National Defence Committee on Oct. 25th, 2011

[Corneliu Chisu, Conservative, Pickering—Scarborough East, ON]

Thank you very much, Admiral, for the excellent presentation.

I would like to commend the Canadian Forces for the tremendous progress they've made in the area of providing care for the injured soldiers and their families. I can tell you from my personal experience in Bosnia in 2004.... I was one of the pioneers of the assisting officers situation. When a Hungarian contingent working with the Canadians had an accident, with one dead and a severely injured person, I was the only one who spoke Hungarian. So I needed to provide all the services for the families, and also the liaison with the Hungarian forces, who were just coming into Bosnia, to retrieve the body and so on.

Of course, following this, after three days of not sleeping, I became ill, so of course the care I was given by the medical services after coming back from the theatre was excellent. However, I didn't have the assistance to go through the process of recovery, rehabilitation, and reintegration.

I was well enough to deploy in Afghanistan in 2007, and I built the Role 3 hospital in which we installed the 16-slice CT scanner in 2007, instead of having the 2-slice CT scanner, and that saved lives of Canadians and allied troops.

Between 2004 and 2007, in 15 years in Bosnia we had 23 casualties, and during my deployment in eight months in 2007 we had 24 casualties. It is a great difference.

Returning to this, the assisting officer position is a very important one, to deal with families, to deal with the casualties. Can you elaborate on how this assisting officer selection process is taking place and how the training is improved from the time I took this course in 2008? I retired from the forces in 2009. I'm asking this question because of the selection of the assisting officer. He must be very strong psychologically. If you are not doing the selection correctly, in the situation interacting with the victims' families, the assisting officers can be traumatized also.

After you elaborate on the assisting officer training improvements, I will have another question. How are the medical records kept in the CF? Is there room for improvement? If a CF member accesses civilian medical services, how does the CF track down and monitor this member's treatment and well-being?

I am asking this about records transfer because I am still serving the cadets; it's very interesting. There's no conflict of interest, but the fact is that the medical file is not very easily accessible if you or a civilian is requesting.

[RAdm Andrew Smith]

I'll take a quick run at the second question first and say that the Canadian Forces health information system, the electronic health records system that we have just put in place and are rolling out, I would submit, is a world-class electronic health records system, second to none that I have ever seen. Colonel Bernier can speak to that later.

With respect to the assisting officers, as the chief of military personnel, I don't have a direct role in the selection of assisting officers. Individual units in the army, navy, or air force would identify assisting officers. That's strictly with the chain of command. What I can say is that through the director of casualty support management, who works for General Bigelow, they are intimately involved through the JPSU construct with the assisting officer training curriculum to refine that on an ongoing basis to ensure that lessons learned are folded back into that assisting officer piece.

You're absolutely right, it's a critical piece. We have learned lots, and fortunately, but regrettably, I would say, we have learned lots about the importance of assisting officers. I've witnessed that personally, and those lessons learned get folded back into the training curriculum that's provided to every assisting officer.

[The Chair, Conservative, James Bezan]

Your time has expired.

We'll move on.

Mr. Brahmi, you have the floor.

[Tarik Brahmi, NDP, Saint-Jean, QC]

Thank you, Mr. Chair.

My thanks to the witnesses for appearing today.

I heard a term in English, but unfortunately I did not get the French translation. Rear-Admiral, I think you used the term ”casualties“: 2,000 casualties.

Is that dead and injured or just injured?

[RAdm Andrew Smith]

It refers to the ill and injured specifically.

[Tarik Brahmi, NDP, Saint-Jean, QC]

So it does not include those who have been killed.

[RAdm Andrew Smith]

Not necessarily.

[Tarik Brahmi, NDP, Saint-Jean, QC]

Not necessarily, or not at all?

[RAdm Andrew Smith]

My priorities are the ill, the injured and the missing. Support for missing members mainly involves the families.

[Tarik Brahmi, NDP, Saint-Jean, QC]

My question was about the figures from Afghanistan. You mentioned 2,000 casualties. Does that mean 2,000 injured, or does it include the fallen?

[RAdm Andrew Smith]

It does not include fallen members.

[Tarik Brahmi, NDP, Saint-Jean, QC]

Fine. I just wanted to make sure about that.

I would like to continue along the same lines as RAdm Smith. He touched on the question of keeping up medical skills. I am sure that the skills needed to treat those wounded in action are different from normal medical skills.

Could you tell me whether the physicians and nurses deployed in Afghanistan will get programs that will allow them work in war zones once again and will maintain or improve those specific skills? Or are they going to come back to Canada and do completely different work?

[RAdm Andrew Smith]

The best man to answer your question is Colonel Bernier.

[Col Jean-Robert Bernier]

After their civilian training, all our medical personnel receive specialized training. So all those employees receive normal training, whatever their area, as clinicians, for example, as paramedics, as medical technicians, as surgeons or medical specialists. At the same time, they are also placed in university trauma centres in each region; that is especially the case with clinical specialists. Even in peace time, here in Canada, they continue to be exposed to very complex trauma cases. Before every deployment, they get a great deal of additional training. At the same time, they have professional training programs, such as going to conferences specifically on combat medicine. There are two training centres for trauma injuries, one in Montreal and one in Vancouver. There, all our personnel work together as a team and get additional training on combat injuries. In basic training, which is held in the school at Borden, personnel are trained to deal with disaster victims, chemical and biological weapons, tropical medicine, and so on.

Our medical technicians receive very specialized training in tactical medicine. They learn to care for war injuries in realistic combat conditions, with smoke or explosions, in the cold or dark. In addition, all medical units receive training in teamwork so that their skills are at a high level from the moment they arrive in Afghanistan, or any other theatre of war, and from the first injury they have to treat.

[Tarik Brahmi, NDP, Saint-Jean, QC]

Fine. Could we also talk about improvements to personal protective equipment, or PPE? Could you tell me about any specific recent cases where technological improvements have provided soldiers with additional protection?

[Col Jean-Robert Bernier]

We are working on a program with our three main allies, the United States, Great Britain and Australia. Canadian Forces Health Services and Defence Research and Development Canada are both involved.The program is called CASPEAN; it encompasses all our wounded and fallen in action. We carry out a precise assessment of their injuries, or causes of death, and the effects on their protective equipment or armoured vehicles. We conduct in-depth analysis, here in Canada and in cooperation with our allies, so that appropriate changes can be made to vehicle protection and personal equipment. As a result of that process, changes to armoured vehicles and personal equipment have been made.

[Tarik Brahmi, NDP, Saint-Jean, QC]

Thank you, Mr. Chair.

[The Chair, Conservative, James Bezan]

Mr. Strahl, you have the floor.

[Mark Strahl, Conservative, Chilliwack—Fraser Canyon, BC]

Thank you very much for coming to speak to us today. I want to come back to the issue of mental health.

If a soldier has an injury, breaks a leg, you can fix that up. You can patch it up. Two months later, they're back at full service. Mental illness often is a lifelong process. It can be managed, but it's not like something you can snap someone out of sometimes. You can't treat it and it's gone. There's no timeframe, often, for mental illness.

Is there a process for soldiers so that they are able to manage it and get back into serving fully operationally again? When someone has a mental illness event or seeks that help, are you looking for a cure, or is it management of the situation?

[RAdm Andrew Smith]

I would say a couple of things in response. Colonel Bernier can expand subsequently. First, I would agree with you that there is not necessarily any set timeframe. We have had people who have been fully treated and have returned to work. I know personally of many people who have been identified with any number of mental health issues and conditions who have successfully gone through a combination of clinical and non-clinical mental health treatment and returned fully fit for employment and deployment. They have indeed gone back to the operational theatre and have successfully completed the mission.

I said publicly during the Caring for our Own symposium that I now realize, given all the research we've done and our ability to categorize, that personally, when I came back from the Persian Gulf in 2002, I slipped from a green state of mental health to a yellow state and then rebounded back some months later. That was in hindsight. Having read up on it, I think it was a totally normal reaction that happens to many people.

I would say that we're looking to treat as many people as possible to bring them back to a normal state, acknowledging that there are some people, especially when you're talking about severe mental health conditions, severe post-traumatic stress disorders, and severe operational stress injuries, who will never be able to recover or be treated successfully. That's a fact. But we have had great success in treating people and returning them to service.

When I was in Afghanistan in 2010, I spoke with a mental health nurse. She had a wonderful mandate to go out into the field, on an intervention piece, and reinforce some of the training and awareness for people in the field who had incidences of anxiety. She would be there to discuss it with them, to reinforce some of the training, and, on an intervention basis, to focus them and help them deal with their anxiety to enable them to return to full service without having to be patriated out of the operational theatre. Those are some of the advancements I think we are really moving ahead with.

[Mark Strahl, Conservative, Chilliwack—Fraser Canyon, BC]

How would you say mental health treatment or awareness in the Canadian Forces compares to that of our NATO allies? Are we taking best practices from our allies and implementing them here in Canada?

[RAdm Andrew Smith]

I'm going to ask Colonel Bernier to expand.

I would put our mental health program up against any one of our allies' programs. The Road to Mental Readiness program was used as a model. It is a system the United States developed. I would submit to you objectively that our system is significantly further ahead than the United States model now. We also have the “Be the Difference” campaign that General Natynczyk launched back in 2009. It was an awareness and de-stigmatization program that has gone a large measure towards saying to people that it's all right to put your hand up, as a question earlier alluded to. When the leadership says it's okay to put your hand up, boy, you can't get a much better endorsement than that.

We've had témoignages from people who have gone through some of those terrible events and have come out the other side. I think in this country we are significantly ahead of a lot of our allies. I think part of that is because, ultimately, I would submit, Canadian society, on balance, is a far more tolerant society than many others. And I think that's a reflection of people's acceptance of mental health injuries, just like physical injuries, as part of life.

Colonel Bernier, do you care to expand on that?

[Col Jean-Robert Bernier]

The NATO research committee looks to Canada for leadership in mental health to the point that I was asked, partly for that reason, to be the chair of the NATO medical and health research committee. One of our specialists is the chair of the mild traumatic brain injury research group, and another is the mentor of the military suicide research group. NATO tends to look to us for lots of reasons, but primarily because of the comprehensiveness and the extent of our programs.

A couple of years ago, the Journal of the Royal Society of Medicine did a study of stigma in the armed forces. It found that of the major allies—Britain, Canada, the U.S., the U.K., and New Zealand—Canada had the lowest rate of mental health stigma. And the commentary included comments about the comprehensiveness of our program and that it appears to be working in many respects.

[The Chair, Conservative, James Bezan]

Thank you.

Mr. Christopherson, it's your turn.

[David Christopherson, NDP, Hamilton Centre, ON]

Thank you, Chair.

I'll defer my time to Mr. Chisholm.