USU Nurse Anesthesia Students Brave Gunfire for Trauma Training Exercise at FBI Academy

USU Nurse Anesthesia Students Brave Gunfire for Trauma Training Exercise at FBI Academy

The Black Hawk helicopter lands in a field behind the FBI Academy, its main rotor sending up a massive plume of dust and grit.

A handful of Uniformed Services University (USU) Graduate School of Nursing (GSN) Registered Nurse Anesthesia students hunker down over the litter they’re carrying to protect themselves and their “patient” from the helicopter’s powerful downwash.

Given the “all-clear” signal, the team gets up and moves to the Black Hawk, staying low under the awesome power of the blades as they evacuate their casualty. The students, using hand gestures to communicate, then work with Navy Cmdr. Ken Radford, USU’s Nurse Anesthesia program director, to intubate the training mannequin, their simulated patient. The first student is successful; Radford offers them a fist bump, and it’s time for the next student to step up and give it a try.

These GSN students are taking part in the Trauma Culmex training exercise held in conjunction with the FBI’s elite Hostage Rescue Team in Quantico, Va., just days before their graduation from USU.

Radford says GSN faculty have provided training for the Hostage Rescue Team medical personnel in the past, which helped to open the door for the nurse anesthesia students to receive their own educational opportunity on the FBI Academy grounds.

“This is the first time that we’ve held this simulated trauma experience so this is an incredible opportunity for them to round out their training,” Radford says.

The event was conceptualized by Dr. Matthew Welder, special assistant to the USU President for operational medicine and Radford, and executed by Air Force Lt. Col. Janet Sims, director for Simulation and Navy Lt. Cmdr. Lauren Suszan, director of Clinical Education, for the RNA program at USU.

The Trauma Culmex was developed to fulfill the registered nurse anesthesia student trauma simulation curriculum requirement in their last semester of clinical education. Students take part in training and exercises focused on providing care in austere environments for both injured service members and military working dogs.

Radford says providing his students with a chance to close out their training with the event helps to get them in the right mindset for an operational deployment.

“Our mission is to train anesthesia providers that can provide anesthesia care in austere settings and this was a way for us to round out their education as they approached graduation,” Radford says. “It’s really incredible.”

Inside one building, its walls still spattered with the bright paint of simulated training ammunition used to mimic live bullets during exercises, USU students work on crisis actors made up to look like they have a host of traumatic wounds. Instructors analyze the decisions of the soon-to-be-graduates as they manage the series of injuries their patients experience.

Sims checks in on one group, making sure all of the many moving parts of the trauma culmination exercise are running smoothly before heading back outside. There, a team of four load their patient onto a military ambulance, climbing on and providing care as the vehicle drives off. Sims says their mission with the exercise is to prepare independent military anesthesia providers to give care in any operational and austere environment. She adds that partnering with the FBI and the Hostage Rescue Team was a natural choice to help meet this mission.

“USU students are well-prepared to provide medical care in fixed medical facilities with adequate staff and equipment,” Sims says. “However, operational readiness courses (like this) help prepare them for anesthesia care in the field.”

As students go from one exercise scenario to another, flash bangs go off, the rattle of gunfire echoes nearby, and FBI teams train only feet away in the next room.

“(The students) are taking care of patients with minimal equipment in a building of opportunity, transporting patients and dealing with all that comes along with that — lack of supplies, lots of noise, flash-bangs going off, gunfire, helicopters taking off and landing,” Sims says. “We also have to take care of the military working dogs as CRNAs (certified registered nurse anesthetists) when we’re deployed because they are one of the team and if they get hit, we take care of them until we can transfer them to a higher level of care.”

At another location students are being introduced to a retired military working dog and a half dozen “wounded” canine mannequins. The real dog waits patiently as the new group files in to learn about working with an injured military canine in the field.

“The experience has been great,” says Army student Maj. Andre Brown, adding that he and the others didn’t initially know what to expect before arriving for the exercise. “They hadn’t really given us any information before we got here. It was ‘hey, get a hotel at Quantico, meet at this place and these are the times we’re going to start.’ Then we get out there and it’s like ‘here’s your scenario, go — how would you react?’”

Brown says one of the day’s impactful lessons was learning about how to give care to an injured military working dog.

“I knew enough to get the dogs from point A to point B but here we’re learning more effective care, and a more effective means of how to do things,” Brown says. “… Everybody has been super knowledgeable with helpful tips that I hadn’t even thought about.”

Sims says this year’s collaboration with the FBI and the Hostage Rescue Team is essentially a test run for future trauma culmination exercises. She says the university currently has the “Gunpowder” exercise which helps expose USU students to a variety of challenges they may come across in the field, training them on tactical field care, tactical combat casualty care, prolonged casualty care, and forward resuscitative care.

“Unfortunately, the timeframe (for Gunpowder) does not align with most of our nurse anesthesia students as they attend a 21-month clinical rotation at various locations throughout the country” Sims says. “We’ll see how this exercise goes and obtain feedback from the faculty cadre and students and add or remove content to make it most beneficial to train and assess their trauma anesthesia skills.”

Navy student Lt. Cmdr. Joseph Dimarucut says taking part in the Trauma Culmex has been an amazing experience. Particularly, he says working to intubate a patient from within the confined space of a helicopter stands out to him as a valuable lesson that couldn’t be practiced in a hospital.

“It’s a good culmination of everything that we’ve learned put into practice and what we’ll expect to see in the field,” Dimarucut added.

Hurrying past FBI agents rappelling down a wall, the next group of USU graduate nursing students carries a litter holding a simulated patient, an instructor following closely behind. They arrive at an open field and soon the sounds of a helicopter’s rotor chopping through the day’s warm air once again grows louder. The dust hits them, they get up and hurry for its open doors and the training begins all over again.

Michigan Becomes 20th State to Allow CRNAs to Work Free of Physician Supervision

Michigan Becomes 20th State to Allow CRNAs to Work Free of Physician Supervision

Practice authority for advanced practitioner nurses took another stride forward on May 10 when Michigan became the 20th state to opt out of federal regulations that require physician supervision of Certified Registered Nurse Anesthetists (CRNAs).

The American Association of Nurse Anesthesiology (AANA) reports that the governors of 19 additional states and Guam have exercised such exemptions. Adam Kuz, MS, CRNA, president of the Michigan Association of Nurse Anesthetists (MANA).

Gov. Gretchen Whitmer’s action in signing the opt-out ensures Michigan’s patients have access to value-based, high-quality care and optimizes healthcare teams across the state, according to Adam Kuz, MS, CRNA, president of the Michigan Association of Nurse Anesthetists (MANA).

In March 2020, to maximize healthcare resources during the outbreak of the COVID-19 pandemic, Gov. Whitmer enacted an executive order removing physician supervision for CRNAs. In July 2021, she signed HB4359 to remove supervision requirements for CRNAs in the state nurse practice act, and HB4359 is now permanent.

Highlights of the law include:

All of the following apply to a registered professional nurse who holds a specialty certification as a nurse anesthetist:

(a) In addition to performing duties within the scope of the practice of nursing, his or her scope of practice includes any of the following anesthesia and analgesia services:

          (i) Development of a plan of care.

          (ii) Performance of all patient assessments, procedures, and monitoring to implement the plan of care or to address patient emergencies that arise during implementation of the plan of care.

          (iii) Selection, ordering, or prescribing and the administration of anesthesia and analgesic agents, including pharmacological agents that are prescription drugs as defined in section 17708 or controlled substances. For purposes of this subparagraph, the authority of a registered professional nurse who holds a specialty certification as a nurse anesthetist to prescribe pharmacological agents is limited to pharmacological agents for administration to patients as described in subdivision (b), (c), or (d), and his or her authority does not include any activity that would permit a patient to self-administer, obtain, or receive pharmacological agents, including prescription drugs or controlled substances, outside of the facility in which the anesthetic or analgesic service is performed or beyond the perioperative, periobstetrical, or periprocedural period.

(b) He or she may provide the anesthesia and analgesia services described in subdivision (a) without supervision and as the sole and independent anesthesia provider while he or she is collaboratively participating in a patient-centered care team.

(See full text of Michigan House Bill 4359 at http://www.legislature.mi.gov/documents/2021-2022/billengrossed/House/htm/2021-HEBH-4359.htm)

“Removing barriers to CRNA practice allows Michigan hospitals to select the anesthesia delivery model that maximizes their workforce and increases access to safe, affordable care for all patients,” said former MANA president Toni Schmittling, DNAP, MBA, CRNA. “By signing this important legislation, Michigan recognizes that CRNAs are qualified to make decisions regarding all aspects of anesthesia care based on their education, licensure, and certification.”

Anesthesia services are provided predominantly by CRNAs in Michigan’s critical access hospitals, which offer surgical services in 99% of its rural hospitals. They comprise 68% of the state’s anesthesia care providers.

“The AANA applauds Gov. Whitmer for recognizing the important role CRNAs have in the delivery of safe anesthesia care in Michigan,” said AANA President Dina Velocci, DNP, CRNA, APRN. “Increased demand, limited resources, and a state with diverse populations, both rural and urban, dictate that a system capable of meeting the needs of all Michigan residents be maintained. By signing the opt-out letter, this has been achieved.”

Throughout the COVID-19 pandemic, nurse anesthetists across the country have, in addition to providing top-of-the-line anesthesia care, served as experts in airway management, hemodynamic monitoring, management of patients on ventilators, and overall management of critically ill patients. Instrumental in addressing the deadliest part of COVID-19, CRNAs have become highly sought-after anesthesia care providers.

Alabama Expands CRNAs Scope of Practice

Alabama Expands CRNAs Scope of Practice

Alabama patients now have increased access to safe, affordable care with the signing today of HB 268 by Governor Kay Ivey. The law provides that, in addition to physicians and dentists, Certified Registered Nurse Anesthetists (CRNAs) may provide anesthesia care under the direction of or in coordination with a physician, podiatrist, or dentist.

The law further clarifies that the CRNA scope of practice includes ordering of medications and tests before, during, and after analgesia or anesthesia in accordance with the anesthesia plan.

“Removing barriers to CRNA practice will allow Alabama healthcare facilities to maximize their workforce and increase access to safe, affordable care for our patients,” said Wesley Canerday, CRNA, president of Alabama Association of Nurse Anesthetists (ALANA). “By signing this important legislation, Alabama recognizes that CRNAs are qualified to make decisions regarding all aspects of anesthesia care based on their education, licensure, and certification.”

Anesthesia services are provided solely by CRNAs in many of Alabama’s critical access hospitals offering surgical services, and in a majority of its rural hospitals.

The law also specifies that anesthesia care, when an anesthesiologist is not present, is provided by CRNAs “in coordination with” a physician, podiatrist, or dentist, defined as a working relationship in which “each contributes his or her respective expertise in the provision of patient care, which includes the discussion of patient treatment, diagnosis, and consultation.”

“The American Association of Nurse Anesthesiology (AANA) applauds Gov. Ivey for recognizing the important role CRNAs have in delivery of safe anesthesia care to the residents of Alabama,” said AANA President Dina Velocci, DNP, CRNA, APRN. “Increased demand, limited resources, and the rural nature of the state dictate that a system capable of meeting the needs of all Alabama residents be maintained and this law provides that.”

As advanced practice nurses, CRNAs are members of one of the most trusted professions according to Gallup.  CRNAs provide anesthesia care across all settings and in all patient populations and are the primary anesthesia providers in rural and underserved areas and on the battlefield in forward surgical teams. Because of their expertise in anesthesia delivery and management of critically ill patients, CRNAs have been a highly sought-after healthcare provider during the COVID-19 pandemic.

Nurse of the Week: CRNA Donna Dzialo Transforms Tools of Her Trade Into Art

Nurse of the Week: CRNA Donna Dzialo Transforms Tools of Her Trade Into Art

Like many of her fellow nurse/artists, Nurse of the Week Donna Dzialo, CRNA has her own distinctive take on Creative Nursing. DailyNurse has spotlighted talented nurse photographers, pop singers, and ICU mural painters, but this might be our first found-objects nurse artist.

Donna Dzialo, CRNA and artist.

During a shift one day in 2018, Dzialo had a Eureka moment when items a nurse anesthetist customarily disposes of after use caught her eye. The drug vial caps she’d been tossing without a thought covered the color spectrum. The caps in the bin ran the gamut from deep, jewel-like blues and purples, to intense reds and yellows… and, wasn’t there something potentially beautiful there? From that day forward the CRNA stopped throwing out those bright plastic caps and instead began pouring them into a unique and meaningful home-based recycling project.

Dzialo earned a bachelor’s in 1996 from the Wayne State University (WSU) College of Nursing and then a master’s in 1999 from the Eugene Applebaum College of Pharmacy and Health Sciences Doctor of Nurse Anesthesia Practice program (as it is now known), but now she is taking multitasking to a whole new level. Asked about her choice of medium, she said, “The caps have a unique beauty that I appreciated as a nurse, a scientist, and an artist.”

A colleague at Ascension Providence Rochester Hospital, pre-op RN Cheryl Dassow-Chapman, suggested she create a mosaic version of a Monet painting, “but when COVID came and changed the world, it also changed my design plan.”

Dzialo spent hours upon hours in her basement workspace, ultimately piecing together more than 6,000 caps of nearly 400 different colors, sizes, shapes and textures. Using IV tubing and needle covers along with the caps, she created “COVID Time CAPSule,” representing infected cells, blood cells and antibodies. (And if there is Hall of Fame recognition for great puns, she should definitely be a nominee).

“Viruses are smaller than a grain of salt but have an astounding impact on us all — on our health, mental wellness, work, travel, and community and family relationships,” Dzialo said. “The caps shown here, with different colors, shapes, sizes, finishes and all their different potential combinations, make this work as unique as we are.”

 

The 8- by 4-foot project earned a coveted spot on display at the downtown JW Marriott hotel during last fall’s ArtPrize, an international art competition held in Grand Rapids, Michigan, since 2009. ArtPrize celebrates artists working in all mediums from anywhere in the world and is open to anyone with artwork to enter and a venue willing to host it.

For three weeks each autumn, art is exhibited throughout the city in parks and museums, in hotels and storefronts, in bars and on bridges, and even in the river that runs through town. Visitors from around the world gather to view the art, engage in meaningful discussions, and vote for their favorite entries, with cash prizes and grants awarded to select artists in the end.

“While displaying this piece at ArtPrize for 21 days, I found that people were really attracted to it,” said Dzialo, who maintains a website to promote her art. “Especially those who had gotten infected or lost a loved one to COVID, and of course all of those with medical backgrounds.”

During conversations about the creative project with ArtPrize attendees, Dzialo was quick to share credit with her support team.

“Health care professionals have been on the front lines during this pandemic, and I would be remiss if I didn’t mention how many nurses, assistants, techs and pharmacists at work helped by saving me caps. Everyone from pre-op to recovery pitched in to get me a certain color I was low on, or a special size and shape I needed more of,” Dzialo said. “Heidi Beverly would save me caps from her other CRNA jobs where they had different manufacturers and suppliers. For two years, our wonderful scrub techs saved any caps I had left behind in operating rooms and made sure I got them! And then my 16-year-old daughter Stephanie sorted everything I brought home by color, shape and size. I’m grateful for the combined support.”

While she happily accepts contributions from clinicians with access to particularly aesthetic vial caps, Dzialo also wants to give back. She hopes to eventually sell her artwork and fund a scholarship at her alma mater, Wayne State University, with the proceeds. To see more of her work, visit the gallery at the top of her personal webpage.

 

AANA Presents Excellence in State Government Relations Advocacy Award to Pennsylvania Assn (PANA)

AANA Presents Excellence in State Government Relations Advocacy Award to Pennsylvania Assn (PANA)

The American Association of Nurse Anesthesiology (AANA) is presenting the Pennsylvania Association of Nurse Anesthetists (PANA) with the Excellence in State Government Relations Advocacy Award at its Mid-Year Assembly in Washington, D.C. this week.

The Excellence in State Government Relations Advocacy Award, established in 2016, is presented annually to a state association based on the quality of its efforts in the state legislative or regulatory arena for the nurse anesthesiology profession. The recipient is chosen by the AANA Government Relations Committee.

AANA advocacy for CRNAs.In 2021, the PANA successfully lobbied for a law that includes formal title recognition for Certified Registered Nurse Anesthetists (CRNAs) in statute for the first time, clarifies the CRNA relationship with physicians and dentists, and allows for CRNAs to work with podiatrists.

“The pandemic raised awareness of the critical roles that CRNAs play in healthcare settings and how some state policies prevented CRNAs from practicing to the fullest extent of their education and training at precisely the time they were most needed,” PANA President Lew Bennett, DNP, CRNA, said. “We are honored to be recognized by the AANA for our achievements.”

To increase the flexibility of healthcare resources, Pennsylvania Governor Tom Wolf waived physician supervision during the pandemic. PANA used this opportunity to build relationships with legislators to support title recognition legislation.

“The relationships PANA developed with the governor and legislators will benefit CRNAs for years to come,” Bennett said. “Thank you to the many Pennsylvania CRNAs who laid the foundation for this effort, and those who will continue to fight to protect CRNA practice in the future.”

In addition, PANA developed relationships with a coalition of nursing, rural health, and other groups, including Americans for Prosperity, the Pennsylvania Farm Bureau, and the National Guard, all of which validated and reinforced PANA’s message to legislators.

As advanced practice nurses, CRNAs are members of one of the most trusted professions according to Gallup.  CRNAs provide anesthesia care across all settings and in all patient populations and are the primary anesthesia providers in rural and underserved areas and on the battlefield in forward surgical teams.

During the COVID-19 pandemic, nurse anesthetists across the country have been essential in addressing the deadliest part of the disease in addition to providing top-of-the-line anesthesia care. They have served as experts in airway management, hemodynamic monitoring, management of patients on ventilators, and overall management of critically ill patients.

AANA President: Proposed Bill Would “Delay, Deny, and Disrupt” Vets’ Access to Care

AANA President: Proposed Bill Would “Delay, Deny, and Disrupt” Vets’ Access to Care

The president of the American Association of Nurse Anesthesiology (AANA) issued the following statement in response to a bill designed to prevent Certified Registered Nurse Anesthetists (CRNAs) from practicing to the full extent of their licensure in the Veterans Health Administration (VHA). AANA President Dina Velocci, DNP, CRNA, APRN, is calling on Congress to reject this “dangerous legislation and support our veterans’ access to the highest quality care.” Full statement:

“Today, allies of the American Society of Anesthesiologists introduced a bill to deny, delay, and disrupt veterans’ access to care in the middle of a public health emergency. In a direct attack on CRNAs, who have been serving on the front lines of the COVID-19 pandemic, the bill would limit the ability of the Veterans Administration (VA) to allow CRNAs to provide care to veterans. The bill would benefit physician anesthesiologists at the expense of our veterans and in denial of all available evidence and data. Reports from the VA Office of the Inspector General have shown dozens of facilities citing shortages of anesthesia staff, and on the ground evidence shows that overly onerous supervision requirements have caused delays and denials of care for veterans.

AANA strongly opposes this misguided legislation that would only serve to hurt veterans’ access to care. All available evidence shows that CRNAs working independently are the most cost-effective method of anesthesia delivery and the safest, which is why CRNAs are able to practice independently in every branch of the military and why 49 states do not require the involvement of physician anesthesiologists in CRNA practice. This is why multiple Veterans Service Organizations (VSOs) supported CRNA full practice authority in 2016 and why several VSOs have testified in support of national standards of practice that would allow CRNAs and other providers to practice to the top of their scope.

The move to eliminate CRNA full practice authority within the VA is being done without the health and wellbeing of our nation’s veterans in mind. While CRNAs provide the most cost-effective and timely access to highest quality care, we do recognize the need to have both physician and nurse anesthesiologists providing anesthesia collaboratively to our veterans, moving away from antiquated delivery models that have one qualified provider overseeing another qualified provider. Any model that unnecessarily restricts CRNA practice will only increase costs, delay care, and adversely affect veterans. At a time when the healthcare system is seeing overwhelming levels of retirements and burnout, stressing the workforce, and limiting care, the ASA and their allies are seeking to further limit care and put veterans at risk for their own benefit.

This is an unconscionable bill meant to slander nurses and hurt veterans.”

More than 1,100 CRNAs currently work in the VA. CRNAs have historically provided much of the anesthesia delivery to active-duty military in combat arenas since World War I and predominate in veterans’ hospitals and the U.S. Armed Services, where they enjoy full practice authority in every branch of the military. CRNAs have been in high demand during the pandemic, due to their skill in ventilator and airway management, as well as anesthesia and pain management. Information on CRNA safety and cost efficiency is available at anesthesiafacts.com/the-research.

 

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