HMCS CHICOUTIMI Health Surveillance Study
The fire onboard Her Majesty's Canadian Ship (HMCS) CHICOUTIMI on 5 October 2004 resulted in one death as well as smoke-related lung injuries in a number of the 56 surviving crewmembers. Initial medical assessments and care of the crew, as well as an environmental health and safety investigation of the submarine after the fire, was provided by Canadian Forces Health Services. Crewmembers received extra medical follow-up during the year after the fire, as well as additional post-deployment mental health screenings in early 2005. After that, the crew received regular care from their military and civilian primary health care providers.
This study identifies a number of health effects that were recorded in the military medical records of HMCS CHICOUTIMI crewmembers (CC) in the five years before the fire to the five years after the fire. These findings were then compared to those of a random group of unexposed Royal Canadian Navy submariners (Controls) for the same time periods. Similarly, the health of the Faslane Care & Custody Team (CCT) was included in the study as a second group of personnel who had possible exposure to the interior of the boat after the fire. Both the CCT and Controls received regular standard medical care during the study period with no additional medical screening.
Healthcare professionals, who were trained and monitored, conducted the medical records review. The data collection process by individual reviewers and between reviewers was checked for consistency and accuracy.
Results indicate that the short to medium term post-fire medical outcomes of the CC were different from the other two submariner groups. The significant findings included a number of health effects. For example, the CC had more blocks of sick leave of at least three days in length (SL) and were more likely to be limited in their ability to do their work (have medical employment limitations(s) or (MEL(s)). Indeed, the CC were medically unfit to go to sea on about 26% of their post-fire service days (due to either SL or MELs), compared to around 5% of the days for Controls.
Although low to begin with, the CCT had a higher rate of days in the “sick leave or any type of MEL” category than Controls, but there was no significant difference between the two in the number of days in the “lost to sick leave or Unfit Sub/Unfit Along-side MEL” category after the fire.
The medical cause most often associated with SL and MELs was psychiatric, both in terms of the percentage of the CC and the proportion of work days affected. Post Traumatic Stress Disorder (PTSD) was the most common new medical condition diagnosed. It was found in 60% of the CC and occurred at approximately 45 times greater rate than that found in unexposed Controls. New cases of depression were reported to have occurred after the fire in 15% of the CC, compared to 2% of the Controls.
The second most common medical condition among the CC after the fire was new onset breathing problems (asthma/reactive airways disease), occurring in 21%. This represented a 10 times greater rate than in Controls. Slight increases in muscle and joint/spine conditions were noted in the CC group but the numbers were not statistically different when compared to the Controls or the CCT.
There were no observed differences in the numbers of the above major health outcomes between the CCT and Controls.
As of 31 December 2009, over one third (35%) of the CC had been released from the CAF, which was similar to the number released in the Controls (34%). A larger number of the CC released medically, 12.5%, as compared with only 5.3% of the Controls. The 4.8% of the CCT who released was not statistically different from the Controls.
No cancers were reported in the CC or the CCT during the study period. As detailed in a previous report, it was felt unlikely that the CC exposure would increase their chances of developing cancer above that of Canadian general population background levels.Footnote 1
Together the data and results identify, document, and provide insights into the short to medium term health effects associated with the HMCS CHICOUTIMI fire. The major medical conditions noted above were evident clinically and statistically, given the large proportion of members affected (effect size). Ongoing medical support and medical care of these submariners will occur through the usual health care systems (CF H Svcs clinics for CAF members and the provincial health care systems for those who have released), and the Veterans Affairs claims process.
As for further stages of the study, as outlined in two calculationsFootnote 2,Footnote 3 used to plan the study (statistical power calculations), making sound statistical conclusions about medical conditions that occur infrequently is limited by the small number of crew members. As more study subjects leave the military and transition to civilian medical care it will be more challenging, for a variety of reasons, to accurately count health outcomes from community medical records. This would make subsequent stages of the study less effective in providing follow-up to the CC or CCT. It is recommended that the medical monitoring of key outcomes would be more effectively done through the now established Canadian Forces Cancer and Mortality Study IIFootnote 4, which is based on the most complete data sources for this information.
- Dr. Steve TsekrekosFootnote 5, Occupational Medicine Specialist, who executed the study, performed the data analysis, and developed the initial draft of the study.
- Dr. Gregory Banta, Occupational Medicine Physician, who coordinated the completion of the final copy of the study.
- Dr. Jeff Whitehead, Environmental & Occupational Health Surveillance/Epidemiology Head, who provided a post hoc power calculation.
- François Thériault, Health Surveillance Analyst, who provided epidemiology support to the analysis of the data.
Medical File Reviewers:
- Ms. Evelyn James
- Ms. Julie Lanouette
- Ms. Pauline Sinkinson
- Ms. Anik Resendes, Administrative Support
- Ms. Nathalie Romain, Administrative Support
- Ms. Katherine MacGillivray, Program Co-ordinator
Health Records Clerk:
- Ms. Jill Greer
Pharmacy Profile Development:
- Ms. Julie Pratt
- Ms. Janice Ma
Study Document Reviewers:
- LCol Paul Eagan, A/Director Force Health Protection
- LCol Serge Blier, Occupational & Environmental Health Section Head, DFHP
- Dr. Steve Schofield, Senior Advisor of Pest Management & Entomology, DFHP
- Dr. Janick Lalonde, Senior Advisor of Toxicology, DFHP
Substantial credit goes to the crew of HMCS CHICOUTIMI. Without their participation and the larger submariner community of the Royal Canadian Navy, this study would not have been possible.
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