AANA Presents Excellence in State Government Relations Advocacy Award to Pennsylvania

Apr 1, 2022

Park Ridge, Ill. (AANA)—The American Association of Nurse Anesthesiology (AANA) will honor the Pennsylvania Association of Nurse Anesthetists (PANA) with the Excellence in State Government Relations Advocacy Award at its Mid-Year Assembly to be held in Washington, D.C., April 2-6.

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.

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.

About the American Association of Nurse Anesthesiology

CRNAs Play Critical Role in Lifesaving Mission in Field of Battle

With Veterans Day upon us, I want to share a story about a military mission (Wall Street Journal: “A Secret U.S. Rescue in Yemen Played a Role in Mideast Peace Deal,” Oct. 19) in which CRNAs were involved at the highest level.

This mission actually was executed three years ago in August 2017. At that time, my Critical Care Air Transport Team (CCATT) had just returned to Al Udeid in Qatar from Germany. We were exhausted and hungry, and we all needed a shower. We were unloading our equipment from the Boeing C-17 Globemaster III military transport aircraft when we were alerted to the next mission.

Our briefing was limited to the following facts: 1). Secretary of Defense (SECDEF) General James Mattis authorized the mission; and 2). we were headed to a contested airfield to rescue a foreign nation’s military members from a helicopter crash.

Our commander asked if we were up for the task, considering that we had just been awake for more than 24 hours completing our previous mission. The team quickly discussed and decided that if the SECDEF authorized this mission, then we better proceed.

When we arrived at the other C-17 for use in this mission, they were hot loading and preparing to take off quickly. We were met with numerous “high-fives” and hugs as the other CCATT team and the AE crews were happy that we joined them. (We were considered the more experienced team with a trauma surgeon and CRNA components.)

Almost immediately, we began to strategize the rescue.

I looked around and noticed that the Phoenix Ravens had joined us. They are an elite team that is deployed to provide extra security for U.S. military aircraft. They were armed with weapons that I won’t mention here. I will admit that I was a bit nervous once I saw them --- if they were part of the mission, then I knew we were heading to an area of elevated terrorist activity.

We landed on the contested airfield in low-light operations (no lights on plane). The skill of our pilot was incredible! As soon as we landed, we rendezvoused with several Ospreys and began treating the wounded. The first person to board our C-17 was a special operations CRNA with night vision goggles (NVGs) and a huge patch on his body armor that said “CRNA.”

I was so proud! CRNAs are everywhere --- on the front lines and in special missions!

We did a hot load and had to quickly secure the patients for a long flight to Germany. Many of our patients were critically injured and required resuscitation during flight. We ended up giving lots of whole blood, placed chest tubes, and performed other procedures while en route. All of our patients survived.

We arrived in Germany to a large coalition of Middle East leadership who had beat us there in their private jets. At this point, I pulled up a CNN television newscast on my phone and realized the purview of our mission. We were debriefed by SECDEF General Mattis once we returned to home base. He told us that we had just performed “Medical Diplomacy” that would pay dividends for years to come.

The Wall Street Journal just published an article about that mission. It’s copied in full below.

I would like to thank all those who have served and are currently serving our country. You make a difference and are more important than you may ever realize. CRNAs are there --- for every heartbeat, every breathe, every second and have been huge assets worldwide in many conflicts and peace missions. Some of my fondest memories and closest friendships were cultivated during my military days. I am blessed and humbled to have served.

For all you do, thank you --- and have a wonderful Veterans Day!

LT Col. Laura L. Wiggins, CRNA, DNP

United States Air Force (Retired)

*****

WSJ News Exclusive

A Secret U.S. Rescue in Yemen Played a Role in Mideast Peace Deal

The U.S. helped rescue U.A.E. soldiers after a 2017 helicopter crash, building a reservoir of trust that helped lead to recent agreement

By Dion Nissenbaum

Oct. 19, 2020

WASHINGTON—On Aug. 11, 2017, a United Arab Emirates helicopter filled with soldiers taking part in an offensive against al Qaeda militants crashed in Yemen, leaving three soldiers dead and seven seriously wounded, including a young member of the royal family.

As Emirati leaders scrambled to rescue their soldiers, they turned to the U.S. and asked America to organize an urgent rescue mission.

In a matter of hours, according to U.S. military officials, American special operations forces rushed to save the Emirati royal and the other soldiers. In ways that couldn't have been anticipated at the time, the unusual military mission helped pave the way three years later for the Israel-U.A.E. peace deal that is reshaping the Middle East.

Until now, the U.A.E. and U.S. military have never acknowledged that American forces saved the young royal that day.

The American at the center of the rescue mission was Maj. Gen. Miguel Correa, a gregarious Puerto Rican who now serves as a special White House adviser and the top National Security Council official for U.S. policy in the Gulf.

Gen. Correa, then the defense attaché at the U.S. Embassy in Abu Dhabi, coordinated the risky 2017 mission, leading to a celebration of the young royal’s homecoming six months later.

The rescue mission made Gen. Correa something of a hero among Emirati leaders, including Crown Prince Mohammed bin Zayed al Nahyan, the country’s ruler, who is also uncle and father-in-law of the wounded soldier saved by the Americans that day.

Gen. Correa’s close relationship with the Emirati leaders became an unanticipated asset in the Trump administration’s secret talks between Israel and the U.A.E. that led to the historic peace deals—known as the Abraham Accords—signed last month at the White House.

The accords marked the biggest achievement in efforts by the Trump administration to solidify ties between Israel and its Gulf neighbors, based on mutual interests in countering Iran that have shifted relationships in the Middle East in recent years.

Officials from the various countries acknowledged the notable behind-the-scenes role played by Gen. Correa. At the White House, before the Sept. 15 signing ceremony, according to people in attendance, the Emirati foreign minister—who is the crown prince’s younger brother and an uncle to the soldier America saved in 2017—pointed to Gen. Correa and told President Trump: “That general is part of my family.”

“This would not have happened without him,” said Abdullah bin Zayed al Nahyan.

That was a feeling shared by the White House team led by Jared Kushner, the president’s son-in-law and the White House point man on Middle East policy. While Mr. Kushner and his deputy, Avi Berkowitz, did much of the heavy diplomatic lifting, they both said Gen. Correa played a key role in securing the deal.

Yousef Otaiba, the influential Emirati ambassador to the U.S. who played a central role in the talks, said their success was built on the confidence the U.A.E. had in Gen. Correa and the rest of the White House team.

“The truth is, for the Abraham Accords to have materialized, there was a very much-needed element of trust, and we had that trust with Miguel Correa and the White House,” he said. “A pretty big leap of faith was required from all sides for this to happen.”

The 2017 rescue mission took place days after Yemeni forces, backed by the U.S. and U.A.E., launched a military operation to drive al Qaeda militants from one of their biggest strongholds.

For years, the U.S. had carried out airstrikes against al Qaeda militants in Yemen, who were considered some of the extremist group’s most dangerous leaders.

Gen. Correa was at his home in Abu Dhabi in 2017 when he got a call that the Emirati helicopter had gone down in Yemen while carrying out a counterterrorism mission.

Officially, Emirati officials said mechanical problems brought down the helicopter. But U.S. officials have said the cause was unclear, leaving open the possibility it was shot down by militants in Yemen.

Three Emirati soldiers were killed. Zayed bin Hamdan al Nahyan, a 27-year-old nephew and son-in-law to the country’s crown prince, was one of seven others seriously injured. U.S. officials soon learned that the young Emirati royal was among those being rescued.

Two American Ospreys carried a special operations forces medical team to the helicopter crash site in Yemen. The American medical team flew the seven injured soldiers to the USS Bataan, a U.S. Navy amphibious assault ship in the Gulf of Aden, said Capt. Bill Urban, spokesman for U.S. Central Command. One soldier died on the way to the ship as a surgeon on the Osprey revived a second Emirati whose heart stopped, said Capt. Urban.

Medical teams on the Bataan worked frantically for 48 hours, Capt. Urban said, as American forces onboard lined up to give blood for the Emirati soldiers. The medical team used 54 of 66 units of blood, making it the largest such “walking blood bank” the Navy has used since World War II, said Capt. Urban.

Meanwhile, U.A.E. leaders asked the Americans for special permission to fly the six soldiers, including the Emirati royal, to Landstuhl, Germany, where the U.S. Army has a medical hospital that specializes in treating combat injuries.

Gen. Joseph Votel, then head of Central Command, called then-Defense Secretary Jim Mattis, who quickly approved the plan as Gen. Correa kept the anxious Emiratis apprised.

The U.S. flew the Emirati soldiers from the ship back to an airport in Yemen, where an Air Force C-17 cargo plane equipped with a special medical unit was waiting to fly them to Germany,

Flying the massive plane into Yemen posed a risk. The U.S. landed the plane at night and flew out before the sun rose to ensure everyone’s safety.

Last year, Gen. Correa’s career was interrupted by complaints that, as defense attaché in Abu Dhabi, he cultivated ties with Emirati leaders without keeping his civilian boss apprised, according to current and former U.S. officials.

He was removed from the post in April 2019 by the top American diplomat in Abu Dhabi, the officials said. A formal Pentagon inspector general investigation concluded that Gen. Correa did nothing wrong, the officials said, and the general eventually secured a new job at the White House National Security Council as senior director for Gulf affairs. The State Department declined to comment. Earlier this year, Gen. Correa was promoted to two-star general.

In mid-June, Mr. Otaiba wrote an op-ed in a leading Israeli newspaper warning the country that its looming plans to annex West Bank land once expected to be part of a Palestinian state would imperil Israeli hopes of building ties with the U.A.E. and other Arab nations.

The op-ed sparked weeks of secret talks between Mr. Otaiba, Israeli Ambassador Ron Dermer and the White House team. The two ambassadors never spoke directly, according to U.S., Emirati and Israeli officials involved in the talks. Instead, they carried out the negotiations through the White House.

In late July, Gen. Correa, who was dubbed the “Arab Whisperer” by his colleagues, flew to Abu Dhabi for a one-on-one meeting with Prince Mohammed. They talked through details of the deal and Gen. Correa reassured the Emirati leader that the U.S. would ensure the terms were honored, according to U.S. officials.

Before the meeting began, Prince Mohammed invited his son-in-law—the one rescued in Yemen that day in 2017—to see Gen. Correa. The young U.A.E. royal rolled in, smiling from his wheelchair.

“The U.S. didn’t need a thank you,” Gen. Correa said recently. “I wanted to show the Emiratis that this was not transactional.”

Mr. Trump unveiled the Mideast deal in an Aug. 13 tweet.

The White House team worked to come up with a name for the agreements, which Bahrain also joined a few weeks later. Gen. Correa was reminded of an interfaith complex the U.A.E. is building in Abu Dhabi known as the Abrahamic Family House because Islam, Christianity and Judaism are all religious branches from the prophet Abraham. Gen. Correa suggested the agreement be called the Abraham Accords.

“I love it,” Mr. Trump told Gen. Correa and the team in the Oval Office. On Sept. 13, officials from the U.A.E., Israel, Bahrain and the U.S. signed the Abraham Accords at the White House.

https://www.wsj.com/articles/a-secret-u-s-rescue-in-yemen-played-a-role-in-mideast-peace-deal-11603099801

Without CRNA designation in Pa., nurse anesthetists face challenges

Lt. Col. Laura Wiggins, a critical care nurse and reservist in the U.S. Air Force, was the only anesthesia provider on her base when she was deployed to Kyrgyzstan in 2006. That’s not uncommon. CRNAs usually are the primary anesthesia providers in austere combat theaters, and often the only anesthesia providers in the military’s forward surgical teams.

A native of Johnstown, Pa., Wiggins received her bachelor’s degree in 1994 from Penn State University and graduated in 2003 from the Bethesda, Md.-based Uniformed Services University of the Health Sciences, one of the top-ranked schools in the country for CRNAs. Wiggins currently is enrolled in the Doctorate of Nursing Practice Program at the University of Pittsburgh.

While deployed and on active duty, she was able to practice to the fullest extent of her education and training, putting her skills to work as an advanced practice registered nurse credentialed provider. At home, it was an entirely different story.

CRNA Designation in Pa.

Pennsylvania, where Wiggins took her state board exams, is one of only four states that fail to recognize the CRNA designation in some form. There is no definition for “certified registered nurse anesthetist” under the state’s Professional Nursing Law, meaning Wiggins and other professionals like her are recognized only as registered nurses (RNs), not CRNAs.

Without that designation from Pennsylvania, Wiggins, a reservist who is approaching 20 years of military service, needs other state credentials to continue her work on behalf of the USAF Nurse Corps to serve as a credentialed provider while ensuring that military members and veterans have access to care. She currently is an RN in Ohio with a Certificate of Authority to practice as a CRNA, and as an RN in Virginia, where she is licensed as an Advanced Practice Nurse, which covers CRNAs.

The inability to be recognized as a CRNA in her home state brings many challenges --- logistically and financially.

Not only are the costs of licensing going up in each state each year, but new continuing education requirements also keep popping up. That means more out-of-pocket expenses to renew the license, finding conferences that offer the appropriate CEUs that are required, and paying more to travel out of state to obtain the CEUs, background checks and other legal requirements she needs to stay licensed and credentialed as a CRNA in the military. Getting the time off to maintain all of these requirements is an added expense.

This isn’t a problem unique to just Wiggins and other veterans, either. Pennsylvania CRNAs on humanitarian missions find it harder to get credentialed when offering their services overseas.

Legislative Fix Essential

The state legislature wrapped up its two-year 2015-16 legislative session without fully addressing the issue of CRNA designation. The Senate Consumer Protection and Professional Licensure Committee unanimously approved legislation (S.B. 481) in June to officially recognize CRNAs under Pennsylvania statute. But the measure never made it to the full Senate for consideration. A companion bill (H.B. 764) died in the House without a vote. Both measures must be reintroduced in the 2017-18 legislative session, which begins in January.

“The burden is on us,” Wiggins said. “It’s a nurse fix. I’m fixing [the designation issues] on my end as I’m waiting for the legislature to fix it on their end. And it’s getting more and more expensive to fix. Each year it’s worse.”

Wiggins, who lives in Cheswick, located along the Allegheny River about 15 miles northeast of Pittsburgh, works for UPMC and Anesthesiology Services Network. While she works mostly in Pennsylvania, she also practices in Ohio, picking up shifts or covering for vacations to stay licensed there. She also keeps her certification in Virginia to maintain her scope of practice for military service.

CRNAs are trained for procedures such as epidurals and spinals for orthopedic and obstetrical anesthesia; central venous catheter placement for complicated surgeries that require the possibility of transfusions and closer monitoring; and peripheral nerve blocks that are excellent pain management techniques for the wounded warrior. Wiggins expertly administered those procedures without any complications when she was the only anesthesia provider on base. Stateside in Pennsylvania, she can’t perform those same tasks without a supervising physician.

“If this state would just recognize what we do already,” Wiggins said. “Nurse Anesthetists have been administering anesthesia on the battlefield since the Civil War. Pennsylvania is over 150 years behind the times in recognizing our profession.”

Defining CRNA in Pennsylvania law is the first step. The act would carry across borders and finally give CRNAs the recognition they deserve in Pennsylvania.

Learn more about CRNAs in Pennsylvania at www.PANAforQualityCare.com. Additional details are available via Twitter at @PANACRNA and on Facebook at www.facebook.com/PANACRNA.