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Medical Rehabilitation and Reintegration of
Wounded Canadian Soldiers
A primary care perspective
Michael Crouzat MD, CCFP(SEM)
Diploma Sport and Exercise Medicine
Flight Surgeon
Advanced Dive Medical Officer
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Overview
• Background
• Soldiers’ stories
• Phases of reintegration
• Lessons learned
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Personal Background
• No military experience
• Began November 2000
• Civilian General Duty Medical Officer
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Background
• Town of Petawawa
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Background
• Garrison Petawawa
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Background
• Clinical practice changed following 911
• Changed dramatically in the summer 2006
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Soldiers’ Stories
• Individuals behind the injuries
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MCpl Trauner (Infantry)
• IED blast injury Dec 5th 2008-Aghanistan
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MCpl Trauner
• Left Transfemoral amputation
• Right Transtibial amputation
• Right thumb injury
• Left hand/forearm reconstruction
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MCpl Trauner
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Sgt Nielsen (Infantry)
• IED blast injury July 1st 2010-Afghanistan
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Sgt Nielsen
• Occurred during dismounted patrol
• Left transfemoral amputation
• Severe left arm injury
• Bilateral TM rupture
• Left thoracic injury
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Sgt McFadden
(Combat Engineer)
• IED blast November 24, 2010-Afganistan
• While disarming an IED
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Sgt McFadden
• Left Transradial amputation
• Distal right index amputation
• Significant Dental injury
• Left TM rupture
• Multiple shrapnel injuries
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Cpl B. (Special Forces Operator)
• Gun shot wound Left leg 2015-Iraq
• FFI resulting in one fatality
• Comminuted left femoral fracture
• Significant Soft tissue injury
• Left Femoral superficialis artery injury
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Cpl B.
• Required External fixation
• Prolonged intubation-28 days
• Femoral-femoral bypass venous graft
• Total of 9 surgeries
• Complicated by DVT/Infection
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Sgt Daniels (Infantry)
• T11 Blowout fracture Parachute landing accident-2005
• Permanent/complete paraplegic
• Injured prior to many support program being available
• Sped up his release process to begin school
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New Chapter
• All these stories are factual, but markedly incomplete
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MCpl Trauner
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Sgt Nielsen
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Sgt McFadden
• Retained in Canadian Forces as a Combat Engineer
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Cpl B.
• This week returned to his second Tour of Duty to Iraq
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Sgt Daniels
• Chance encounter 5 years later
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Sgt Daniels
• An unbelievable journey
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Photographic Pause
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Phases of Reintegration
• Honeymoon phase
• Physical phase
• Emotional/psychological phase
• Reconciliation
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Honeymoon phase
• Short
• Unrealistic expectations
• Pit falls of administrative promises
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Physical phase
• Takes precedent
• Focus
• Varies in duration
• Administrative snags
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Emotional / Psychological phase
• New normal
• PTSD/OSI not related to catastrophic event
• Chronic PTSD not the norm
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Emotional / Psychological phase
• Struggle with “internal narrative”
• Pre-existing co-morbidities
• “Self-medication”
• Surrounding factors
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Reconciliation phase
• Key to successful reintegration
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Reconciliation
• Resilience
• Forgiveness
• Resetting internal narrative
• Overrides disabilities
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Reconciliation
• Personality driven
• Not universal
• Co-morbid impact
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Reconciliation
• Empowering vs enabling the victim role (we play a role)
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Reconciliation and the Severely Wounded
Soldier
• Physical injuries don’t appear to reflect psychological sequelae
• Offers better environment?
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Clinical care
• Medical care
• Civilian Specialist
• Continuity of care
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Administrative and Non-Clinical support
• Area of friction
• Evolution over the Afghanistan war
• Strive to be Industry Leader
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Administrative and Non-Clinical Support
• Potential paradoxical effect
• Direct impact on medical treatment
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Medical Transition from the Canadian
Forces
• DND Case Manager
• Integrated Transition Process (ITP)
• Veterans Affair of Canada VAC
• SISIP
• Integrated Personel Support Centre (IPSC)
• Soldier On
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Retention
• Universality of Service
• Operational entity
• Long term care short comings
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Summary
• Courage to ask honest, hard questions
• Will dictate our moral obligation
• What are the right things to do
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Thank you