The Future of Healthcare for Deployed Forces

Author: Haifa Al-Aryan
Canadian Forces Health Services Group

Sometimes, change can be a good thing. That’s how the folks at the Canadian Forces Health Services Group (CFHSG) views their Modernization Initiative, a commitment to providing high quality patient care all the while adapting and improving key elements within the organization. The improvements aim to revamp both the care Canadian Armed Forces (CAF) members receive in-garrison, as well as when deployed on operations.

In line with our allies, the CFHSG is developing capabilities to place greater clinical competencies further forward in the battlespace than has ever been the case. A prime example is the new Forward Aeromedical Evacuation (Fwd AE) capability known as the Canadian Medical Emergency Response Team (CMERT). A scalable capability, the CMERT can operate from a two Medical Technician (Med Tech) team aboard a CH 146 Griffin, or up to the full complement of a four person team to include a General Duty Medical Officer Emergency Medicine (GDMO EM), a Critical Care Nursing Officer, and two Med Techs on a CH 147F Chinook.

The full CMERT capability provides advanced pre-hospital care including damage control resuscitation involving blood and advanced airway management. Depending on the operational and environmental conditions, Fwd AE will pick up casualties as far forward as tactically possible. The speed, range and flexibility of the helicopters, combined with the clinical capabilities of the CMERT allows for faster evacuation over longer distances than is possible with ground based evacuation.

Fwd AE was the CAF’s primary role of the recently concluded Operation PRESENCE in Mali.

In September 2018, Canada conducted its first successful medical evacuation and continued to perform medical evacuation operations until August 2019, before they handed over to the Romanians. As the mission has officially ended, the operations are currently being reviewed in order to identify lessons to properly adjust equipment, clinical and military training, and key clinical skills. Building on the successes of the Mali mission, the Chief of Defence Staff has directed that Fwd AE will become a standing capability for the CAF.

The Fwd AE initiative offers exciting new opportunities for GDMO EMs, Critical Care Nurses and Med Techs. The CMERT operates in a high stress environment which demands a high level of physical and mental fitness. In addition to enhanced clinical skills sets required by team personnel, they must complete a series of Royal Canadian Air Force (RCAF) mandated qualifications such as the Survival, Evasion, Resistance and Escape training.

Under the Defense Team Establishment Plan, the CFHSG will gain at least 16 positions specifically for the Fwd AE capability. The first eight positions have been approved to be created in 2020, with the remaining eight positions planned for 2021. Once the positions are created, the intent is that the physicians and nurses will primarily be employed in civilian hospitals in order to maintain their life-saving clinical skills. This will be similar to how our medical specialists are managed.

In order to maintain the CMERT capability for the long term, the RCAF Surgeon in conjunction with 2 Canadian Air Division is developing a Canadian version of the Dutch Air Force’s Operational Readiness Aeromedical Course which was used to prepare teams for the Mali mission.

In the end, whether the CFHSG is re-aligning structure or creating new capacity so as to remain relevant and responsive, the devotion to high quality care remains the same; and so, Fwd AE is an excellent example of how change can be a good thing.