ARCHIVED - Medical Support to Canadian Forces Operations

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Backgrounder / August 10, 1999 / Project number: BG-99.082

Today's military operations have become increasingly complex and dangerous. Since 1949, more than 100,000 Canadian Forces (CF) members have served in areas outside Canada in various peacekeeping and peacemaking operations. While these roles have not necessarily required participation in active combat operations, members who have served in these areas may be exposed to hazardous conditions not normally associated with peacetime service. In order to minimise the risks and potential health impact of operations, the Canadian Forces employs a number of medical procedures before, during and after a mission.

Before Deployment

Before each CF member is deployed on a mission, his/her medical file is reviewed. Where a member has a valid Periodic Health Examination (PHE) an individual will fill out a health questionnaire (form CF 2078). A medical officer will review the member's medical file and form CF 2078 to ensure that there are no conditions that may warrant a complete medical examination. Where the member does not have a valid PHE, a complete medical examination is done. This is to establish that CF members going on deployments are in good physical condition to carry out their mission.

Medical information in the region of the deployment is gathered and analyzed by the Medical Intelligence Section at Canadian Forces Medical Group Headquarters (CFMGHQ) in Ottawa. The up-to-date, comprehensive and accurate information is obtained from public sources, various health organisations and our Allies. It identifies concerns such as air pollution, altitude sickness, local communicable disease risks and immunization requirements, and medical resources available in-theatre (from host nation or allied forces), to name a few.

During Deployment

Every battalion-sized unit deploys with a Preventative Medicine Technician (P Med Tech). This individual is responsible for advising the Unit Medical Officer (UMO) about the public health of the unit. The P Med Tech recommends to the UMO ways to maintain the over-all state of hygiene within the unit, and to keep the environment as safe as possible. He or she also assesses the health hazards that CF members may be exposed to while they are in theatre.

 During the mission, the UMO is responsible for the medical well being of the unit, treating injuries and medical ailments as required. The UMO records information on a temporary medical file which is incorporated into the member's main medical file upon return to Canada.

After Deployment

Current policy states that at the end of a deployment, the UMO sees each member of the unit that served overseas. At this time the member makes a declaration of illness or injury. If a member declares that he or she has been injured or had an illness, that member must receive a full medical exam within two working days of his/her return home. However, if the member does not report an injury or illness, a full medical examination is required within 30 days upon return to Canada.

Caring for Injured Personnel, Veterans, and Retirees

Canadians who join the CF accept unlimited liability as a condition of service. No matter where they are serving, members must always be mentally and physically prepared to subject themselves to danger, uncertainty, disease, job-related stress, injury, and possibly death.

In return for this commitment, the Department of National Defence (DND) has an obligation to see that all sick and injured personnel receive consistent and comprehensive medical support while they are serving, and to support them when they leave the CF. Furthermore, recognising that the injury or death of a CF member has an immediate and traumatic impact on the financial and psychological well-being of his/her family, it is essential to provide the proper care to those affected in a humane and timely manner.

Recent Initiatives to Improving Heath Care for CF Members

In April 1998, DND established a Disability Compensation Information Advisory Cell to provide information and help to CF members who have been released, or are about to be released, for disability reasons.

In early 1998, the Department announced that military personnel medically released because of injury while in a special duty area, such as during UN missions, would be given priority for employment in the Public Service of Canada.

DND established four new Post-Deployment Regional Health Clinics at Esquimalt, Edmonton, Valcartier, and Halifax in February 1998. These were in addition to the Clinic already established in Ottawa. All five clinics are accessible to CF members both serving and retired that feel they may have a health concern related to an operation.

Since 1996, DND has placed significant emphasis on coordinating with Veterans Affairs Canada (VAC) and the Royal Canadian Legion to ensure a continuum of care is provided to CF members released for medical reasons who may be eligible for disability benefits.

In a unique interdepartmental partnership, DND and VAC are working together to study the recommendations of the Standing Committee on National Defence and Veteran's Affairs report on Quality of Life in the CF. The ultimate beneficiaries of this joint approach will be CF members, former members, and their families.

As a result of this partnership, The Care of Injured Personnel and their Families Review, The Study of the Treatment of Members Released from the CF on Medical Grounds, and the SCONDVA report, DND and Veterans Affairs are in the process of implementing many new initiatives. These initiatives include the following:

  • On April 1, 1999, the new DND-VAC Centre for the Support of Injured and Retired Members and their Families was established. The Centre’s staff provide answers, referrals, and assistance. They are also responsible for all casualty information in the CF. The Centre is also ensuring that mid and long-term follow-up for all CF injured personnel takes place, even after release.
  • A toll-free help line (1-800-883-6094) provides easy access to the Centre, where injured and non-injured members can receive information and assistance to address possible concerns about their military medical treatment.
  • Medical-evacuation and medical-repatriation procedures and assistance to injured CF members are more clearly defined. The requirement to establish and staff national medical liaison teams for foreign operations is mandatory and will be enforced.
  • In May of 1999, DND introduced the CF Member Assistance Program. This program established a completely confidential assistance and social counselling service for CF personnel and their families. Under the terms of this program, CF members or their families can access a counsellor at any time of the day or night via a 1-800 telephone number. Based on this initial telephone contact, the caller will be referred to an appropriate counsellor in their area for a more in-depth, face-to-face assessment.

New Initiatives

  • In addition to the already operating Post-Deployment Clinics, five specialised Operational Behavioural Sciences Centres will be fully functional by September of this year. These centres will be located in Halifax, Valcartier, Ottawa, Edmonton, and Esquimalt, and be staffed by a team of specialised care providers whose mandate will be to focus on those personnel suffering from psychological, emotional and spiritual effects of modern era military operations.
  • Additional resources will be directed to improving the occupational and environmental medicine capabilities of the CF. Once these changes are implemented, a typical operation would go like this:

Prior to any deployment, an environmental team consisting of a Certified Industrial Hygienist, a P Med Tech, and an environmental engineer would travel with the reconnaissance team and confirm the area's geography, various environmental conditions including any environmental threats such as industrial waste and communicable disease, and the condition and state of available infrastructure. The report would serve as the basis for advising the Unit Medical Officer of health risks in the deployment area.

The P Med Tech focuses on hygiene, sanitation and pest control to keep communicable disease to a minimum through education and inspection. The Certified Industrial Hygienist analyzes the concentration of chemical product and assesses the information in relation to the health of individuals. An epidemiologist keeps track of possible exposures and how that may affect group or individual health outcomes.

At any time during the deployment and environmental team is on site and able to make a health-risk assessment. Whenever a potential health risk is identified, it is officially recorded, and the patient's name registered in a database dedicated to tracking potential exposure to contaminants.

Whenever a CF member has a doubt on whether his/her condition is linked to possible exposure to a contaminant on a mission, an independent toxicologist would then conduct a Human Health Risk Assessment. The toxicologist will base his/her conclusions on data included in the Hazardous Exposure Data Base and various samples collected on site. The likelihood of the patient’s symptoms being linked to the medical condition would then be annotated on the medical file.

Chief Review Services (CRS) Review of Canadian Forces Medical Group

In January 1999, the Chief of the Defence Staff directed the CRS to examine the Canadian Forces Medical Group (CFMG).

This review will be a comprehensive and independent examination of the quality and continuity of care for CF members. The Chief of Review Services will evaluate CFMG's ability to provide services and recommend areas for improvement.

The CFMG has not been the subject of a major review since the renewal and restructuring exercise initiated by Operation PHOENIX in 1994. The aim of that restructuring was to provide a more operationally-focused medical service that could achieve its objectives with fewer uniformed members. A final report from CRS is due in the fall of 1999.

Conclusion

Military service is an inherently dangerous occupation, whether a member is serving in Canada or abroad. Military service requires Canadian Forces members to remain in top physical and mental health so they can complete their mission.

Medical care of all members is a key priority for the Canadian Forces. Commanders on the ground look to take every appropriate step necessary to reduce risk of injury to members serving on deployments. More importantly, where members are injured, DND is committed to see that they are well taken care of. Servicemen and servicewomen must be confident that if they are injured or die while on duty, they and/or their family will be treated with dignity, fairness, and compassion.

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