PA PROFILE • BY NICK, CCPA

Life as a Canadian Military Physician Assistant

Practice as a Canadian Military Physician Assistant

From Anne: Nick is a Physician Assistant with the Canadian Armed Forces. He is French Canadian. He has volunteered with CAPA-ACAM, and we’ve met a few times at past CAPA Annual Conferences.

He is currently on a mission overseas, and his current location is classified. I’ve confirmed with Nick hat the pictures shared here are de-classified and are okay to share.

Life as a Military Physician Assistant

How I become a Physician Assistant with the Canadian Armed Forces

Like the majority of Physician Assistants who are currently serving in the Canadian Armed Forces (CAF), I started my career as a Medical Technician (AKA- Medic) 17 years ago with the Canadian Army. During this time I have been employed as both, a Med-Tech and a Physician Assistant (PA) in various military and civilian settings. While serving in my 12th year as a Medical Technician (Med-Tech), I was given the opportunity to become a Physician Assistant through a CAF meriting system. This system is based on set medical and professional criteria, only those whom have the greatest chances of being successful within the military’s 2 year program are selected. If you decide to take the PA route you go through PA education at the Canadian Forces Health Services Academy (CFHSA) located at Canadian Forces Base (CFB) in Borden, Ontario. Once you have successfully completed the CAF PA program you are required to write the CAPA Certification exam which if you are successful you become a Physician Assistant Officer.

Life as a Canadian Military Physician Assistant

Work life in the military will vary depending on your practice setting and where you have been deployed. For example, a PA posted to Halifax may work on a ship and be deployed by the navy where they will run a small clinic in the middle of the ocean.  This would be very different from a PA who works at CFB Petawawa  where they may work with new recruits, which is different from a PA that works with the infantry and troops in armored vehicles. On each Garrison (base) we do a lot of primary care, however this changes with our specific elements, where we work and where we get deployed.

If I am posted to a clinic where new recruits are put through basic training, day-to-day life would consist of working in an essential primary care clinic. Where we see a lot of upper respiratory issues, A LOT of musculoskeletal injuries that may be sustained during training, as well as psychiatric issues. With new military recruits you are taking people from a civilian life and placing them into the world of the military, this transition may not be a for everyone.

Working in the Navy – After completing the military PA Program through Borden, and successfully passing the Canadian PA Certification Exam through PACCC, I was deployed with the Navy. Before being posted to the Navy I did not have a lot of experience on a ship but had taken the necessary training for Navy Medicine. One of my deployments with the Navy was four months long where we conducted counter-narcotics operations in the Caribbean.

“The Royal Canadian Navy (RCN) is a highly adaptable and flexible force. While being Canada’s outer line of defence, it conducts sovereignty patrols and search and rescue operations. It also assists other government departments in disaster relief, law enforcement, fishery and drug patrols. The Navy supports Canadian foreign policy by providing humanitarian assistance, and participating in peace support operations and maritime security operations.” https://www.canada.ca/en/department-national-defence/services/caf-jobs/career-options/navy-army-air.html

Working in the Canadian Army – There are some similarities to military medicine and rural medicine – in that the resources available to you to investigate and treat patients are not endless like a university medical centre. This is one of the things I enjoy most about being a military PA – you have to make use of the resources available to you based on the element you are working in, in order to stay on top your game.

“The Canadian Army provides trained, combat-ready, agile and quickly responsive troops to meet Canada’s defence objectives. These troops respond to conflicts across the globe to fight for freedom, stability and human rights. The Army also sends soldiers and equipment to assist countries that have suffered natural disasters.”

Royal Canadian Air Forces –

“The Royal Canadian Air Force protects Canadians, Canadian sovereignty and Canadian interests at home and abroad. The Air Force defends Canadian airspace and, working with the Navy, Army and other government departments, conducts maritime and northern patrols, search and rescue missions, and intercepts of vessels carrying illegal drugs. The RCAF also airlifts military personnel and supplies, and moves disaster relief supplies to regions in need. Abroad, combat-ready forces take an active role in multinational missions, representing Canada’s interests and helping maintain global stability.”

Life of a Canadian Military Physician Assistant

Do PAs work on the Frontlines of Combat?

The frontline is usually where the medical technicians are found. At present, all Canadian PAs were former medics and have experience in the front line. However, PAs are found on the “forward operating bases”, which are away from the big bases and the front lines. You usually should not find a PA in the front lines as this is where we are not the most efficient. You are more efficient as a PA in a protected medical environment.  Here is where you will find a PA, often with no physician on site but available via phone. This does happen a lot and essentially – you’re it.

Where Do Canadian Military PAs Practice and Specialize?

Canadian military PAs specialize in areas like Chemical, Biological, Radiation, Nuclear (CBRN) counter measures, trauma,Tactical Combat Casualty Care (TCCC), mass casualty  incidents, Naval medicine, Dive medicine, and Flight/Aviation/Aerospace Medicine.

Some CAF PAs take on additional areas of specialization with training lasting over weeks to months in areas such as:

  • Chemical, Biological, Radiation, Nuclear (CBRN medicine) – here you learn to take protective measures where there may be chemical, biological radiological and nuclear warfare/this may include situations with terrorism.
  • Naval Medicine
  • Dive Medicine
  • Flight/Aviation/Aerospace Medicine
  • Disaster Assistance Response Team (DART)
  • Mass Casualty Incidents
  • Trauma and Tactical Casualty Care

I elaborate on the different practice settings below.

What Conditions do military PAs see?

Across all of the different practice settings for military PAs – including clinics for recruits, navy medicine, and aviation medicine – 95% of our job is primary care. Our troops present with gastrointestinal issues, genitourinary issues, musculoskeletal complaints, etc. The big traumas you tend to see in the movies only represent perhaps 5% of our work when you think about day to day medicine. YES it does happen, but it is not a daily occurrence. Our job as military PAs is to be prepared for these things. This can be challenging as we are not exposed to these on a regular basis, e.g. mass casualty events. However when it does happen, we have to be ready and prepared to respond to it.

Navy Medicine:

  • In the Navy, you see a LOT of sea sickness within the first 72 hours of launching. I personally had never been that sick in my life, and I literally vomited for hours. Despite this I still had to treat patients. You get really good at prescribing antiemetics.
  • When working in the navy there are a lot of ladders and hatches. As a result, we do see a lot of MSK and head injuries related to falling off ladders and having the hatch top hitting heads.
  • While onboard PAs function primarily as primary care providers but do take care of acute conditions that present while deployed.
  • When the troops are at sea it may be many months at a time. PAs are often seeing, and assessing cardiac issues. Some of my PA colleagues have treated STEMIs while employed onboard RCN vessels.

Canadian Military PAsField Combat Medicine

  • This involves providing acute trauma care to front line soldiers that sustain injuries which may take place on the battlefield
  • Some conditions we come across include blast injuries from improvised explosive devices (IED), amputation, penetrating wounds (such as gunshot wounds) and head wounds.
  • Some of my PA colleagues have placed multiple chest tubes in patients, treated bad traumas, exsanguinations and stabilized unstable patients on the battlefield before sending them rearwards for treatment where surgeons are available to provide stabilizing care.
  • Psychiatry is a large component of military medicine, as anyone – including PAs, medical technicians, medical officers, and other staff – may struggle with nightmares and PTSD. The advantage of working as a PA in this setting is that many of us are embedded with the troops which at times may place us on the front lines with some of our colleagues such as medics. During times like these we are provided the opportunity to build a rapport with many of the soldiers. While forward deployed some of the soldiers open up to us, as this seems to help them heal, or at least improve somewhat. For instance, one of my colleagues was involved in an incident in Kandahar in the past, and with recent occurrences happening in Kabul this brought back some difficult memories. As a result, he came to me to discuss his concerns. PAs can play a big role in helping to support our soldiers to ensure they have a safe working environment.

Disaster Assistance Response Team (DART)

  • DART is a team from the Canadian Arm Forces who respond to both, domestic, and internationally to regions affected by natural disasters. The DART team includes a team of medical personnel of which PAs can be a part.  The DART provides food, water, as well as the treatment of civilian patients with a variety of ailments.
  • As a result this medical team may treat personnel outside of adult men and women which we normally see in a CAF clinic. Oftentimes you are treating children which as a result we require the PALS certification. Some of my PA colleagues have treated pregnant women including performing deliveries during the Haiti relief operations.
  • Past Operations: *
    • Honduras – Hurricane Mitch (Category 5), 1998
    • Turkey – 7.4 magnitude earthquake affecting north-west Turkey , 1999
    • Sri Lanka – Indian Ocean Earthquake and Tsunami, 2004
    • Pakistan – 7.6 magnitude Kasmir eqarthquake , 2005
    • Haiti – Earthquake relief operations,, 2010 http://www.nationalpost.com/news/story.html?id=2455966
    • Philippines – Typhoon Haiyan 2013

_________

Source: https://en.wikipedia.org/wiki/Disaster_Assistance_Response_Team

Continuing Professional Development in the Military

Like civilian PAs we have to complete continuing professional development hours. We have a lot of different courses available to us covering trauma resuscitation which is offered in Vancouver and through McGill.  Military PAs also need to re-qualify in these domains regularly as a result, we do many hours in different emergency settings. Courses like ACLS and ATLS are the basic foundations, with a few “modifications” to protocols for the military setting. For instance, in ATLS it is taught that airway is first. However in a military setting massive bleeding is always our first concern. However the military approach to trauma and resuscitation is very similar to what you would experience in a trauma bay in the civilian world.

Pros and Cons of working in the Military

I have always enjoyed the diversity of experiences you get with working in the military. I have worked everywhere from a basic training environment primarily in a clinic. I have also worked in the Canadian army, deployed in small teams, and I have also worked in the Royal Canadian Navy. Every day is not necessarily full of excitement, sometimes it can get repetitive if you are in one posting for several months. However, you might be posted somewhere completely different (e.g. switched to a posting requiring knowledge of diving medicine or aeromedical evacuations).

Military PAs do not move around as frequently as many people think. To date my family has moved around once every 4 to 6 years depending on where we are posted. There are some international deployments with Canadian PAs stationed in Belgium and Germany, however the majority of CAF PA positions are in Canada.

When you are deployed overseas, it may feel lonely from time to time.

A downside is that you do not necessarily have all medical resources or technology available to you. Although it would be ideal to have a full lab available just down the corridor – that is not always a reality. You really have to tailor your medicine to what is available to you. You have to develop your clinical acumen and trust your clinical judgement, this can be a big challenge.

Treating Civilians

Providing medical care in the military is primarily providing primary care, with a small percentage being acute care and trauma. We usually treat military members. However we have a “duty of care”, which is, anything that involves emergencies of life, limb or eyesight we will treat – whether military or civilian.

The way the military works for primary care is; usually we treat  military members however we will also treat civilians including  kids, and pregnant woman.  I’ve had PA colleagues deliver babies in Haiti who were part of the Disaster Assistance Response Team (DART).

Life as a Canadian Military PA

Can Civilian PAs apply for Military PA positions?

At this time civilian trained Physician Assistants cannot apply for military Physician Assistant positions. You have to gain experience as a medical technician (a.k.a. medic) first.  However, this may change in the future. The PA profession is currently sourced from our medical technicians in the military.

On April 2017, the Canadian Armed Forces mass commissioned PA officers, resulting in Non-Commissioned Members (NCM) becoming commissioned officers. This was a big recognition of what we accomplished by completing our PA program not to mention something that military PAs were hoping for (CFB Lookout/ Navy News).

When PAs were NCMs they were primarily tasked with completing administrative duties and leadership roles which took PAs away from the clinics. The transformation of NCM PAs to commissioned members (officers) of the Canadian Armed Forces means that these leadership, administrative tasks will be reduced.

Military Physician Assistants

Canadian Forces Health Services began a mass commissioning of Physician Assistants (PAs) as part of a monumental transformation of a non-commissioned member occupation to a commissioned officer trade (CFB Lookout / Navy news)

Do you get to pick where you are positioned?

Where you are posted or deployed depends on the needs of the CAF first. At times you can have a say in where you get to be deployed /posted. You can make suggestions based on positions that are open, however this may not be true all of the time. I have personally had an opportunity to have an input for where all of my postings to date have been.

PA/MD Relationship in the Military

Often when you’re in different elements as a PA, you are the senior medical authority with a supervising physician who may be hundreds of miles away, but available via satellite phone. We are not required to check in daily or after every patient, we only call if there is an issue or if we require guidance.

Communicating with Friends & Family while Overseas

On my first tour in 2007 we had satellite phones and a designated 25 minutes per week to speak with your friends and family. Unfortunately the internet connection was very poor.

Things have changed since then. Nowadays we usually have access to a great wi-fi connection making it easier to communicate with home. Not all deployments are treated equally in terms of frequency of communication, however right now, I can talk to my wife every day.

Characteristics of PAs who do well in the military

A PA who would do well in a military setting would include someone who is flexible, versatile and does not fear change. The majority of PAs currently serving have a Type A Personality – whereby they are ambitious, organized, enjoy learning, and are not afraid to take on challenges.

Do PAs leave the military?

All CAF Physician Assistants are Canadian Certified Physician Assistants (CCPAs), as a result we are able to transition to a civilian setting if and when the time comes. A lot of ex-CAF PAs are currently working with private corporations on oil rigs up north, and different security organizations around the world. So I guess the answer is; yes, some of our PAs decide to leave the military and find civilian jobs as well.

Have questions about being a military PA? Let us know in the comments below!