadian average. The argument is that people who potentially would commit suicide get weeded out in advance. It seems counterintuitive.

What is your experience with the post-discharge soldier? PTSD and suicidal ideation, all that sort of stuff, may actually be exaggerated after discharge. I would be interested in either your anecdotal or statistical observations.

[Maj Ray Wiss]

I'm not sure I get what you're—

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

Well, you are in a unique position to observe soldiers post-discharge, so I'd be interested in your observations on how both suicidal ideation and PTSD manifests itself in, say, a five-year window.

[Maj Ray Wiss]

Okay, got you.

We're just getting up on that five-year window now. Let me start with a really basic fact about PTSD and that whole constellation of illnesses. We know that of everyone we send to Afghanistan, 6% are going to have mental health issues. We know that 2% of these, one-third, are going to get better on their own; 2% are going to get better with treatment; and 2% are probably going to have long-term issues. I want to re-emphasize the importance of making people understand that we have the best mental health care post-deployment system in the world, and we really need to access that middle 2% who are going to get better with treatment. We need to access them quickly. We also need to access, equally quickly, the 2% who are probably going to have long-term issues, so that we can minimize the effects of their illness.

The reality is that 94% of us come through it, and that's what I'm seeing, anecdotally. Here in Sudbury, where I am, I have a reserve unit that sends dozens of people every year to Afghanistan. I talk to these guys all the time, and the vast majority are doing just great. That's the reality.

[The Chair, Conservative, James Bezan]

Thank you. Your time has expired.

Mr. Opitz, please.

[Ted Opitz, Conservative, Etobicoke Centre, ON]

Thank you, Mr. Chair, and through you, Doc, thanks for being here.

I think your time as an infanteer has probably given you some tremendous insights.

Always, we're the Queen of Battle, not the engineers.

I'm sorry, I had to get that in. It's a running battle.

[Maj Ray Wiss]

Yes, Colonel. I'm aware of the Lincoln and Welland.

[Ted Opitz, Conservative, Etobicoke Centre, ON]

You talked in your book about combat stress reaction, or CSR, as you put it. I'm interested in that. You said that the best way to treat that is at the front, which sounds counterintuitive to what we have been told by previous witnesses, in terms of PTSD and other things.

Can you elaborate on that and give us some clarity there?

[Maj Ray Wiss]

Sure.

Consider who a solder is—a young person in the prime of life; they've been training for a significant part of their professional life, maybe their entire professional life, for this job. Then something happens and they have difficulty completing a mission. The loss of self-esteem that entails is devastating. The longer they feel that loss of self-esteem, the harder it is to bring them back, and the closer they are to depression and then to suicidal ideation.

We know this from long-standing experience, going back a couple of wars now. If you want the guy to come back emotionally, you have to treat him as close as possible to the front line. Again, the Canadian Forces is the world leader in that.

We had social workers, psychologists, go out to the FOBs. It was quite the thing. These people had no real combat training experience, and they were getting helicoptered out to the FOB to talk to these guys who had just been in a vehicle where two of their buddies had been killed and they were having a tough time dealing with it. Here you have a mental health professional, out there getting rocketed at the same time we were, talking to them about what's going on.

That's the way to do it. If you bring them back for two months, the only thing they're going to think about for those two months is that they let their buddies down. Remember, that is the deepest motivation a soldier has—much more than distant ideals like democracy, than hatred of the enemy, and more than self-esteem. The most important motivation a combat soldier has is his buddies and not letting them down. All he's going to think about for those two months back in Canada, or wherever, is that his buddies are out there still fighting and he's not. That's devastating to a psyche. The only way to improve that is to deal with it early and quickly.

[Ted Opitz, Conservative, Etobicoke Centre, ON]

I'm glad for your perspective. You fight for the man, and you fight for the man on your left and on your right—that kind of deal.

I'm delighted you said that, because we've had a lot of negative stories. But as you've just pointed out in some of your statistics and things like that, there are a lot of positive results that have happened with our treatment.

I'm delighted to hear you say that Canada is one of the leaders.

[Maj Ray Wiss]

The leader.

[Ted Opitz, Conservative, Etobicoke Centre, ON]

The leader in looking after our soldiers.

You've treated all kinds of injuries in your two different tours of Afghanistan. What effect does the protective equipment have now? It protects the core, and the ballistic helmet and ballistic glasses and things like that protect the head and the eyes.

There are some horrific injuries, obviously, to the extremities. You said the “kill boxes”, as you called them, are well protected because you also have that ceramic plate in behind the tac vest.

Can you talk about some of the injuries you've treated over your two tours?

[Maj Ray Wiss]

Hippocrates, the father of medicine, said that if you want to be a surgeon, go to war. He said that 2000 years ago, and it's just as true now. If you want to learn how to do this job, go to war, because the panoply of injuries is pretty much infinite, especially now with what modern weapons will do.

To address your question about the protective equipment, there is always a balance between firepower, mobility, and protection. You choose a mix of that and then you go into action. You might choose it right for that particular mission, or maybe you choose it wrong; there's no way of knowing ahead of time.

I can tell you that having slogged it out on patrols with that frag vest on me and the tac vest over top, I wouldn't want that thing to be any heavier. That would be about the limit.

It is very effective, and that's part of what we're seeing. We're seeing the effects of that in terms of the casualties.

Bill Kerr, in my hometown, is a guy I've been personally looking after for the past five years now. He is Canada's only triple amputee. He'd be dead as a doornail if it hadn't been for all the stuff he was wearing. So it's very effective armour, for sure.

[Ted Opitz, Conservative, Etobicoke Centre, ON]

That's great to hear.

Do you think overall that we have the services for physical injuries, mental injuries, psychological injuries, that the troops generally need in this system—the services that Canada provides for our wounded and our mentally wounded?

You alluded to it earlier. You said we're a world leader. Do you think we have the right mix of things to treat our people the best that we can?

[Maj Ray Wiss]

Yes, and again, that's a really important message I want to leave with the committee. We have this outstanding system. The way it has been for the past several years, it has really been doing a tremendous job, and yes, when disasters happen and people fall through the cracks, you want to be nimble in how you pick them up.

[Ted Opitz, Conservative, Etobicoke Centre, ON]

Is there anything we can do better?

[Maj Ray Wiss]

I suppose we could be more nimble in how we pick them up, but more importantly, get the message out there that the vast majority of people who are having mental and physical health problems are getting good care. If that's your problem, don't be dismayed. Come and see us.

The biggest obstacle to our getting to the PTSD crowd is that they're not coming. That hurts more than anything else.

[The Chair, Conservative, James Bezan]

Thank you.

Ms. Moore, you have the floor.

[Christine Moore, NDP, Abitibi—Témiscamingue, QC]

Thank you kindly, Mr. Chair.

Let's use the example of someone who works as an emergency room nurse in a small community. In that sort of setting, the nurse could quite easily come across someone they know well, if not very well, and have to treat that person. That is the reality they have to live with. Regardless of what is going on in members' lives, the Canadian Forces is still something of a small family, and the likelihood of having to treat someone you know is pretty high.

Earlier, you showed a picture of Corporal Nicolas Beauchamp and of his spouse, Corporal Dolores Crampton, who was also a medical assistant and went to Afghanistan. In fact, she was one of the people in my NQ4 medical course; we spent a lot of time together. She is someone whose spouse died and who is a care provider. What would you say about those situations? How do you deal with health care providers and help them face the reality that, one day, they will probably have to treat someone they know very well?

It, is after all, not uncommon in the Canadian Forces to have spouses who are both members of the military. How do you support members who have suffered the loss of a spouse?

[Maj Ray Wiss]

I was at the repatriation ceremony for Corporal Beauchamp, as was Corporal Crampton. After that, you live with the grief, as I am doing now. You get through it in the same way.

There is another perhaps lesser known problem. How do you react to comrades who come back wounded? That was our day to day at the FOB, or forward operating base. We took care of our people. On a combat team, medical personnel are not seen as separate. They are truly part of the combat team. Those people weren't part of the medical team, but they were part of the infantry, armoured personnel. When something happened to one of us, it was extremely tough.

Something I can recall vividly, and I describe it in my first book, is the agonizing feeling I had when I knew that a major operation would result in our members' incurring severe injuries in a few minutes. It was my first mass call, my first event with a large number of wounded. At first, I was very rattled, but I can tell you that my training kicked in and I went into automatic pilot. And the same goes for my young nurses, even though their training was shorter than mine but excellent regardless. When a wounded member arrives, your training kicks in and you respond almost automatically, a reflex that is absolutely vital in those situations.

[Christine Moore, NDP, Abitibi—Témiscamingue, QC]

Yes, when you are trained to treat a patient, you are usually able to do what needs to be done in the middle of the action. When the patient isn't doing well, when the heart monitor goes off, you can handle it. But what about afterwards, when the pressure subsides, how can you be sure that those people will be able to provide care for six months? Those are tough situations, but those people have to be able to continue providing treatment and doing their job. They build a shell around themselves. There is a shortage of medical personnel. So it's crucial that we make sure the personnel we do have remains healthy. The textbooks don't teach them how to react and cope with the fact that they are treating people they know personally. How are those individuals supported?

[Maj Ray Wiss]

I can't tell you what it was like in other combat teams, but when I went to Afghanistan, it was my third war. I took part in two others with Doctors Without Borders. I was 48 the first time. I was always very careful.

The benefit of the medical system in periods of war is that there isn't always an operation going on. There are times when you have a lot of wounded. Then things calm down for a good while. Whether we had 10 people wounded or only 1, I would always have a meeting with my medical team to debrief so they could vent and talk about what had happened. It certainly had an educational dimension. I was very helpful as an educator in emergency medicine. I had a lot to teach them and I made sure that we talked about situations they had had a hard time with, even in the educational context.

Let's use the example of facial injuries. Those are incredibly difficult to deal with because our face defines us to other human beings. It is staggering just how emotionally difficult facial injuries are. When we were dealing with those injuries, I made sure to talk to the personnel and acknowledge how hard those situations were. It was an opportunity for them to process and for their emotions to stabilize, to use a medical term.

That's what you do in those situations. I would even say you have much more time for that kind of thing in the field than you do in an emergency room, where you move from one patient right to the next.