Finding Health & Wellness During a Pandemic

It’s hard to believe, but CRNA Week in Pennsylvania this year is starting to look and feel a lot like CRNA Week last year.

We may not be locked down in 2022 like we were in 2021, but hospitals and health-care facilities once again are facing critical staffing shortages, with some areas setting COVID-19 case records.

Clearly, the pandemic is not finished. The dizzying speed of omicron’s spread has left everyone scratching their heads and questioning what they know about COVID-19.

Through it all, certified registered nurse anesthetists have remained on the frontline, putting their advanced education and training to work to care for critically ill patients.

This year, CRNA Week in Pennsylvania is a tribute to every nurse anesthetist who courageously has stepped forward to serve during this pandemic and who works daily to save lives and provide the best possible care in a variety of settings.

Thank you for all you do to serve our profession so honorably and your patients so faithfully.

All of us are under enormous pressure. To be the most effective we can be, however, we need to ensure we take care of ourselves, so we are able to care for others.

One of my top priorities as PANA president is promoting health and wellness.

Health and wellness have always been important in our profession, but they take on a new meaning during this prolonged pandemic, as health-care providers, including CRNAs and SRNAs, confront a disproportionate share of physical and emotional strain.

Self-care in the workplace and at home is essential. Health and wellness issues span a wide spectrum --- from finding ways to reduce risks and limit stress on the job to making positive choices and managing lifestyles to improve health and fitness.

We are best for others when we are at our own personal best.

PANA values the importance of pillars, which is why you will see more health and wellness activities incorporated into regular meeting, lectures, and spring and fall meetings. Now more than ever, we need to support each other.

I hope CRNA Week in Pennsylvania offers you a time to reflect and celebrate the work we do.

Please share your stories with PANA and your peers, and tag #CRNAinPA on Facebook and Twitter so we can add them to our collections. While you’re at it, visit our new Instagram page, @PANACRNA, which launched this week. Tag us here, too, and show us what you’re doing.

Thank you for stepping forward to serve during this pandemic, for proving yourselves as battle-tested providers on the frontlines at home and in combat, and for fighting to ensure access to safe, cost-effective anesthesia care each and every day.

Lew Bennett, DNP, CRNA

President

Pennsylvania Association of Nurse Anesthetists

Bloomsburg CRNA Selected for Trauma Critical Care Team

Elite team responds immediately to disasters and public health emergencies domestically and around the globe

Christopher Heiss, who has worked for more than 10 years at Geisinger Medical Center in Danville, Pa., has been a flight nurse, a flight paramedic, and even the developer of a protective intubation shield, or the Barrier for Respiratory Aerosolization (BRA), equipment that protected frontline hospital workers and ambulance personnel during the COVID-19 pandemic.

And now, after years of trying, he can finally add one more major achievement to his already impressive resume: Heiss has been named to the exclusive U.S. Department of Health & Human Services (US HHS) National Disaster Medical System (NDMS) Trauma Critical Care Team (TCCT).

TCCT is the United States’ special operations medical force that is called on within the first 24 to 48 hours of natural and man-made disasters and public health emergencies to set up field hospitals or augment health systems to provide critical, operative, and emergency care to people in need.

TCCT members are medical professionals who are deployed at the request of local authorities to supplement federal, state, local, tribal and territorial resources, and the only component of the NDMS that is international, going anywhere in the world on a moment’s notice to respond to the crisis and then coordinate with the NDMS Patient Movement System to get U.S. citizen evacuated home or to a safe location for care.

While each state has at least one or multiple Disaster Medical Assistance Teams, with thousands of members nationwide, all working under the umbrella of Health & Human Services’ NDMS, TCCT is an elite operation, even serving at every presidential inauguration and State of the Union address. The United States has just one TCCT with 70 to 80 members spread across the country --- and Heiss is one of them.

“This is something I’ve always wanted to do, something that has been a long-time goal of mine,” Heiss said. “It’s incredibly humbling.”

Heiss applied in August 2020 and more than a year later finally was interviewed by a TCCT pioneer who was on the scene after earthquakes in Haiti and Iran, during flooding from Hurricane Katrina, and at ground zero after the 911 terrorist attacks on the United States. Just like crises emerge without warning, so did that interview. The trauma surgeon called one random Sunday afternoon asking him if he could talk “right now.” Yes, of course he could, he said.

Heiss was offered the position in October and takes his oath in January.

Heiss will continue to work for Geisinger. Like other TCCT members, he will keep his civilian job but have periods when he is on call for deployments and must serve out his mission before returning home.

As excited as he is about fulfilling this dream, Heiss says he is excited that eventually he will be able to serve the TCCT as a CRNA from Pennsylvania --- something that simply would not have been possible without Act 60 of 2021.

Before the enactment of that law on June 30, Pennsylvania had been one of just two states that failed to recognize “certified registered nurse anesthetist” in some form. With no definition for nurse anesthetists under the state’s Professional Nursing Law, CRNAs were recognized only as registered nurses.

That means Heiss had to secure credentials from another state to serve on the TCCT as a CRNA, which he did. By granting formal title recognition to nurse anesthetists, Act 60 changes all that --- for him and thousands of other CRNAs in Pennsylvania.

Heiss is already providing lifesaving and life-sustaining care to people where he lives and works. But now, through TCCT, whether it is deploying in the wake of a tornado or responding to a terrorist attack, he can put those same skills to work to help people across the United States and around the world.

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A training program is making surgery easier on veterans and safer for health care staff

One day at his job at the VA Pittsburgh Healthcare System (VA), nurse anesthetist William Pileggi (NURS ’97G) was with a patient who was coming out of anesthesia after surgery. The patient woke abruptly, reached through the side rails of his stretcher and shoved Pileggi to the ground as he shouted, “Get down! You’re gonna get shot!”

The patient had woken up in a disoriented state, unaware of where he was, in an episode of emergence delirium (ED). ED occurs when patients emerge from general anesthesia agitated, confused or — in some cases — aggressive. This patient also was a combat veteran with a history of post-traumatic stress disorder (PTSD), which research shows put him at a high risk for emergence delirium. The incidence of ED in adult combat veterans has been reported to be as high as 27%, compared to only 5% within the general population.

Pileggi, a veteran himself, has seen patients thrash on the bed, remove their IV line, self-extubate and even injure hospital staff without realizing what’s happening.

“They go to sleep in Pittsburgh but wake up in Iraq,” he says.

The problem has slowly been gaining attention. In the 2010s, two nurses at the VA started a program called Project Golden Eagle that helped to identify patients with PTSD. Those patients were placed in quiet rooms and given a gold surgical cap, instead of the usual blue, so that staff would be aware of the heightened risk of ED.

Still, when Pileggi joined the VA in 2016, he and his colleagues would encounter ED an average of twice a week. It was distressing to the staff, who feared for their own safety, as well as to the patients, who were thrust back into a state of fear and trauma from past experiences. He knew something more needed to be done.

So, in 2017, he teamed up with behavioral health and education specialists David Julian and Michael Boland, as well as fellow nurse anesthetist Amanda Beckstead (NURS ’15, ’20G) to research more, strategize improved practices and create a training program for better assessment and screening for patients with PTSD. Their group — the PTSD/Emergence Delirium Training and Response Team — discovered that certain anesthesia drugs affect the neurocircuitry of the brain in PTSD patients more than others.

In people who have experienced trauma, the amygdala (which is responsible for the “fight or flight” response) often is perpetually hyperactive, and the hippocampus — which controls emotional memory — does not function optimally. Commonly used anesthetics like benzodiazepines and volatile inhalants are particularly dangerous for trauma patients, due to the way they blunt reactions in the amygdala and hippocampus and wear off quickly. Thus, the team’s plan emphasized using alternative anesthetics and tailoring the dosage and timing of particular drugs to each individual’s risk factors.

They also created preassessment questions to identify patients with a history of PTSD (even if undocumented), what triggers might activate a bad response and how to help those patients wake up with ease.

Finally, they compiled the research into a training program that was required for all perioperative hospital staff, complete with recorded demonstrations and hands-on practice.

The effects were almost immediate: The incidence rate of ED plummeted to 2.7% in high-risk PTSD patients, and in 2019 and 2020, there were no cases of staff injuries, lost airways or lost IVs. Pileggi saw patients cry with gratitude that their worst fears about waking up didn’t happen.

In recognition of their impact, the team won a 2020 Gears of Government Award from the U.S. Department of Veterans Affairs and a 2021 I Am Patient Safety Achievement Award from Pennsylvania’s Patient Safety Authority. Veterans Affairs hospitals around the country are now requesting the training program. Pileggi also was recognized as a 2020 Excellence in Education awardee by the National APRN Council.

In the end, it’s about patient care. “Our home run is making that wake up better,” says Pileggi.

This story appears in the latest Pitt Nurse magazine, which will be hitting mailboxes soon. Photos courtesy of William Pileggi and the VA Pittsburgh Healthcare System