Can Canada’s health system survive if we find ourselves at war?

From the Toronto Star. Not behind the paywall, which is interesting considering they usually are.

Went to check and guess what? It’s behind the paywall now- So via archive.ph

On the first night of a war games exercise meant to help Canada prepare for a possible global conflict, Russia sent drones into Poland, and NATO forces opened fire for the first time since the beginning of Russia’s war in Ukraine. Not in the game: in real life. On the elevator up to the introductory dinner at the Royal Canadian Military Institute for the sequel to the war game from last year involving Canada’s health-care system, one doctor said, “It’s not so hypothetical anymore, is it?”

One year earlier a group of health-care leaders, Canadian Armed Forces officials, and provincial government representatives completed an almost unprecedented Ontario-focused war games exercise based on a wider war in Europe involving Canadian troops. As trauma expert, NATO blood panel leader, and military surgeon Dr. Andrew Beckett put it, “the last time we did something like this was probably 1939.” To the vast majority of Canadians, and even to those in the room at the time, the idea of a society-wide war was hard to even imagine.

This time, the urgency was palpable. As the Russian war in Ukraine continues, the world is sliding into a more militaristic posture. Eastern European nations along Russia’s border — Lithuania, Poland, Latvia, Estonia — are engaged in various levels of medical wartime planning. Russia’s drone incursion into Poland in early September was followed by suspected drone incursions across Europe, shutting down major airports or seeming to map territory. Norway’s defence minister says Russia has nuclear weapons in the northern Kola Peninsula, pointed at the U.S., the U.K., and Canada, in case of war with NATO. (???)

Meanwhile, Germany is expecting to treat 1,000 wounded patients daily in the case of a wider European conflict, and is discussing the return of mandatory military service; this summer France’s health ministry directed its hospital system to prepare for potential military casualties by March 2026. 

Canada is further from Ukraine, and further behind in its preparations — for instance, the plan to use public servants as military reservists, as reported by the Ottawa Citizen, which was hastily reconsidered — which is what this war game was trying to solve. It was called Exercise Canada Paratus, and it was bigger than the first edition. There were federal officials in the room, along with a wider range of expertise: burn surgeons, rehab specialists, a flight surgeon, an airport official, emergency preparation officials, and more. It was conducted under Chatham House rule, meaning nobody’s in-game statements could be directly quoted by name; this reporter played the role of the press, pressing decision-makers with difficult questions.

Exercise Canada Paratus Post-​Exercise Report

The war games were a collaboration between the Dalla Lana School of Public Health at the University of Toronto, the CAF, the Canadian Institute for Military and Veteran Health Research, St. Michael’s Hospital, and other military-focused organizations.

Last year, the moves to relieve pressure on the hospitals mirrored COVID, because that was the only crisis playbook available, and the exercise was confined to Ontario. This time the field widened, which was appropriate: in a war the federal government would be in charge, and the whole federation would have to work together. Canada hasn’t effectively done that in generations, either.

The game presumed an average of 100 casualties per week coming home, with injuries mirroring the data from Ukraine: a huge number of both burns and traumas, a high probability of multi-drug resistant bacteria, significant traumas. There is a shortage of both burn surgeons and skin for grafts in Canada: right now most Canadian skin grafts are sourced from the United States, and as someone noted, skin cannot be donated while you are alive. Later, rehabilitation, physiotherapy, prosthetics and more would be absolutely overwhelmed, in so many ways.

But it’s the societal impact of a stream of those patients, with potentially complex and long-term needs that would impact Canada at a higher level, especially in big cities, with big hospitals. In the game Pearson Airport was knocked offline by a cyberattack, and separately, there was a terrorist attack in Ontario. The wounded had to come home on private planes, reconfigured and under national control — Canada doesn’t have enough military planes to spare. POWs were an added complication: where do you put them?

Read entirely at Archive.ph link