Where do we start?
In the past 15 years, the Canadian Forces, like all NATO armies, has experienced a higher number of injuries and health conditions associated with increased operational tempo, aging and the changing nature of the mission. In recent years, the CF has seen more seriously wounded personnel who suffer complex battlefield injuries – traumatic limb amputation, life-altering limb injury, traumatic brain injury, depressive disorders, PTSD, and poly-trauma.
New conflicts are more demanding and complex. They require a high level of mental and physical preparation of our soldiers but some collateral damages cannot be avoided.
The best possible care for military members and veterans calls for efficient management of the conditions described above. We need to ensure our own practices offer both high quality and cost-effective care. The recent creation of the Canadian Institute of Military and Veteran Health Research (CIMVHR) promises the necessary collaboration to ensure that military members and veterans receive care based on the latest research from across Canada.
When adding resources, the Canadian Forces Health Services must ensure that allocations, both in quantity and quality, are based on the true and known profiles and incidences of injuries. Research can help.
First, research can provide a broad and strategized review of the impact of all health conditions and injuries with the objectives of: 1) developing support for a strategic plan of capturing necessary information; 2) sharing information to facilitate integrated approaches; 3) developing integrated performance measurement strategies; and 4) identifying research priorities.
Many qualified researchers and experts in Canada could be involved in this research so we need a common voice that understands CF needs and priorities and can unite these efforts. Clinicians, researchers, operators, academics, military and civilians need to work closely together. Research priorities must not be dictated by personal interests or by specific ambitions of universities and research centres.
Second, research should incorporate a greater focus on the broad determinants of health for military and veterans. We believe that if the CIMVHR is structured carefully and focuses on national programming, it could be used as a formidable leverage for research. Also, with the establishment of the first Chair in clinical rehabilitation for the Canadian military and veterans by the University of Alberta, there is a unique opportunity to plan a research program that will affect the quality, effectiveness and cost of rehabilitation services.
Research must aim to facilitate high quality, evidence-based research initiatives to produce evidence that guides decisions consistent with CF values and processes. A common effort – well coordinated between the CIMVHR, the clinical rehabilitation chair, and the CFHS HQ – would provide a formidable group to offer optimal rehabilitation to our soldiers and veterans.
Third, research should focus more on promotion, prevention and appropriate investments in the broad determinants of health to improve care and control costs over the long term. Research should also focus on the development of a national surveillance/research tool looking into such areas as resource allocation, including personnel, material/equipment and financial resources, and research priorities, that could provide CFHS with data to identify ways of improving services.
Finally, we strongly believe that one research priority should be musculoskeletal injuries. As stated by the former U.S. Army Surgeon General, James Peake, non-battle-related injuries are “the hidden epidemic” plaguing modern armies, which suggests that prevention of such injuries, and control of associated pain, has a pivotal role in preservation of unit readiness. This increase of non-battle-related injuries is not unique to U.S. forces. In British troops stationed in Bosnia during peak levels of combat in 1996, the top four reasons for hospital admission were musculoskeletal, dermatological, gastrointestinal, and psychiatric disorders. Similarly, in Canada, MSK conditions account for more than 50 percent of all Veteran’s Affairs Pension claims with pension pay-outs exceeding $60 million annually. From the CF physiotherapy workload statistics from 2003 to 2006, an average of 26 percent of the total CF population sought physiotherapy care, with some bases reporting a percentage as high as 50 or one out of every two soldiers.
In conclusion, the CFHS must provide services to enhance and maintain operational readiness anytime, anywhere. The return of CF members to universality of services and to deployable levels of function and positive outcomes is the product of appropriate and timely medical rehabilitation. This process of physical and mental rehabilitation is unique to the military with no equivalent service or concept of operations found in the Canadian health care system, or private medicine. That is why this dedicated domain of research to the health of military and veterans, through CIMVHR, will make a difference.
Major Luc J. Hébert and LCol Peter Rowe are with the Directorate of Medical Policy, Canadian Forces Health Services Group.